吴坤 曹秉振

[摘要] 目的 探讨结缔组织病（CTD）中枢神经系统（CNS）病变的临床特点及常见误诊原因分析。 方法 选取误诊为颅内感染的CTD患者8例，对其临床表现、腰穿、脑电图、头颅MRI等结果进行分析讨论。 结果 8例均为慢性病程，隐匿起病，以神经系统损害为突出症状，部分反复发作，主要表现有头痛、癫痫、运动障碍、认知障礙、精神异常等；腰穿8例均异常，其中脑脊液压力升高3例，白细胞数升高5例，蛋白升高4例。脑电图5例为轻度异常，2例为中度异常。头颅MRI 1例正常，7例异常，病灶分布于大脑皮层、基底节、深部脑白质、脑干、小脑等部位，呈长T2信号，T2FLAIR为高信号。 结论 CTD导致的CNS病变在临床表现和影像学上呈多样性，并可早于其他系统性症状出现。对于不明原因的多病灶反复发作的CNS病变需考虑CTD的可能。

[关键词] 结缔组织病；误诊；中枢神经系统；颅内感染；临床特点

[中图分类号] R593.2 [文献标识码] A [文章编号] 1673-7210（2016）02（b）-0152-05

Analysis of 8 cases of connective tissue disease misdiagnosed as intracranial infection

WU Kun1 CAO Bingzhen2

1.Department of Neurology， General Hospital of Ji'nan Military Area， Clinical Medical College of Second Military Medical University， Shandong Province， Ji'nan 250031， China； 2.Department of Neurology， General Hospital of Ji'nan Military Area， Shandong Province， Ji'nan 250031， China.

[Abstract] Objective To investigate the clinical characteristics of connective tissue disease （CTD） with central nervous system （CNS） lesions and analysis the misdiagnostic reasons. Methods 8 CTD patients misdiagnosed as intracranial infection were chosen， their features of clinical manifestation， cerebrospinal fluid （CSF）， electroencephalogram （EEG） and magnetic resonance imaging （MRI） were analyzed. Results All 8 cases had the features of chronic course and gradual onset characterized by significant neurologic impairments， and some patients had recurrent attacks. The main symptoms of nervous system included headache， seizure， movement disorder， cognitive dysfunction， psychosis etc. The CSF of 8 patients were all abnormal， of which pressure increased in 3 cases， number of leukocyte increased in 5 cases， and level of proteins increased in 4 cases. The EEG of 5 cases were mild abnormal， 2 cases were moderate abnormal. Head MRI were performed， 1 case was normal， 7 cases consisted in hyperintense areas in the cerebral cortex， basal ganglia， deep white matter， brainstem， cerebellum on T2-weighted and fluid-attenuated inversion recovery （FLAIR） sequences. Conclusion The CNS lesions induced by CTD vary widely in clinical manifestation and imaging， which can perform earlier than other systemic symptoms. The possibilities of CTD should be considered when patients suffer unexplained， multifocal， recurrent CNS lesions.

[Key words] Connective tissue disease； Misdiagnose； Central nervous system； Intracranial infection； Cinical feature

结缔组织病（CTD）是一类反复发作的全身广泛受累的变态反应性疾病，以血管和结缔组织的慢性炎症为病理特点，病变可累及多个器官和系统，中枢神经系统（CNS）损害在CTD中并不常见，目前临床上并无明确的分类标准，同时因其具有异质性、迁延性等特点，诊断较为困难，尤其是以神经系统损害为突出表现的患者。本研究对济南军区总医院（以下简称“我院”）2010年1月～2015年8月收治的8例误诊为颅内感染的CTD患者的临床资料进行总结分析，旨在提高临床对该病的认识，避免误诊误治。

1 资料与方法

1.1 一般资料