一位以頭痛一個月為表徵的43歲男性

頭痛是臨床常見的主訴，雖然絕大多數的頭痛具自限性病程，卻也可能是中樞神經系統感染的初始症狀之一，此時若未能及時診斷治療，會導致病人有較高的風險發生永久性神經功能缺損、甚至造成死亡。本案例描述一位43歲男性，主訴入院前一個月開始出現發燒及持續性頭頂鈍痛症狀，尤其清晨睡醒時頭痛最為劇烈，入院前一周頭痛加劇，並出現複視、雙下肢麻痛等症狀。到院時意識清楚，身體檢查發現右眼無法外旋，腦部影像正常，腦脊髓液中白血球及淋巴球比例皆異常增多，血清中嗜伊紅性白血球比例偏高。詳問病史發現病人於頭痛前五天曾生食青蛙，以酵素結合免疫吸附法檢驗腦脊髓液及血清後發現有廣東住血線蟲之抗體，診斷為廣東住血線蟲引起之嗜伊紅性腦膜炎。經治療後病人恢復良好，頭痛發燒皆已解除，惟右眼仍無法完全外旋。本案例提醒我們：當遇到淋巴球性腦膜炎，合併血清或腦脊髓液中嗜伊紅性球比例異常偏高時，需主動詢問發病前之飲食狀況，以判斷是否有食入遭寄生蟲汙染之食物與飲水之可能性。

關鍵字

嗜伊紅性腦膜炎；頭痛；廣東住血線蟲

並列摘要

Headache is a common clinical complaint mostly with a self-limited course but may also be a symptom of central nervous system infection. If the diagnosis is not established in time, permanent neurological deficits and even death may occur. We presented a 43-year-old man who had fever and persistent dull pain in the top of the head as symptoms for a month before admission, especially the most severe headache when waking up in the morning. The headache got worsened, diplopia and bilateral lower extremities numbness were noticed one week before admission. Despite several visits to a local clinic, no definite diagnosis was made. On admission, the patient was conscious. However, he was unable to rotate his right eye internally. The brain images showed no abnormality. A cerebrospinal fluid examination suggested that the lymphocytic meningitis and serum eosinophils levels were higher than expected. After a thorough medical history inquiry, we found out that the patient ate raw frogs five days before the headache was occurred. Enzyme-linked immunosorbent assays identified antibodies to Angiostrongylus cantonensis in his cerebrospinal fluid and serum. Eosinophilic meningitis caused by Angiostrongylus cantonensis was therefore diagnosed. The patient recovered smoothly after a four-month treatment with a minor sequelae symptom remaining. This case reminds us that when encountering lymphocytic meningitis and the proportion of eosinophils in serum or cerebrospinal fluid is abnormally high, it is necessary to take the initiative to inquire about the dietary history to determine whether there are ingested parasites potential from contaminated food and drinking water.

並列關鍵字

eosinophilic meningitis ； headache ； Angiostrongylus cantonensis

參考文獻

Ansdell, V., Kramer, K. J., McMillan, J. K., Gosnell, W. L., Murphy, G. S., Meyer, B. C., Blalock, E. U., Yates, J., Lteif, L., Smith, O. A., & Melish, M. (2021). Guidelines for the diagnosis and treatment of neuroangiostrongyliasis: Updated recommendations. Parasitology, 148(2), 227-233. https://doi.org/10.1017/S0031182020001262

Chesdachai, S., Katz, B., & Sapkota, S. (2020). Diagnostic Challenges and Dilemmas in Tuberculous Meningitis. American Journal of the Medical Sciences, 359(6), 372-377. https://doi.org/10.1016/j.amjms.2020.03.010

Do, T. P., Remmers, A., Schytz, H. W., Schankin, C., Nelson, S. E., Obermann, M., Hansen, J. M., Sinclair, A. J., Gantenbein, A. R., & Schoonman, G. G. (2019). Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology, 92(3), 134-144. https://doi.org/10.1212/WNL.0000000000006697

Federspiel, F., Skovmand, S., & Skarphedinsson, S. (2020). Eosinophilic meningitis due to Angiostrongylus cantonensis in Europe. International journal of infectious diseases, 93, 28-39. https://doi.org/10.1016/j.ijid.2020.01.012

Fejes, E., Feher, G., Gurdan, Z., Gombos, K., Koltai, K., Pusch, G., & Tibold, A. (2020). Characteristics of Patients Referred To A Specialized Headache Clinic. Scientific Reports, 10(1), 1146. https://doi.org/10.1038/s41598-020-58234-w

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