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军团菌病(退伍军人病)中的神经系统受累

[Nervous system involvement in legionellosis (legionnaires' disease)].

作者信息

Pokrovskiĭ V I, Fokin M A, Belen'kiĭ S N, Gruzman G B, Aleshkin N N

出版信息

Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(3):38-41.

PMID:1646536
Abstract

According to the authors' observations, the symptoms of nervous system derangement associated with legionnaires' disease rather often enter the disease structure and can virtually be characterized as a manifestation of infectious and toxic encephalopathy and polyneuropathy (encephalopolyneuropathy). In the majority of cases, the neurological disorders develop acutely or subacutely after or simultaneously with respiratory lesions. The clinical picture of encephalopathy is marked by permanent headache, mental abnormalities, memory disturbances, insomnia, pronounced astheno-vegetative and vascular manifestations. In patients with legionellosis, polyneuropathy is manifested by paresthesias, less frequently by pains in the distal parts of the limbs and myasthenia without visible atrophies. Vegetative disorders such as vegetative polyneuropathy of the hands and legs, visceral polyneuropathies are typical symptoms of the disease whatever its gravity. Vegetovascular dystonia together with long-term AP instability is an obligate sign of the disease. Electrophysiological examinations (EEG, REG, EMG) support the clinical findings and may serve the basis for an objective evaluation of the gravity of the neurological disorders. The degree of pulmonary lesions and the intensity of vegetative disorders eventually determine the torpidity and characteristics of the disease course.

摘要

根据作者的观察,与军团病相关的神经系统紊乱症状相当频繁地纳入疾病构成,实际上可被视为感染性和中毒性脑病及多发性神经病(脑多神经病)的一种表现。在大多数情况下,神经功能障碍在呼吸系统病变之后或与之同时急性或亚急性发作。脑病的临床表现为持续性头痛、精神异常、记忆障碍、失眠、明显的无力-自主神经及血管表现。在军团菌病患者中,多发性神经病表现为感觉异常,四肢远端疼痛较少见,且无明显萎缩的肌无力。诸如手足植物性多发性神经病、内脏多发性神经病等自主神经障碍是该病无论轻重的典型症状。植物神经血管张力障碍以及长期血压不稳定是该病的必然体征。电生理检查(脑电图、脑血流图、肌电图)支持临床诊断结果,可为客观评估神经功能障碍的严重程度提供依据。肺部病变程度及自主神经障碍的强度最终决定疾病进程的迟缓性及特点。

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