课件：脑囊虫病.ppt

* * * * 脑囊虫病 Neurocysticercosis * 内 容 提 要 最新诊断标准 流行病学 临床表现 实验室检查 影像学表现 鉴别诊断 治疗 Diagnostic criteria Absolute criteria Neuroimaging criteria Clinical/exposure criteria Histological demonstration of the parasite from biopsy of a brain or spinal cord lesion. Visualization of subretinal cysticercus. Conclusive demonstration of a scolex within a cystic lesion on neuroimaging studies. 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，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。 Absolute criteria 图1 脑或脊髓病变组织活检发现囊虫（大箭头所指为囊虫的特征性顶突；小箭头所指为囊虫寄生膜） CT 或 MRI 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。典型的有头节的囊性病灶见图 3 图2 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神经系统的一部分。但不包括眼前房囊虫病。 Neuroimaging criteria Major neuroimaging criteria； Cystic lesions without a discernible scolex. Enhancing lesions. Multilobulated cystic lesions in the subarachnoid space. Typical parenchymal brain calcifications. Neuroimaging criteria Confirmative neuroimaging criteria： Resolution of cystic lesions after cysticidal drug therapy. Spontaneous resolution of single small enhancing lesions. Migration of ventricular cysts documented on sequential neuroimaging studies. Minor neuroimaging criteria: Obstructive hydrocephalus (symmetric or asymmetric) or abnormal enhancement of basal leptomeninges. Clinical/exposure criteria Major clinical/exposure:： Detection of specific anticysticercal antibodies or cysticercal antigens by well standardized immunodiagnostic tests. Cysticercosis outside the central nervous system. Evidence of a household contact with T. solium infection.. Minor clinical/exposure: Clinical manifestations suggestive of neurocysticercosis. Individuals coming from or living in an area where cysticercosis is endemic. Degrees of diagnostic certainty Definitive diagnosis： One absolute criterion. Two major neuroimaging criteria plus any clinical/exposure criteria. One major and one confirmative neuroimaging