双语病例——脑囊虫病
朗读老师：司东雷 石家庄市第三人民医院
翻译老师：王长耿 福建省晋安医院
审校老师：姜春雷 青岛市第九人民医院
22-year-old woman with fever, headache, vomiting
22岁女子因发烧、头痛、呕吐就诊
Findings
CT: There is prominence of the ventricular system including bilateral temporal horns consistent with hydrocephalus. There is no definite transependymal CSF flow.
CT表现：脑室系统扩大，包括双侧颞角，符合脑积水表现。脑脊液无明确的跨过室管膜。
MRI: There is an expansile multicystic lesion in the fourth ventricle with a few foci of enhancement in the small anterior cystic components. There is abnormal T2/FLAIR signal along the fourth ventricle. Given the imaging findings and prior lumbar puncture results of aseptic meningitis with eosinophilic predominance, neurocysticercosis of the fourth ventricle is the leading differential diagnosis. The curvilinear T1 hyperintense region along the superior aspect of the lesion may represent scolex.
MR表现：在第四脑室有一个膨胀性的多囊性病变，在小囊性成分中的前部有一些强化病灶。沿第四脑室有异常T2FLAIR信号。鉴于嗜酸性粒细胞比例较高，影像学表现为无菌性脑膜炎，以及先前的腰椎穿刺结果，第四脑室脑囊虫病首先需要鉴别。沿着病变上部的曲线样T1高信号可能代表囊虫的头节。
Differential diagnosis
· Metastatic disease
· Tuberculomas
· Pyogenic cerebral abscesses
· Perivascular spaces
· Neurocysticercosis
Diagnosis: Neurocysticercosis
鉴别诊断：转移瘤 结核瘤·化脓性脑脓肿 血管周围间隙扩大·脑囊虫病
Discussion
Neurocysticercosis
诊断：脑囊虫病
Pathophysiology
Taenia solium is a species of cestode (commonly known as a tapeworm) that can infect humans and cause neurocysticercosis. T. solium may cause disease through any of three main mechanisms: the presence of the parasite itself (i.e., mass effect, obstruction); the ensuing inflammatory response (i.e., edema); and residual scarring (i.e., fibrosis, granulomas, and calcifications). The combination of these factors makes neurocysticercosis a highly pleomorphic disease during imaging evaluation, forming part of a vast differential diagnosis in countries where the disease is endemic. With respect to location, it has traditionally been classified into subarachnoid-cisternal, parenchymal, intraventricular, and spinal forms.
病理生理学
猪带绦虫是绦虫的一种（俗称tapeworm），可感染人类并引起脑囊虫病。梭状芽孢杆菌可通过三种主要机制中的任何一种引起疾病：寄生虫本身（即占位效应、阻塞）；随后的炎症反应（即水肿）；和残余瘢痕组织（即纤维化、肉芽肿和钙化）。这些因素结合一起，使脑囊虫病在影像评估中成为一种高度多形性疾病，在该疾病流行的国家许多鉴别诊断的一部分。根据病变位置，传统上将其分为蛛网膜池下型、实质型、脑室型和脊髓型。
Epidemiology
Incidental calcified granulomas are found in 10% to 20% of the general population in endemic settings, with an estimated 75 million people in Latin America at risk for neurocysticercosis. Neurocysticercosis affects males and females equally and manifests predominantly in young adults, with a peak occurrence between 25 and 35 years of age; however, infection likely occurs earlier in life (5-15 years of age). The disease is endemic in Central and South America, regions of Africa, China, and India.
流行病学
在流行病区，10%至20%的普通人群中可发现偶发钙化性肉芽肿，拉丁美洲有大约7500万人处于囊虫病的风险中。囊虫病性别没有差异，年轻人好发，高峰发生在25至35岁之间；然而，在5-15岁也可以发生感染。这种疾病在中美洲和南美洲、非洲地区、中国和印度流行。
Clinical presentation
Clinical presentation is variable depending on the location of the lesions and associated inflammation. Common presenting symptoms include nausea, vomiting, headache, and seizure.
临床表现
临床表现因病变位置和相关炎症而异。常见症状包括恶心、呕吐、头痛和癫痫。
Imaging features
Neurocysticercosis demonstrates multiple stages of development that can be delineated with imaging:
Vesicular stage: There is a small CSF-like cyst with a thin wall and an eccentrically located scolex, no contrast enhancement of the cyst's wall, and no surrounding tissue edema.
Colloidal vesicular stage: The density and signal intensity of the cystic fluid change from that of CSF. The cystic wall is thicker. The scolex becomes ill-defined and finally shrinks in size. Ringlike enhancement is seen. The surrounding tissue edema is obvious.
Granular nodular stage: There is a small enhancing cyst or nodule, with mild surrounding edema and little mass effect.
Nodular calcified stage: There is a small calcified nodule with no surrounding edema; it is better seen on CT.
The nodular calcified stage is deemed a nonactive infection while the other three stages are active infection.
影像特点
脑囊虫病影像学可表现多个发展阶段：
囊泡期:有一个小的脑脊液样囊肿，壁薄，可见偏心性的头节，囊肿壁无对比增强，周围组织无水肿。
胶状期:囊液的密度和信号强度与脑脊液不同。囊壁较厚。头节变得模糊不清，最终缩小。可见环状强化。周围组织水肿明显。
结节肉芽肿期:有一个小的强化囊肿或结节，周围水肿较轻，占位效应轻。
结节钙化期:有一个小的钙化结节，周围无水肿；CT上更容易看到。
认为钙化期是非活动性感染，而其他三个阶段是活动性感染。
Treatment
Treatment is variable depending on the lesion location and disease burden. Treatments include procedures to relieve intracranial hypertension, antiparasitic medication, surgical excision, and seizure medication.
治疗：根据病变部位和疾病的严重程度，治疗方法也有所不同。治疗方法包括减轻颅内高压、抗寄生虫药物、手术切除和癫痫药物治疗。