摘要目的 分析以脑血管病为主要表现的神经型布鲁杆菌病的临床特点,并探索可能的脑血管病发病机制.方法 回顾分析北京协和医院2007年1月至2018年2月以脑血管病为主要表现的神经型布鲁杆菌病患者,采集其一般人口学信息、流行病学史,血/脑脊液常规及病原学、影像学(MRI平扫+弥散加权成像、磁共振血管造影、头颈CT血管造影)检查结果、心脏超声、治疗方案及预后等信息,并结合其临床表现及影像学特点,分析神经型布鲁杆菌病伴发脑血管病的可能机制.结果 我院共确诊神经型布鲁杆菌病31例,其中7例患者以脑血管病为主要临床表现(3例为首发症状),占神经型布鲁杆菌病的23％.其中3例表现为脑梗死,1例表现为脑梗死合并脑出血,1例表现为短暂性脑缺血发作,2例表现为脑小血管病相关影像学异常.3例自动出院,4例应用米诺环素/多西环素、利福平及头孢曲松治疗,预后良好.结论 神经型布鲁杆菌病可表现为短暂性脑缺血发作、脑梗死、脑出血或脑小血管病影像学改变.对于伴听力下降、乏力等全身非特异性症状的脑血管病,需鉴别布鲁杆菌感染;血管痉挛、血管炎及感染诱发动脉硬化性梗死可能是此类患者发生卒中的可能机制.

abstractsObjective To analyze the clinical features of neurobrucellosis manifested as cerebrovascular diseases and explore the possible pathogenesis.Methods Cases of neurobrucellosis presenting as cerebrovascular diseases in Peking Union Medical College Hospital from January 2007 to February 2018 were analyzed retrospectively.The demographic information,epidemiological history,routine and etiology tests of blood and cerebrospinal fluid,imaging (magnetic resonance imaging + diffusion weighted imaging,magnetic resonance angiography/head and neck computed tomography angiography),echocardiography,treatment and prognosis of the above patients were collected.The possible mechanism of neurobrucellosis with cerebrovascular diseases was analyzed according to clinical manifestations and imaging characteristics.Results Totally,31 cases of neurobrucellosis were diagnosed,of which seven cases were mainly presented as cerebrovascular diseases (three cases as the first symptoms),accounting for 23％ of neurobrucellosis.There were three cases of cerebral infarction,one case of cerebral infarction accompanied with cerebral hemorrhage,one case of transient ischemic attacks (TIA),two cases of imaging abnormalities related to cerebral small vessel disease.Three patients were discharged voluntarily and four patients were treated with minocycline/doxycycline,rifampicin and ceftriaxone.The prognosis of the treatedcases was good.Conclusions Neurobrucellosis may be presented as TIA,cerebral infarction,cerebral hemorrhage or cerebral small vessel disease related imaging features.For cerebrovascular diseases with systemic nonspecific symptoms such as hearing loss and fatigue,it is necessary to differentiate Brucella infection.Vasospasm,vasculitis and infection-induced arteriosclerotic infarction may be the possible mechanism of stroke in these patients.