From the Department of Radiology, The Ottawa Hospital-University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada. K1Y 4E9.
Radiology. 2024 Oct;313(1):e240620. doi: 10.1148/radiol.240620.
A 30-year-old female patient who was 25 weeks pregnant presented to the emergency department with a 1-month history of mild headache and 2 weeks of progressive somnolence and photophobia accompanied by binocular horizontal diplopia and right gaze deviation. The patient also described new neck pain with passive head movements, without neck stiffness. Overall, the pregnancy was uncomplicated, with no high-risk features. Fever, chills, cough, shortness of breath, and abdominal or chest pain were denied. The patient had no history of rash, intravenous drug use, immunosuppressive medication use, or documented congenital abnormalities. She had not traveled recently, although she lived in Vancouver, British Columbia, Canada, 2 years prior to presentation. There was no recent or recurrent bacterial or viral illness. At clinical examination, the patient exhibited a decreased level of alertness and appeared tired. Vital signs were unremarkable, with a normal temperature (37.1 °C). Cranial nerve assessment revealed mild right abducens nerve palsy; neurologic examination was otherwise normal. Fundoscopic examination showed moderate grade 3 papilledema, left greater than right, with obscuration of some of the vessels leaving the disk. A CT scan of the head at admission was interpreted as normal (Fig 1). MRI of the brain performed 5 days later, due to persistent symptoms, revealed infratentorial and supratentorial imaging abnormalities (Figs 2-5). Lumbar puncture revealed high cerebral spinal fluid (CSF) opening pressure (32 cm HO; upper limit of normal, 25 cm HO). The CSF was clear, and analysis revealed an elevated total nucleated cell count (136 ×10/L; reference range, 0-5 ×10/L), with predominant lymphocytic moderate pleocytosis (100 ×10/L; reference range, 0-5 ×10/L) (59% lymphocytes) and normal glucose (3.3 mmol/L; reference range, 2.2-3.9 mmol/L) and normal total protein (0.27 g/L; reference range, 0.16-0.49 g/L) levels. Blood culture results for mycobacteria and anaerobic and aerobic microorganisms showed no growth. Findings from extensive additional diagnostic workup, including serologic testing for herpes simplex virus, varicella-zoster virus, enterovirus, , and mycobacteria, were negative. The HIV test result was negative, and the CD4 lymphocyte count and complement and immunoglobulin levels were within normal range. Autoimmune screening results were also negative.
一位 30 岁的女性患者，25 孕周，因轻度头痛病史 1 个月，进行性嗜睡和畏光伴双眼水平复视和右侧凝视障碍 2 周就诊于急诊科。患者还描述了新的颈部疼痛，伴有被动头部运动，无颈部僵硬。总体而言，妊娠无并发症，无高危特征。无发热、寒战、咳嗽、呼吸急促、腹痛或胸痛。患者无皮疹、静脉吸毒、免疫抑制药物使用或有记录的先天异常病史。她最近没有旅行，尽管她在就诊前 2 年住在不列颠哥伦比亚省温哥华。最近没有或反复出现细菌或病毒感染。在临床检查中，患者表现出警觉性下降，看起来疲倦。生命体征无异常，体温正常（37.1°C）。颅神经评估显示右侧外展神经轻度麻痹；神经系统检查正常。眼底检查显示中度 3 级视乳头水肿，左侧大于右侧，一些离开视盘的血管模糊。入院时头部 CT 扫描结果正常（图 1）。由于持续存在症状，5 天后进行的脑部 MRI 显示幕下和幕上影像学异常（图 2-5）。腰椎穿刺显示高颅内压（32 cm H2O；正常上限为 25 cm H2O）。CSF 清亮，分析显示总核细胞计数升高（136×10/L；参考范围 0-5×10/L），以淋巴细胞为主的中度淋巴细胞增多（100×10/L；参考范围 0-5×10/L）（59%淋巴细胞），葡萄糖正常（3.3 mmol/L；参考范围 2.2-3.9 mmol/L），总蛋白正常（0.27 g/L；参考范围 0.16-0.49 g/L）。分枝杆菌和需氧和厌氧菌的血培养结果无生长。包括单纯疱疹病毒、水痘-带状疱疹病毒、肠道病毒和巨细胞病毒的血清学检测在内的广泛其他诊断性检查结果均为阴性。HIV 检测结果为阴性，CD4 淋巴细胞计数和补体及免疫球蛋白水平均在正常范围内。自身免疫筛查结果也为阴性。
