单纯脑白质疏松症与皮质下动脉硬化性脑病的临床对比研究

目的探讨单纯脑白质疏松症(LA)和皮质下动脉硬化性脑病(BD)的临床表现、影像学及脑诱发电位的改变特征。方法(1)调查114例单纯脑白质疏松症患(LA组)和41例皮质下动脉硬化性脑病患(BD组)的发病危险因素和临床表现。(2)两组患均行CT检查，并按照脑白质异常程度分为3型。(3)LA组74例患，BD组35例患行MRI检查，根据T2WI显示的脑室周围高信号分为5型。(4)两组分别选择部分伴有高血压的患进行躯体感觉诱发电位(SEP)、脑干听觉诱发电位(BAEP)和视觉诱发电位(VEP)检查。结果(1)LA组患的危险因素呈多样化，无神经局灶体征，临床表现仅为轻度记忆力减退、步态不稳。CT显示脑白质异常以1型为主，占70．2％(80／114)；MRI脑白质异常也同样以1型为主，占71．6％(53／74)，均无脑室扩大。电生理学检查显示，SEP异常率为83．7％(36／43)，其中轻度60．5％，中度23．2％；BAEP异常率为62．8％(27／43)，潜伏期和峰间期延长；VEP异常率为53．5％(23／43)，各波潜伏期延长，均无波形消失。(2)BD组患危险因素以高血压为主(95．1％)，临床表现以神经局灶体征、明显认知功能障碍和卒中样发作为主。CT分型以3型多见，为73．2％(30／41)；MRI检查显示3型为54．3％(19／35)，4型45．7％(16／35)，41例患均有双侧脑室对称性扩大。电生理学检查显示，SEP异常率为96．7％(29／30)，其中轻度6．7％，中度46．7％，重度43．3％；BAEP异常率86．7％(26／30)，潜伏期和峰间期进一步延长，部分伴有Ⅲ、Ⅴ波缺失；VEP异常率为83．3％(25／30)，各波潜伏期进一步延长，部分P2单侧波形消失。结论单纯脑白质疏松症无特征性临床表现，诊断主要以影像学1型脑白质异常为依据；诱发电位表现为各波潜伏期延长，无波形完全缺失。皮质下动脉硬化性脑病的危险因素为高血压，临床有较明显的认知功能障碍，常见卒中样发作等特征，影像学检查CT显示3型脑白质异常，MRI显示3型或4型为诊断依据；诱发电位呈现各波潜伏期进一步延长并伴有部分波形完全缺失。

Clinical comparative study on simple leukoaraiosis and Binswanger disease

Objective To study the clinical, imaging and evoked potential cha racteristics in simple leukoaraiosis (LA) and Binswanger disease (BD). Methods 1) The risk factors, clinical manifestations in simple leukoaraiosis (n = 114, L A group) and Binswanger disease (n = 41, BD group) were studied. 2) The patient s in both groups were examinated by CT and divided into 3 types according to the abnormal degree of white matter. 3) Patients in LA group (n = 74) and BD group (n = 35) were examinated by MRI and divided into 5 types according to the periv entricular high signal demonstrated by T2WI. 4) The somatosensory evoked potent ial (SEP), brainstem auditory evoked potential (BAEP) and visual evoked potentia l (VEP) were performed in selected patients associated with hypertention. Resul ts 1) The risk factors in LA group were various. There was no focal neurologic al signs in simpe LA and only mild memory deterioration and gait instability in clinical manifastations. The CT demonstrated that brain white matter changes wa s mainly in type 1 (70.2%, 80/114). The MRI demonstrated that abnormal type 1 o f brain white matter was 71.6% (53/74), but ventricular enlargemant was not foun d. The electrophysiological examination showed the abnormal rate of SEP was 83. 7% (36/43) including mild 60.5% and moderate 23.2%; the abnormal rate of BAEP wa s 62.8% (27/43), latent period and peak interval were prolonged; the abnormal ra te of VEP was 53.5% (23/43), latent period of waves was prolonged and disappeara nce of waves was not found. 2) Hypertension was the main risk factor in BD grou p (95.1%). In BD group the important clinical manifestations were focal neurolo gical signs, significant disturbance of cognitive function and stroke like episo de. The type 3 in CT typing was 73.2% (30/41). The MRI demonstrated type 3 was 54.3% (19/35), type 4 was 45.7% (16/35) and bilateral symmetric enlargement of v entricles were found in all cases. The electrophysiological examination demonst rated that the abnormal rate of SEP was 96.7% (29/30), among them 6.7% mild, 46. 7% moderate and 43.3% severe cases were found, latent period and peak interval w ere further prolonged. These were partially associated with III, V wave deficit ; the abnormal rate of VEP was 83.3% (25/30), the latent period was further prol onged, and partial P2 unilateral waves were disappeared. Conclusion There is no characteristic clinical manifestations in simple LA, thus its diagnosis is main ly based on type 1 abnormal of white matter. The evoked potential pattern is pr olonging of wave latents without wave deficit. The risk factor of Binswanger di sease is hypertension, its clinical manifestations are characterized in signific ant disturbance of cognitive function, strok like episode etc, and the imaging e xamination showed that type 3 white matter abnormal in CT and type 3 or type 4 i n MRI are the diagnostic basis. In this disease the latent period of waves is f urther prolonged and associated with deficit of partial waves in evoked potentia l.