耳源性肥厚性硬脑膜炎伴颞叶水肿及器质性精神障碍一例

易自翔　张榕　肖文惠  中华耳鼻咽喉科杂志 2000年第4期第35卷

　　【摘要】　目的　肥厚性硬脑膜炎(hypertrophic cranial pachymeningitis， HCP)属罕见疾病，易被误诊，报告1例耳源性肥厚性硬脑膜炎伴颞叶水肿及器质性精神障碍的病例，希引起共同注意。方法　患者男性，26岁，以右侧剧烈头痛、眩晕、恶心、呕吐、面神经及外展神经麻痹等，于1997年7月入院。磁共振成像及CT检查提示颞骨炎性病变，岩尖硬脑膜及其相邻的小脑幕增厚，明显强化呈条带状。诊断为右侧周围性面瘫、迷路炎、岩尖综合征。手术行面神经减压、迷路切除、乳突及岩锥炎性气房清除、岩尖病变探查等。术后除耳聋以外所有症状消失。术后9个月后，患者出现精神异常，曾住精神病院未获改善。1998年5月13日复查磁共振并增强扫描，发现右中颅窝的硬脑膜及小脑幕增厚，颞叶下极明显水肿，海绵窦壁增厚，包围颈内动脉使之受压变小。结果　耳源性HCP伴颞叶水肿及器质性精神障碍的诊断确定，大剂量青霉素静脉点滴治愈。23个月后随访患者生活工作良好，未见复发。结论　MRI是诊断耳源性HCP的主要手段，抗生素治疗此例HCP有效。

Otogenic hypertrophic cranial pachymeningitis associated with edema of the temporal lobe and organic mental disorder-case report

YI Zixiang，ZHANG Rong，XIAO Wenhui（Department of Otorhinolaryngology of First Affiliated Hospital, Fujian Medical University and The Otorhinolaryngology Institute of Fujian Province, Fuzhou 350005, China）

　　【Abstract】　Objective　Hypertrophic cranial pachymeningitis（HCP） is a rare disease which might be misdiagnosed. One typical case of otogenic hypertrophic cranial pachymeningitis(HCP) associated with edema of the temporal lobe and organic mental disorder was reported. Literatures associated with HCP were reviewed for reference. Methods　In July,1997, a 26-year-old man was admitted for right-sided severe headache, dizziness, nausea, vomiting, facial and abducens nerve palsy. MRI and CT revealed inflammation in the temporal bone and locally thickened dura mater with obvious enhancement as a band in the petrous apex and nearby tentorium cerebellum. The patient then underwent operation including decompression of the facial nerve, labyrinthectomy, and eradication of the inflammatory cells in the mastoid and petrous portion. Postoperatively, the clinical signs disappeared except hearing loss. Seven months later, the patient suffered from mental disorder with interrupted excitement to hit and abuse the family members. He was then treated in a psychosis hospital but no improvement could be seen. On May 13,1998, MRI

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