Nikolić S, Vujosević M, Sasić M, Poluga J, Misić S, Najdanović Lj, Dulović O, Dragojlović J, Milosević B
Institute of Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade.
Srp Arh Celok Lek. 1998 May-Jun;126(5-6):209-13.
Neurologic manifestations are present in about 10-20 percent of patients with trichinosis. They could be a serious diagnostic problem in the absence of corresponding epidemiological data and typical symptoms and signs of the disease. In untreated patients the mortality rate is about 50%. Several pathogenic mechanisms are responsible for the neurological complications in trichinosis: obstruction of brain blood vessels by larvae, cysts or granulomas, toxic vasculitis with secondary thrombosis and haemorrhages, granulomatous inflammation of the brain parenchyma and allergic reaction. Neurotrichinosis is manifested with clinical symptoms and signs of meningitis, encephalitis, polyradiculoneuritis, poliomyelitis, myastenia gravis, paresis and paralysis, with the clinical picture of systemic disease of the connective tissue involving the nervous system and, extremely rare, as a sinus thrombosis. Thus, the broad spectrum of neurological lesions in trichinosis is, probably, the results of the fact that Trichinella spiralis larvae, during haematogenic dissemination has no special affinity for particular parts of the nervous system. We present five patients with encephalitis and focal cerebral lesions in trichinosis. In one patient the neurologic manifestations were the only sign of the disease. We believe that all pathogenic mechanisms mentioned above, were involved in the onset of neurological manifestations in our patients. The diagnosis of the disease was based on the clinical picture, epidemiological data, microscopic identification of larvae in the muscular tissue, the presence of antibodies against Trichinella spiralis in cerebrospinal fluid (with preserved blood brain barrier) and in serum confirmed by IIF method, computerised tomography and magnetic resonance imaging of the brain, eosinophilia in the peripheral blood picture. One patient died, and in the remaining patients the course of the disease was favourable; they were discharged from the hospital with minimal neurologic sequelae.
旋毛虫病患者中约10% - 20%会出现神经系统表现。在缺乏相应流行病学数据以及该病典型症状和体征的情况下，这些表现可能会成为严重的诊断难题。未经治疗的患者死亡率约为50%。旋毛虫病的神经系统并发症由多种致病机制引起：幼虫、囊肿或肉芽肿阻塞脑血管，继发血栓形成和出血的中毒性血管炎，脑实质的肉芽肿性炎症以及过敏反应。神经旋毛虫病表现为脑膜炎、脑炎、多发性神经根神经炎、脊髓灰质炎、重症肌无力、轻瘫和瘫痪的临床症状和体征，伴有累及神经系统的结缔组织全身性疾病的临床表现，极少数情况下表现为静脉窦血栓形成。因此，旋毛虫病广泛的神经病变谱可能是由于旋毛虫幼虫在血行播散过程中对神经系统的特定部位没有特殊亲和力这一事实导致的。我们报告了5例旋毛虫病合并脑炎和局灶性脑病变的患者。其中1例患者的神经系统表现是该病的唯一症状。我们认为上述所有致病机制都与我们患者神经系统表现的发生有关。该病的诊断基于临床表现、流行病学数据、肌肉组织中幼虫的显微镜鉴定、脑脊液（血脑屏障完整）和血清中抗旋毛虫抗体的存在（通过间接免疫荧光法确认）、脑部计算机断层扫描和磁共振成像以及外周血嗜酸性粒细胞增多。1例患者死亡，其余患者病情好转；他们出院时仅有轻微的神经后遗症。
