可逆性脑后部白质病变综合征影像学特点分析

目的探讨可逆性脑后部白质病变综合征的影像学特点。方法回顾性分析11例可逆性脑后部白质病变综合征患者的影像学资料。结果患者中累及枕叶9例,顶叶8例,额叶8例,基底节6例,颞叶2例,胼胝体1例和小脑1例。CT平扫示枕叶、顶叶、额叶、基底节、颞叶、胼胝体和小脑等低密度。MRI平扫示T_1WI为低信号、T_2WI及Flair为高信号。DWI可呈等或稍高信号,ADC可呈等、稍高、高或低信号。结论可逆性脑后部白质病变综合征可累及部位主要局限于顶枕叶,但额叶、基底节、颞叶、胼胝体及小脑等部位亦可受累。Flair、DWI和ADC序列对病变最为敏感。     

儿童流行性乙型脑炎MRI及扩散加权成像早期诊断的优势

目的探讨儿童乙脑MRI影像特点及早期扩散加权成像价值,以提高对乙脑影像征象认识及早期检出。方法回顾性分析2006-2013年经我院临床诊治的27例乙脑患者,全部病例均为血清IgM乙脑抗体阳性。磁共振扫描仪采用GE 1.5T超导磁共振成像扫描仪。其中20例在发病至神经系统出现症状7d内应用DWI。结果 27例儿童乙脑中24例累及丘脑,13例累及中脑黑质,6例累及皮层或皮层下白质,4例累及基底节,2例累及海马,2例累及胼胝体压部。20例在急性期(7d内)应用DWI检查:8例为细胞毒性水肿,DWI显示病灶范围、信号强度均优于T2WI、FLAIR,其中DWI单独显示3例。7例血管源性水肿,T2WI、FLAIR优于DWI。3例脑内多发病灶内两种水肿共存,DWI与T2WI、FLAIR在显示病灶能力中互有优势。结论儿童乙脑好累及双侧丘脑、中脑黑质,影像学具有一定特征,早期DWI比T2WI、FLAIR更易发现病灶。     

流行性乙型脑炎的影像学特点

目的：分析流行性乙型脑炎的MRI表现特征，探讨MRI对流行性乙型脑炎诊断价值。方法：回顾分析经临床和血清学证实的4例流行性乙型脑炎不同发病时期的MRI资料，其中成人1例，儿童3例。MRI均采用常规横轴位T1WI和T2WI，冠状面FLAIR及DWI。成年患者还经钆喷酸葡胺（GD2DTPA）增强检查。结果：4例患者MRI都有双侧丘脑、中脑病变，其中2例还有大脑皮质病变。增强扫描病灶未见强化。结论：流行性乙型脑炎的MRI特征是双侧丘脑和中脑异常信号。     

弥漫性轴索损伤

弥漫性轴索损伤(DAI)属于闭合性原发弥漫性脑损伤。是由于头部成角、加(减)速运动或旋转性暴力出现弥漫性轴索扭曲、肿胀、断裂及皮髓质交界区穿行血管中断所致。好发于皮髓质交界区、胼胝体、尾状核、丘脑、内囊及中脑被盖的背外侧。其病理变化包括:(1)广泛性轴索损害,累及大脑、脑干和小脑的白质和大脑深部核质,包括中线旁皮质下白质、胼胝体、穹窿柱、内囊、基底节及丘脑、齿状核背侧小脑叶、皮质脊髓束、内侧丘脑系、内侧纵束等。(2)胼胝体局限性出血灶。(3)上脑干背外     

原发性胼胝体变性临床特点

目的探讨原发性胼胝体变性(MBD)的临床及影像学特点。方法回顾性分析7例MBD患者的临床资料。结果 7例均有大量饮酒史,临床上以意识障碍、精神症状、智能下降、反应迟钝、肢体震颤为主要表现。急性患者主要以意识障碍、精神异常起病;亚急性以快速进展的痴呆起病;慢性以智能下降、反应迟钝起病。患者MRI检查均可见胼胝体异常信号,为长T_1、T_2信号,Flair高信号。急性及亚急性起病者以胼胝体膨胀性改变为特征,慢性起病以"三文治征"为特征;2例伴胼胝体邻近白质病灶。结论 MBD多由于慢性酒精中毒所致,临床表现无特异性。MRI检查发现胼胝体对称性病灶有助于诊断。     

颅脑MRI检查对Wernicke脑病的诊断价值

目的 探讨颅脑MRI检查对Wemicke脑病(WE)的诊断价值.方法 回顾性分析8例WE患者的临床资料及MRI检查结果.结果 8例WE患者MRI示脑部T2 WI、Flair成像及弥散加权成像(DWI)有对称性异常高信号影,其中出现在丘脑内侧6例、中脑导水管周围灰质4例、第三脑室周围灰质3例、乳头体2例及壳核、视交叉、小脑上蚓部、皮质下白质各1例;2例有增强效应.2例发病早期T2 WI、Flair无异常信号影,DWI示丘脑内侧对称性异常高信号影.结论 MRI对WE具有诊断价值,DWI对WE的早期诊断价值更高.     

颅脑多发性硬化的临床及MRI诊断

目的 探讨多发性硬化(MS)的临床及MRJ特征,提高对多发性硬化的认识及诊断水平.方法 对20例颅脑MS患者临床资料、病灶部位、形态、MR信号及强化特点、胼胝体改变进行回顾性分析评价.结果 MS以青、中年女性稍多见,急性、亚急性起病,多以视觉障碍或肢体感觉、运动障碍为首发症状.视觉诱发电位大多数异常.MRJ检查18例发现病灶,敏感性90%(18/20).病灶以双侧侧脑室旁、额叶皮层及皮层下、半卵圆中心多发.病灶大、小不等,多数为圆形、卵圆形."直角脱髓鞘征"及"白质变脏征"是两个较为典型的征象.T1WI上表现为等、低信号,T2WI及Flair序列上表现为高信号,Flair序列显示病灶更清晰.增强扫描病灶可呈结节状强化、环状强化、弧形强化或无强化.结论 MS的临床及MRI表现具有一定特征.MRI有助于脑部MS的诊断及鉴别诊断,是诊断MS最敏感的成像方法.     

成人流行性乙型脑炎患者四例临床特点分析

目的 总结成人流行性乙型脑炎的临床特点,以提高对本病的认识和诊断水平.方法 回顾性分析2007-2008年我院收治的4例成人流行性乙型脑炎患者,总结其临床表现、实验室检查及MRI特点.结果 4例患者均为散发病例,男性2例,女性2例,发病年龄34～68岁,均为夏秋季发病;1例以腹泻起病,3例以头痛、发热起病;4例均有高热、精神异常;2例出现呼吸衰竭.实验室检查4例均有脑脊液白细胞升高,血清及脑脊液乙型脑炎病毒抗体IgM阳性.仅1例MRI见异常信号.2例有后遗症.结论 成人流行性乙型脑炎患者病情一般较重,临床表现不典型,易出现呼吸衰竭,需引起重视.     

原发性干燥综合征中枢神经系统损害八例临床分析

目的探讨原发性干燥综合征的中枢神经系统损害的临床表现、MRI特点、治疗方法。 方法 回顾性分析漳州市福建医科大学附属漳州市医院确诊的8例原发性干燥综合征合并中枢神经系统损害的临床表现、MRI特点。 结果临床可表现为延髓背外侧综合征、肢体无力、智能改变,可类似多发性硬化、视神经脊髓炎,视神经较经常累及;MRI检查示5例出现脊髓损害：病变部位以颈胸髓为主,颈髓2例,胸髓2例,1例同时累及颈髓和胸髓,病灶可大片状、散在斑片状,可轻度、明显强化或不强化,5例出现颅内损害：病变部位可见于延髓背外侧、丘脑、海马、中脑导水管、第四脑室旁、侧脑室旁,可表现为皮质下及脑室旁白质多发小缺血灶,可类似韦尼克脑病,l例出现颈动脉夹层,7例使用了激素后病情有一定改善。 结论原发性干燥综合征中枢神经系统损害的症状、体征及影像学表现多种多样。     

以精神障碍为首发症状的自身免疫性脑炎12例临床分析

正回顾性分析12例以精神障碍为首发症状的自身免疫性脑炎(AE)患者的临床资料如下。1对象和方法为我院2015~2016年收治的AE患者12例;AE诊断符以下标准[1]:(1)急性或亚急性起病;(2)存在认知功能损害、癫痫发作和行为异常等;(3)脑磁共振T2及Flair显示高信号,局限于一侧或两侧颞叶(边缘脑炎)或海马、杏仁体、基底节、下丘脑、脑干、额叶及顶叶等多发性病灶,或都有髓鞘脱失、     

低场MRI在CT阴性脑弥漫性轴索损伤中的应用价值

目的 探讨低场MRI在CT阴性的脑弥漫性轴索损伤（cerebral diffuse axonal injury,DAI）中的应用价值.方法 回顾性分析20例CT阴性、MRI阳性的DAI临床及影像学资料.所有病例均经临床随访证实.CT使用16层CT常规程序扫描,MRI采用0.35T自旋回波T1WI、快速自旋回波T2WI序列、液体衰减反转恢复序列（ FLAIR）、部分使用快速小角度激发序列（FLASH）.结果 MRI各序列共检出CT阴性的115个病灶.其中两侧半卵圆区65个,位于胼胝体25个,侧脑室前后角周围白质区11个,基底节区6 个,丘脑4 个,脑干4个.结论 低场MRI是较为敏感的诊断CT阴性的DAI影像学手段.     

Magnetic Resonance Imaging Findings in Japanese Encephalitis

Ten patients with Japanese encephalitis diagnosed by serological criteria underwent magnetic resonance imaging (MRI) in axial and coronal sections. In 6, a second MRI study was done. The MRI findings were compared with the clinical outcome. Four patients died within several months of onset, 2 had sequelae such as hemiparesis and dementia, and the remaining 4 had no sequelae. In 9 of 10 patients, either diffuse or patchy white matter lesions were observed bilaterally, together with abnormalities in areas such as the thalamus, basal ganglia, and brainstem. For 3 patients who died or remained demented, the second MRI revealed extensive, diffuse white matter abnormalities. This study indicates that Japanese encephalitis can produce white matter involvement, although gray matter structures such as the thalamus, basal ganglia, and brainstem are more severely affected. The severity of these MRI lesions correlated with the clinical outcome.     

A case of Japanese encephalitis demonstrating characteristic changes in MRI]

A 40-year-old woman developed high fever and headache. Five days later, she was admitted because of consciousness disturbance and tremulous movements in upper extremities. The paired sera showed more than fourfold elevation in complement fixation titer to Japanese encephalitis virus. She was diagnosed as Japanese encephalitis from the clinical features and serological tests. Magnetic resonance imaging (MRI), which was performed about seven months after the onset, revealed abnormal intensity areas bilaterally in the thalamus, hippocampus, substantia nigra, globus pallidus and white matter around the lateral ventricle. Eight months after the onset, she was left with bradykinesia, disturbance of rightening reflex, emotional lability and impairment of recent memory with a long period of amnesia, including not only her illness and subsequent events but also about several years before her illness. The characteristic memory dysfunction seems to be due to disorder of bilateral hippocampus, where MRI revealed abnormal intensity areas. And disorder of medial thalamic nucleus would be related to emotional liability. The relation between the clinical features and MRI findings is also discussed.     

Progressive atrophy of the cerebrum in 2 Japanese sisters with microcephaly with simplified gyri and enlarged extraaxial space

This is a case report that describes 2 sisters with microcephaly, simplified gyri, and enlarged extraaxial space. Clinical features of the cases include dysmorphic features, congenital microcephaly, failure of postnatal brain growth, neonatal onset of seizures, quadriplegia, and severe psychomotor delay. Neuroradiological imaging demonstrated hypoplasia of bilateral cerebral hemispheres with enlarged extraaxial spaces, simplified gyral patterns without a thickened cortex, hypoplastic corpus callosum, and enlarged lateral ventricles, with a reduction in gray and white matter volume during the prenatal and neonatal periods. Repeat MRI revealed progressive atrophy of the cerebral gray and white matter, with enlarged lateral ventricles, although the sizes of the bilateral basal ganglia, thalamus, and infratentorial structures were relatively preserved. These neuroradiological findings imply that this disease is caused by the gene involved in neuronal and glial proliferation in the ventricular zone and in tangential neuronal migration from the ganglionic eminence. The nature of the progressive degeneration of the hemispheric structures should be clarified.     

5个CADASIL家族的核磁共振改变特点

目的　分析来自5个CADASIL家族中8名患者的核磁共振(MRI)表现,总结病变不同时期的MRI变化规律及其诊断价值。方法　研究对象为经过超微病理和Notch3基因检查确诊的5个CADASIL家族中的8个患者,均在成年早期发病,主要表现为反复发作的缺血性卒中和进行性痴呆。对先证者1及其母亲、先证者2及其哥哥、姐姐,先证者3、4和5 ,总计8名患者进行了头部MRI检查,其中4名进行了MRI血管成像检查。结果　8名患者的头部MRI均显示多发腔隙性脑梗死,病灶主要分布在基底节、丘脑和脑室旁白质,6例患者出现了外囊梗死,4例出现了胼胝体梗死,3例出现了脑桥梗死。所有8例患者均存在双侧大脑半球多灶性或弥漫性白质疏松,1例患者MRI确诊1年后随访显示多灶性白质病变进展为弥漫性损害,5例患者出现了双侧颞极等T1 长T2 信号。4例患者的头部MRI血管成像检查未见异常。结论　基底节、丘脑和脑室旁白质是CADASIL腔隙性脑梗死的好发部位,外囊和胼胝体梗死以及双侧颞极长T2 信号对本病具有较高的诊断价值。脑干受累可以出现在病程早期,而白质病灶分布形式的变化可以反映病情的进展。     

低血糖脑病的影像学特征

目的探讨低血糖脑病的影像学特征。方法回顾性分析7例低血糖脑病患者的核磁共振资料。结果低血糖脑损害有高度的区域选择性,可不对称。主要累及大脑皮层、海马、基底节和胼胝体压部,甚至皮层下白质;MRI表现为等或稍长T1、长T2信号,DWI呈高信号,伴ADC值降低,部分病变可逆;MRS示病变区乳酸峰无明显变化。结论低血糖脑损害有很强的区域选择性、可不对称;DWI对病变更敏感;大脑皮层和基底节区受累者预后不佳,侵犯胼胝体压部者预后好。     

可逆性后部白质脑病综合征的临床及影像学特点

目的 探讨可逆性后部白质脑病综合征（PRES）的临床和影像学特点。方法 回顾性分析7例PRES患者临床及影像学资料。结果 本组继发于妊娠高血压综合征3例，肾功能衰竭3例，高血压1例。临床表现：7例均有头痛及视物模糊，伴有癫痫发作6例，恶心、呕吐4例，轻偏瘫、共济失调各1例。6例行头颅CT检查，3例枕叶低密度影，其中2例广泛脑白质水肿；1例多发小血肿；2例未发现异常。7例MRI检查显示枕叶均受累，同时伴小脑受累3例，脑干2例，额顶叶皮质下白质2例，尾状核、丘脑各1例。在脑叶呈脑回样、在其他部位呈斑片样异常信号；T1WI呈略低或等信号，T2WI和Fair像呈高信号。2例增强扫描1例无强化，1例呈脑回样、斑片样和环状强化。4例DWI扫描，2例呈略高信号，1例呈低信号，1例未见异常。结论 头痛、视觉障碍和癫痫发作是PRES主要临床表现，影像学特征主要为大脑后部白质对称性长T1、长T2信号。     

Acute disseminated encephalomyelitis after Japanese B encephalitis vaccination.

A 6-year-old girl (Patient 1) and a 5-year-old boy (Patient 2) with acute disseminated encephalomyelitis after Japanese B encephalitis vaccination are reported. Drowsiness, paresthesias, and gait disturbance were observed at 14 days (Patient 1) and 17 days (Patient 2) after the vaccination; however, transient impairment of visual acuity was only found in Patient 1. Laboratory examinations revealed slow theta waves on electroencephalography and elevated myelin basic protein in the cerebrospinal fluid in both patients. The most striking feature on magnetic resonance imaging was the combination of white matter lesions and abnormal intensity signals of the thalamus. The administration of oral prednisolone (2 mg/kg/day) markedly improved the clinical findings and abnormal magnetic resonance imaging findings. A similar magnetic resonance imaging finding of abnormal intensity of the thalamus with deep white matter lesions has been reported in patients with Japanese B encephalitis; therefore, thalamic lesions may be related to the naturally occurring encephalitis.     

15例急性CO中毒伴发急性脑梗死的临床及MRI、MRA研究

目的评价MRI、MRA对急性CO中毒伴发急性脑梗死的诊断价值。方法回顾分析15例经临床确诊的急性CO中毒伴发急性脑梗死患者的头颅MRI、MRA资料。结果15例患者急性脑梗死病变部位:MRI为点状、片状异常信号;DWI表现为高信号;ADC为低信号;ADC值为(0.55±0.14)×10~(-3) mm~2/s;病灶直径(8.62±9.27)mm。病灶部位:10例脑叶,7例基底节及侧脑室旁,2例小脑,2例苍白球,1例脑干。12例侧脑室前后角白质周围片状、云雾状长T_1、长T_2异常信号病灶;11例双侧基底节及侧脑室旁点状长T_1、长T_2异常信号为陈旧性腔隙性梗死;7例脑萎缩。13例MRA表现:8例(61.53%)动脉狭窄,5例(38.46%)动脉管腔僵硬。结论应用头颅MRI、MRA对急性CO中毒伴发急性脑梗死的早期临床诊断、病情程度及预后的评估有一定的实用价值。