国人海洛因白质脑病的临床特点分析

目的:分析和探讨国人海洛因白质脑病(HLE)的发病机制、临床特点、诊断规律及防治经验。方法:对国内11例及我院2例HLE的临床症候进行分析,对图像学特点进行总结。结果:患者11例男性,2例女性,发病年龄在24～55(平均32.7±8.3)岁。吸毒史除1例为4个月,其余均在3年以上,最长为11年。吸毒方式有12例是采取了烫吸(“追龙法”)的方法仅1例为静脉注射。均为急性起病,其中10例均以反应迟钝、言语含糊、行走不稳、乏力等为首发症状;2例以意识障碍起病;1例以胡言乱语,发音不清、幻觉及行为异常起病。查体9例发音含糊,仅1例轻微眼震,肌张力3例增高9例减低、1例正常,肌力记载的11例均轻度减低,Romberg征8例阳性,4例无法配合。Babinski征10例阳性,3例阴性。头颅CT(6例)及MRI(11例)可见双侧小脑、内囊后肢、枕顶叶深部白质、胼胝体、脑干等白质区域异常信号,在CT示低信号,在MRI上为长T1、长T2信号影,1例在弥散加权成像(DWI)上为高信号影。13例中治疗后7例有不同程度的好转,4例无记录,1例无变化,1例死亡。结论:烫吸海洛因的方式及戒断毒品是与HLE发病的主要原因之一,临床表现主要以脑功能障碍,特别是以共济运动障碍、言语含糊、反应尽钝为主,严重者可有意识障碍。HLE可以根据有烫吸海洛因史,并结合临床及影像学特点进行?     

吸食海洛因致海绵状白质脑病的CT及MRI诊断

目的评价海洛因中毒所致的海绵状白质脑病的CT、MRI表现及诊断价值.方法搜集6例海洛因海绵状白质脑病的CT及MRI资料,全部患者均进行MRI检查,检查序列包括T1WI、T2WI、FLAIR序列,其中2例同时行颅脑CT扫描. 结果全部患者MRI显示对称性双侧小脑半球、大脑半球后部、内囊后肢、胼胝体压部、脑干等皮质下白质为主的多发性大片状长T1、长T2信号,加强后病灶无强化;2例行头颅CT检查显示两大脑半球皮质下白质、基底节及两侧小脑呈对称性广泛低密度灶,无占位效应.结论海洛因中毒所致的海绵状白质脑病具有特征性的MRI表现,MRI对本病的诊断具有重要价值.     

瘤样炎性脱髓鞘病MRI的临床意义

目的分析瘤样炎性脱髓鞘病(TIDD)临床、影像与病理特点,探讨磁共振(MRI)检查对TIDD的诊断价值。方法对39例TIDD患者进行头颅、脊髓CT和MRI扫描,并分析临床和影像学特点。结果病灶在头颅CT均为低密度,常规MRI扫描呈T1WI低信号、T2WI高信号,T1WI增强扫描44%可见"开环征",发病早期DWI可见高信号,FLAIR较T1WI及T2WI更清晰显示病灶及其范围。结论 DWI能发现TIDD早期病变,FLAIR较常规T1WI、T2WI敏感,"开环征"是磁共振诊断TIDD的重要辅助依据。     

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.     

表现为后循环缺血性病变的小脑幕硬脑膜动静脉瘘的临床和影像学特点(附3例报告)

目的 探讨表现为后循环缺血性病变的小脑幕硬脑膜动静脉瘘(DAVF)的临床和影像学特点.方法 回顾性分析3例表现为后循环缺血性病变的小脑幕DAVF患者的临床和影像学资料.结果 本组患者起病形式多样,均表现头晕、恶心、呕吐,病变侧共济失调、水平眼震;1例患者出现交叉性感觉障碍、轻度延髓麻痹和不完全Horner征;头颅MRI均示小脑病变,其中1例合并延髓病变,病灶处均出现长T1、长T2及弥散加权成像高信号;2例MRI增强见小脑病灶强化及多条弯曲血管影;3例头部数字减影血管造影(DSA)检查均发现小脑幕DAVF瘘口.结论 小脑幕DAVF可引起小脑及脑干缺血表现,MRI增强扫描可见病灶强化及异常血管影,DSA检查可明确诊断.     

脑型肝豆状核变性MRI诊断价值

目的：分析脑型肝豆状核变性（hepatolenticular degeneration ,HLD）的MRI特征,探讨MRI对脑型 HLD的诊断价值。方法回顾性分析经临床证实的52例脑型 HLD患者的颅脑MRI资料,所有患者均行MRI平扫及DWI成像。结果8例M RI平扫无明显异常,DWI呈等信号。38例表现为双侧基底节区及丘脑对称性分布的稍长 T1、稍长 T2信号,DWI呈稍高信号,其中11例累及中脑及脑桥,呈稍长T1稍长T2信号,4例双侧小脑齿状核呈长T2、长 T1信号影。6例表现为双侧基底节对称性短T1短T2信号,DWI呈稍低信号。36例见不同程度脑萎缩。结论 MRI对脑型HLD有很高的诊断价值,可作为影像检查首选方法,其信号变化可反映病程、判断疗效及预后。     

Marchiafava-Bignami病的临床及影像学研究

目的 探讨Marchiafava-Bignami病(MBD)的临床及影像学改变.方法 回顾性分析了7例MBD患者的临床和CT、MRI资料,包括病灶形态、分布、信号或密度改变等影像学特征:4例同时行CT和MRI检查,2例仅行CT检查,1例仅行MRJ检查.结果 本组患者急性型5例,均表现为胼胝体肿胀及长T1、长T2信号改变,均有双侧脑室周围白质、额叶皮层下白质对称性累及:慢性型2例,胼胝体明显萎缩变薄,并呈长T1、长T2信号及FLAIR像点片状或线样低信号灶.5例患者DWI显示病灶区信号明显增高并有2例出现弥散受限改变.结论 MBD具有特征性MRJ表现,其影像学改变可能反映其临床及预后.     

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。     

瘤样炎性脱髓鞘病的影像学特点观察

目的分析瘤样炎性脱髓鞘病(TIDD)影像特点,探讨磁共振(MRI)特别是强化和弥散加权成像(DWI)检查技术对于TIDD的诊断价值。方法对16例TIDD患者行头颅CT和MRI扫描。结果病灶在头颅CT均为低信号,在MRI平扫上呈T1WI低、T2WI高信号,强化像上可见强化,57%可见开环征,发病早期DWI可见高信号,FLAIR较T1WI及T2WI能显示更清晰的病灶及范围。结论使用多种影像技术可以辅助诊断TIDD,并与脑缺血或肿瘤相鉴别,能区分病灶所处时期,因此,影像检查是诊断TIDD的有效辅诊方法之一。     

海洛因海绵状白质脑病的影像学特征

目的　探讨海洛因海绵状白质脑病 (HSL E)的 CT、MRI和 PET特点。方法　对 2 9例患者的CT、MRI以及 4例患者的 PET资料进行分析。结果　 (1) CT和 MRI显示病变位于双侧小脑、内囊后肢、枕顶叶深部等部位白质 ,病灶广泛且对称 ;(2 ) CT示界限清楚的低密度病灶 ,MRI呈长 T1 WI、长 T2 WI异常信号 ,无水肿 ,快速反转恢复序列 (FL AIR)和增强扫描提示血脑屏障无破坏 ,PET显示为低代谢或无代谢病灶 ;(3)未治疗患者内囊后肢、枕叶和小脑白质无代谢 ,康复期患者代谢明显减低 ;(4 )临床症状改善者和未治疗者小脑皮质代谢降低 ,临床症状明显改善者代谢正常。结论　 HSL E患者的 CT和 MRI改变多局限于白质 ,极为相似。 PET显示病变部位低代谢或无代谢 ,小脑皮质和白质代谢的恢复对 HSL E患者的临床转归非常重要 ,故判断 HSL E患者的转归 ,PET较之 MRI更有价值     

可复性后部脑病综合征的影像学诊断

目的探讨可复性后部脑病综合征（PRES）的影像学表现.方法回顾性分析了12例PRES病人的临床和影像学资料,其中9例为子痫/先兆子痫,2例为高血压脑病,1例为环孢菌素A（CSA）的神经毒性.12例均行MRI检查,其中7例同时行钆喷替酸葡甲胺（Gd-DTPA）增强扫描,4例行磁共振血管造影（3D-TOF MRA）检查,1例行弥散加权成像（DWI）.7例行CT平扫检查,2例行脑血管造影（DSA）检查.结果MRI显示病灶基本上呈双侧对称性分布,多数病灶位于顶、枕叶脑实质内,T1WI呈等或略低信号,T2WI呈高信号,FLAIR像显示皮层和皮层下白质明显高信号影,较T1WI、T2WI更加清楚.注射Gd-DTPA后多无明显异常对比增强.1例DWI显示双侧顶、枕叶及额叶皮层内弥散受限呈高信号,ADC图显示邻近的皮层下白质呈高信号.4例CT显示双侧顶、枕叶及额叶对称性斑片状低密度影,3例CT未见异常.经对症处理后复查示所有病灶几乎完全吸收消失.结论PRES的影像学表现具有特征性.MRI应作为诊断本病的首选手段.     

可逆性后部白质脑病综合征临床及影像学特点分析（附六例报道）

目的 探讨可逆性后部白质脑病综合征的临床及影像学特点。 方法 收集无锡市人民医院神经内科自2007年12月至2010年8月诊治的6例可逆性后部白质脑病综合征患者的临床资料,回顾性分析其发病原因、临床症状、影像学特点、治疗及预后。 结果 6例患者中白血病1例,肾病综合征1例,肾移植1例,嗜铬细胞瘤1例,原发性高血压2例。患者临床表现多样,主要为痫性发作、头晕头痛、恶心呕吐、意识障碍、精神行为异常、视觉障碍等。头颅CT检查示4例脑白质低密度病灶,2例正常。头颅MRI检查主要表现为大脑半球后部白质病变,TIWI呈低或等信号,T2WI呈高信号,液体衰减反转恢复序列(FLAIR)呈高信号,弥散加权成像(DWI)呈低信号或等信号,表观弥散系数图(ADC)呈高信号。5例经对因及对症治疗临床症状迅速改善,影像学表现减轻或恢复正常;1例肾移植患者因拒绝停用环孢霉素A及骁悉而最终死亡。 结论 可逆性后部白质脑病综合征是一组依靠病史、临床特征及影像学特点而诊断的疾病,经积极治疗大多预后较好,但也有小部分患者由于种种原因而预后不良。     

Diffusion Weighted Imaging in Heroin-associated Spongiform Leukoencephalopathy

Background  Heroin-associated spongiform leukoencephalopathy (HASL) is a rare complication of heroin abuse. We report a case that highlights the increased sensitivity of diffusion weighted imaging (DWI) compared with T2-weighted imaging in the acute setting of HASL. Methods  Single case report. Results  A 36-year-old male with a history of heroin abuse (snorting) presented with a 3-day history of lethargy. MRI brain revealed restricted diffusion involving the globus pallidum and cerebral cortex bilaterally that was not seen on fluid-attenuated inversion recovery (FLAIR) images. The patient was diagnosed with acute HASL. Repeated MRI FLAIR at 3 months confirmed the development of atrophy and T2 hyperintensity in the subcortical white matter, consistent with leukoencephalopathy. Neurological exam at 3-month follow-up was nonfocal. Conclusions  Restricted diffusion, which likely corresponds to electron microscopic findings of fluid entrapment between the myelin lamellae, may be detectable earlier than changes on FLAIR. Clinicians should be aware of the neuroimaging findings of HASL and the increased sensitivity of MRI DWI over T2-weighted images in detecting HASL acutely.     

Improved detectability of experimental allergic encephalomyelitis in excised swine spinal cords by high b-value q-space DWI

Experimental allergic encephalomyelitis (EAE) is the primary experimental model of multiple sclerosis (MS), which involves both inflammation and demyelination and is known to be species-dependent. Spinal cord abnormalities were found in more than 80% of postmortem specimens of MS patients. In the present study, T1, T2 and high b-value q-space diffusion-weighted magnetic resonance imaging (MRI) were used, for the first time, to characterize the EAE model in excised swine spinal cords. The MR images were compared with histological staining and clinical scoring. Although all spinal cords were excised from swine with severe or very severe (clinical score between 3 to 5 on a scale of 5) motor impairments, T1- and T2-weighted MRI revealed white matter (WM) abnormalities in only five of the ten EAE diseased spinal cords studied, while high b-value q-space diffusion weighted MRI (q-space DWI) detected WM abnormalities in all diseased spinal cords studied. Interestingly, high b-value q-space DWI was able to detect abnormalities in the normal appearing white matter (NAWM) even in spinal cords where no plaques were identified by the T1- and T2-weighted MR images. Good anatomical correlation was observed between the high b-value q-space MR images and histology. The extent of DWI abnormalities paralleled the clinical scoring and correlated with histology. In addition, areas classified as NAWM by the T1- and T2-weighted MR images that showed abnormalities in the q-space DWI were also found to have abnormal histology. This improved detection level of the EAE model by high b-value q-space DWI over conventional T1-, and T2-weighted MRI is briefly discussed.     

Computed tomography and magnetic resonance imaging of the brain in Hurler's disease

Computed tomographic (CT) and magnetic resonance imaging (MRI) scans of the brain in five patients with Hurler's disease are described and compared to the few available reports in the literature. Computed tomographic scans revealed low attenuation areas in the centrum semiovale and peritrigonal white matter. Ventriculomegaly was not a prominent feature in our patients, compared to those previously reported. In two patients, CT were normal. The most prominent magnetic resonance imaging abnormalities were the presence of radially oriented cystic areas in the centrum semiovale, peritrigonal white matter, corpus callosum, and pericallosal region. Magnetic resonance imaging abnormalities were present in all patients, even when CT scans were normal. Abnormalities on CT and MRI scans tended to be more prevalent in the posterior regions. Magnetic resonance imaging proved to be a more reliable imaging method in Hurler's disease. T1-weighted images delineated the cystic areas more clearly, whereas T2-weighted images were more sensitive in detecting small white-matter abnormalities. Magnetic resonance imaging abnormalities correlated well with known neuropathologic alteration in this disease. It is suggested that the cystic areas seen on MRI correspond to perivascular lacunae seen in histopathologic material.