脑囊虫病.ppt
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1、 脑囊虫病脑囊虫病NeurocysticercosisNeurocysticercosis2 2内 容 提 要p最新诊断标准最新诊断标准p流行病学流行病学p临床表现临床表现p实验室检查实验室检查p影像学表现影像学表现p鉴别诊断鉴别诊断p治疗治疗 Diagnostic criteria Diagnostic criteriapAbsolute criteriaAbsolute criteriapNeuroimaging criteria Neuroimaging criteria pClinical/exposure criteriaClinical/exposure criteria nHis
2、tological demonstration of the parasite from Histological demonstration of the parasite from biopsy of a brain or spinal cord lesion.biopsy of a brain or spinal cord lesion.nVisualization of subretinal cysticercus.Visualization of subretinal cysticercus.nConclusive demonstration of a scolex within a
3、 cystic Conclusive demonstration of a scolex within a cystic lesion on neuroimaging studies.lesion on neuroimaging studies.n大脑或脊髓病变部位发现囊虫,包括螺旋管、顶突、吸盘和大脑或脊髓病变部位发现囊虫,包括螺旋管、顶突、吸盘和钩、或寄生膜,可确诊脑囊虫病。当然,活检也有意外发生,钩、或寄生膜,可确诊脑囊虫病。当然,活检也有意外发生,如取材部位不佳、囊虫进入钙化期等,此时,发现所谓的钙如取材部位不佳、囊虫进入钙化期等,此时,发现所谓的钙化小体,也有助于识别寄生虫。化小体,
4、也有助于识别寄生虫。Absolute criteria Absolute criteria图图1 1 脑或脊髓病变组织活脑或脊髓病变组织活检发现囊虫(大箭头所指检发现囊虫(大箭头所指为囊虫的特征性顶突;小为囊虫的特征性顶突;小箭头所指为囊虫寄生膜)箭头所指为囊虫寄生膜)CT CT 或或 MRI MRI 检查发现脑实质(多位于皮质检查发现脑实质(多位于皮质 -皮质下交界区、基底节,少见于脑干、小脑皮质下交界区、基底节,少见于脑干、小脑和脊髓)、蛛网膜下腔、脑室内发现带有头和脊髓)、蛛网膜下腔、脑室内发现带有头节的囊性病灶。此时,要警惕某些肿瘤的瘤节的囊性病灶。此时,要警惕某些肿瘤的瘤细胞也可形成
5、类似于头节的病灶,一定要根细胞也可形成类似于头节的病灶,一定要根据病灶的性质加以区分,以免误诊。典型的据病灶的性质加以区分,以免误诊。典型的有头节的囊性病灶见图有头节的囊性病灶见图 3 3图图2 2 眼底检查发现视网膜下囊虫,可确眼底检查发现视网膜下囊虫,可确诊脑囊虫病,因为视网膜被认为是中枢诊脑囊虫病,因为视网膜被认为是中枢神经系统的一部分。但不包括眼前房囊神经系统的一部分。但不包括眼前房囊虫病。虫病。Neuroimaging criteria Neuroimaging criteriapMajor neuroimaging criteriaMajor neuroimaging criter
6、ia;Cystic lesions without a discernible scolex.Cystic lesions without a discernible scolex.Enhancing lesions.Enhancing lesions.Multilobulated cystic lesions in the subarachnoid space.Multilobulated cystic lesions in the subarachnoid space.Typical parenchymal brain calcifications.Typical parenchymal
7、brain calcifications.Neuroimaging criteria Neuroimaging criteriapConfirmative neuroimaging criteriaConfirmative neuroimaging criteria:Resolution of cystic lesions after cysticidal drug Resolution of cystic lesions after cysticidal drug therapy.therapy.Spontaneous resolution of single small enhancing
8、 lesions.Spontaneous resolution of single small enhancing lesions.Migration of ventricular cysts documented on sequential Migration of ventricular cysts documented on sequential neuroimaging studies.neuroimaging studies.nMinor neuroimaging criteria:Minor neuroimaging criteria:Obstructive hydrocephal
9、us(symmetric or asymmetric)or Obstructive hydrocephalus(symmetric or asymmetric)or abnormal enhancement of basal leptomeninges.abnormal enhancement of basal leptomeninges.Clinical/exposure criteria Clinical/exposure criteriapMajor clinical/exposure:Major clinical/exposure::Detection of specific anti
10、cysticercal antibodies or Detection of specific anticysticercal antibodies or cysticercal antigens by well standardized cysticercal antigens by well standardized immunodiagnostic tests.immunodiagnostic tests.Cysticercosis outside the central nervous system.Cysticercosis outside the central nervous s
11、ystem.Evidence of a household contact with T.solium Evidence of a household contact with T.solium infection.infection.nMinor clinical/exposure:Minor clinical/exposure:Clinical manifestations suggestive of neurocysticercosis.Clinical manifestations suggestive of neurocysticercosis.Individuals coming
12、from or living in an area where Individuals coming from or living in an area where cysticercosis is endemic.cysticercosis is endemic.Degrees of diagnostic certainty Degrees of diagnostic certaintypDefinitive diagnosisDefinitive diagnosis:One absolute criterion.One absolute criterion.Two major neuroi
13、maging criteria plus any Two major neuroimaging criteria plus any clinical/exposure criteria.clinical/exposure criteria.One major and one confirmative neuroimaging criteria plus One major and one confirmative neuroimaging criteria plus any clinical/exposure criteria.any clinical/exposure criteria.On
14、e major neuroimaging criteria plus two One major neuroimaging criteria plus two clinical/exposure criteria(including at least one clinical/exposure criteria(including at least one major clinical/exposure criterion),together with the major clinical/exposure criterion),together with the exclusion of o
15、ther pathologies producing similar exclusion of other pathologies producing similar neuroimaging.neuroimaging.Degrees of diagnostic certainty Degrees of diagnostic certaintypProbable diagnosisProbable diagnosis:One major neuroimaging criteria plus any two One major neuroimaging criteria plus any two
16、 clinical/exposure criteria.clinical/exposure criteria.One minor neuroimaging criteria plus at least one major One minor neuroimaging criteria plus at least one major clinical/exposureclinical/exposurecriteria.criteria.流行病学流行病学p病原体:猪肉绦虫的幼虫(囊尾蚴)病原体:猪肉绦虫的幼虫(囊尾蚴)-囊虫病(中间宿主猪)囊虫病(中间宿主猪)-猪肉绦虫的成虫猪肉绦虫的成虫-肠绦虫
17、病(终宿主人)。肠绦虫病(终宿主人)。p传染源:绦虫病患者传染源:绦虫病患者。p传播途径:外源性异体感染、外源性自身感染、内在自身感染。传播途径:外源性异体感染、外源性自身感染、内在自身感染。p发病率:普通人群发病率:普通人群2-4%2-4%,神经囊虫病占囊虫病,神经囊虫病占囊虫病60-80%60-80%p易发病地区:易发病地区:我国主要分布在华北、东北、西北地区,农村多我国主要分布在华北、东北、西北地区,农村多于城市。于城市。p脑囊虫病的发病高峰在脑囊虫病的发病高峰在2020一一3030岁,男女均可发病。单一结节型岁,男女均可发病。单一结节型多见于多见于3030岁以下的患者,蛛网膜下腔型多见
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- 囊虫
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