「Paragonimus」 腦膜炎
Review of Literature and Report of Four Cases
Oh Shin-Joong,
소속 상세정보
( Oh Shin-Joong ) - the National Medical Centre Deptarment of Neurology
KMID : 0360919620050070078
Abstract
「Paragonimus」腦膜炎
腦性「肺지스토마」(Cerebral Paragonimiasis)의 하나로서 腦膜炎症狀으 일으킴은 周知의 事實이다. 그러나 詳細한 臨床觀察 및 臨床檢査를 記述한 報告例는 稀有하다.
西紀 1961年 6月부터 1962年 5月까지에 4例의 「肺지스토마」性 腦膜炎(Paragonimus Meningitis)을 觀察하였기에 이에 報告하며 現在까지 文獻上 報告된 5例와 함께 總括考察하였다.
(1) 第1例는 腦性「肺지스토마」를 가진 18歲 韓國人 男子로서 入院中 2回의 腦膜炎症狀을 일으켰다. 腦脊髓液所見은 “細菌性腦膜炎”所見을 提示하였다.
(2) 第2例는 腦性 「肺지스토마」를 가진 28歲 韓國人 男子로서 入院中 3日間 繼續한 腦膜炎症狀을 일으키었다. 腦脊髓液所見은 第1例와 類似하였다.
3) 第3例는 腦性 「肺지스토마」를 가진 9歲 韓國人男子로서 腦膜炎症狀으로는 間歇熱만이 있었으나 腦脊髓液所見은 確定的인 腦膜炎所見을 提示하였으며 또한 그 液속에서 多數의 好酸性白血球를 發見할수있었다.
4) 第4例는 腦性 「肺지스토마」를 가진 韓國人 中年婦人으로서 腦膜炎回復期에 入院하였던 例이었으나 腦脊髓液所見은 前例에서와 類似하였다.
5) 文獻上 報告된 5例와 함께 總括 考察한 結果 다음과 같은 結論을 얻었다.
ⓐ 腦膜炎症狀은 中樞神經系「지스토마」症의 唯獨한 症狀으로 發見될 수도있으며 또는 腦性 「肺지스토마」症의 合倂症으로 나타날 수도 있다.
ⓑ 發病은 急性으로 發熱과 嘔吐가 同伴하며 頭痛이 同伴하기도 한다. 頸强直과 陽性 Kernig Sign은 모든 例에 存在하였다. 著者의 4例에서는 다는 腦膜炎에 흔한 頭痛, 興奮過敏性(Irritability), 一般全身狀態 및 意識의 障碍는 없거나 輕한 것이 特徵이었다.
ⓒ 腦脊髓液所見은 細菌性腦膜炎時의 所見과 類似하였다. 糖分(Sugar)은 모든 例에서 低下되어 있고 鹽化物(chloride)은 正常이거나 若干 低下되어 있다. 相當한 例에서 好酸性白血球의 出現이 있었으나 「肺지스토마」(P.W.)의 卵은 發見못하였다.
ⓓ 報告된 몇가지 例에서 結核性腦膜炎을 疑心하였던 事實로 보아 우리나라에 많은 結核性腦膜炎과의 鑑別이 가장 問題視되나 詳細한 病歷, 檢査 및 上記한 몇가지 特徵을 恒常 考慮하고 있으면 鑑別診斷上 큰 難點은 없으리라 생각 된다.
It is generally recognized that the development of cerebral paragonimiasis in a proportion of case has followed an initial meningitic attack. Lee has thus reported that 9 out of 11 cases had a past history of a meningeal syndrome, which subsided spontaneously within three to seven days. In the 33 cases we have seen during the past three years, 7 of the patients have presented such a history.
Also in the classification of cerebral paragonimiasis a meningitic type is usually included. Ipsikhiat2 has thus divided the symtomatology into four categories: (1) encephalitic, (2) meningeal, (3) epileptoid and (4) tumorous. Kim3´ has described the cerebral menifestations under four headings: (1) seizures, (2) sudden hemiplegia, (3) meningitic syndrome, and (4) mental retardation. He observed in 6 of, his 47 cases a chronic meningitis with headache, stiff neck, vomiting and a low grade fever as. the predominant symptom.
There is thus a clinical as well as a pathological foundation for the assumption of a meningitis as the only or the predominant clinical menifestation of cerebral paragonimiasis.
In contrast to such a frequent history of meningitic episodes in the case reports of cerebral paragonimiasis, there are rather few reports of meningitis which has been observed during hospitalization and thoroughly studied.
The first publication of this kind is from Japan in 1933- by Ikebukuro4 who reported a case of a male patient who was admitted to his clinic with chief complaints of sudden development of left hemiplegia, ´vomiting, frontal headache, and It. facial palsy. The spinal fluid findings showed raised pressure, increased cells with many two segmented eosinophiles, increased protein, decreased sugar and cholride, m´eingitic colloidal gold curve, and negative result for any pathogenic organisms. This patient was suspected of "tuberculous meningitis" prior to autopsy which disclosed "cerebral paragonimiasis".
Three other publications have appeared, also from Japan: by Matzumura5) in 1933, by Konuma and Kanzakisl in 1936, by Yamada7 in 1938. In 1941, Nonomuras published -a case which he simply called paragonimus parasitic meningitis. He -found that 98 % of the cells in the spinal fluid were eosinophiles.
Author has observed four cases of paragonimus meningitis during the past six months. In addition to presenting four cases, all available previous publications are reviewed in an attempt to establish certain clinical criteria of this aspect of the disease which often may be difficult to recognize
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