脑白质疏松症的CT表现

目的 报道20例脑白质疏松症的CT表现,寻找本症的诊断标准和方法,以提高对本病的认识。方法 20例均行CT平扫,其中2例行增强扫描,扫描层厚和间距均为10mm,重点部位采用加层扫描。由有经验的影像学诊断医师4名对脑白质疏松症的CT表现和临床资料进行回顾性分析。结果 20例患者中高血压13例,脑血管病18例,痴呆病人15例,临床既无痴呆也无脑血管病史的“正常”老人4例。CT表现均为两侧基本对称的脑室周围或皮质下区(半卵圆中心)的低密度改变,呈斑片状或弥漫性分布,边缘模糊。累及额叶(20例)、枕叶(17例)、顶叶(14例)、半卵圆中心(12例)及脑干(1例),并伴有不同程度脑室扩大、脑萎缩和多发性脑梗死。结论 脑白质疏松症在CT上有特征性表现,但其诊断及鉴别诊断仍需要结合临床及其他有关检查。     

无症状脑白质疏松的MRI与临床研究

１０３例正常体检者及１５６例首次卒中入院病例的ＭＲＩ及临床资料研究发现无症状白质疏松（ＬＡ）２２例，两组发生率分别为６．７％和８．３％。本研究发现ＬＡ的主要原因是高龄、高血压动脉硬化，而与糖尿病等无明显关系。无症状ＬＡ可能是老年性痴呆的早期阶段，应认为是老年人群脑病损的标志。     

无症状脑白质疏松临床与CT研究

研究了１５４例体检者及２３４例首次脑卒中病例的ＣＴ与临床资料,发现无症状脑白质疏松（ＬＡ）３３例。两组ＬＡ发生率分别为２１．４％及３４．６％。老龄、高血压脑动脉硬化是ＬＡ的主要原因。ＬＡＧ民脑卒中的发生有关而ＬＡ的程度与痴呆发生有关。结果表明ＬＡ是老年性痴呆的早期阶段。本文对ＬＡ的治疗提出了新的观点。     

脑白质疏松的发病机制

背景 现代神经影像学方法可以检测到越来越多的大脑半球白质改变，后者与老龄化相关，并能够促进特殊认知功能缺损的发生。这些脑白质异常（有时称为脑白质疏松）的发病机制尚不清楚。本文对支持脑白质疏松的病因与特殊类型脑缺血有关的假说的现有证据进行评价，强调脑缺血性损害可导致局限于脑白质的选择性结构改变。综述概要 本文是对关于脑白质动脉循环的解剖学和生理学以及脑白质疏松发开门见病机制的论文（大多数为近10年内发表）进行的评论分析。结论 有相当多的线索支持某些类型的脑白质疏松可能是脑缺血性损伤的结果的假说。与老龄化和卒中危险因素相关的脑实质小动脉和微动脉的结构性改变、脑血流自动调节机制的变化以及大脑半球白质独特的动脉供血状态似乎均参与脑白质疏松的形成。根据我们对现有资料的解释，最有可能造成这种脑白质改变的缺血性损伤类型包括以局部脑血流量适度降低（导致不完全性梗死）为特征的短暂性复发事件。这种假说能够在适当的实验模型中检测。     

脑白质疏松是卒中的独立危险因素吗？

背景 脑白质疏松是神经影像学中用于描述脑白质下白质异常表现（在CT上表现为双侧斑片状或弥漫性低密度区，在MRI T2加权像上表现为高信号区）的一个术语，回顾性研究获得的证据表明脑白质疏松与卒中相关，前瞻性研究证实它对卒中（包括缺血性和出血性）或血管性死亡的发生有预测价值。综述概要 脑白质疏松最具有预测意义的缺血性卒中亚型是腔隙性梗死，因为后者很可能是由相同的小血管病理学改变造成的。业已证实，脑白质疏松患者易发生基底节和脑叶部位的脑出血，尤其当患者有广泛性白质疏松并且因原来的缺血事件接受抗凝治疗时。结论 脑白质疏松和卒中有共同的病理生理学机制，很可能是同一种疾病的不同表现，必须把脑白质疏松看作卒中的中间替代物，而不是一种卒中危险因素。     

脑白质疏松对脑梗死后早期意识恢复的影响

目的探讨脑白质疏松对脑梗死后早期意识恢复的影响。方法采用分组对照的方法，对138例脑梗死患者追踪观察3个月，观察伴有白质疏松及不伴有白质疏松的脑梗死患者的早期意识恢复状况，并进行统计学处理。结果经Logistic回归分析发现白质疏松是影响意识障碍的独立危险因素。发病初期白质疏松组的意识障碍不但重于非白质疏松组，且在发病3个月内其改善的程度也明显差于非白质疏松组（P〈0.05）。结论白质疏松是影响意识障碍的独立危险因素，会加重脑梗死早期意识障碍并影响意识功能的恢复。     

脑白质疏松症对大面积脑梗死预后的影响

目的探讨脑白质疏松症对大面积脑梗死预后的影响。方法收集60例首次卒中即表现为大面积脑梗死的患者的临床资料,分为合并脑白质疏松组(LA 组,30例)和不合并脑白质疏松组(LA-组,30例)。记录2组患者神经影像学表现、患者的病死率及发病2年内卒中的再发率,并根据脑卒中患者临床神经功能缺损程度评分标准和简易智能量表对患者进行神经功能和智能状态的评估。结果合并脑白质疏松症的患者平均年龄偏大,初次梗死时梗死灶的数目较多,有更严重的神经功能缺损和智能障碍,2组之间病死率没有差别。在2年随访期间,合并脑白质疏松组的患者的再次卒中和脑出血的比例均增加。2年随访结束时,合并脑白质疏松组的患者有更严重的神经功能缺损和智能障碍。结论合并脑白质疏松的大面积脑梗死患者预后比不合并脑白质疏松的大面积脑梗死患者预后差。     

脑白质疏松症的相关因素分析──与脑梗塞和脑萎缩的异点探索

笔者对277例脑白质疏松症、脑梗塞和脑萎缩的住院病人进行CT与临床出院诊断的回顾性对比分析，比较三者临床疾病伴随车的异同点。结果表明；三者的伴随疾病谱相似，但脑白质疏松症高血压、动脉粥样硬化和心脏病的伴随车分别为58．3～75％，66．7％和41．7～60％均明显高于脑梗塞和脑萎缩组（P＜0．05）。而高粘血症、高脂血症、糖尿病、颈椎病、肺气肿和痴呆的伴随率三者间无显著差异。本文讨论了三者病因与发病机理的异同．并提出一新的假说。     

皮质下血管性痴呆与脑白质疏松症关系的研究

随着社会的老龄化，痴吊患呈逐年递增的趋势，血管生痴呆（vascular dementia,VD)的发病率仅次于阿尔茨海默病（Alzheimer disease,AD)，而皮质下血管性痴呆是血管性痴呆的亚型之一，占血管性痴呆的75.92%；在皮质下血管性痴呆患中，脑白质疏松症（leukoraiosis，     

小儿脑室周围白质软化症的CT分析

脑室周围白质软化症（periventricular leukomacia，PVL）是缺氧缺血性脑病的一种形式，并是造成早产儿脑瘫（主要是痉挛性下肢瘫或四肢瘫）的主要原因。其影像学表现与妊娠时间、临床症状密切相关，儿童期PVL是其后期改变。笔者分析了30例小儿PVL的CT表现，以提高CT对本病的诊断价值。     

Clinical correlation of CT changes in 64 Chinese patients with tuberculous meningitis

Summary CT changes in 64 Chinese patients with proven tuberculous meningitis were compared with the clinical features at diagnosis. In patients presenting with advanced disease, hydrocephalus and cerebral infarction were common, and the hydrocephalus in these patients was more likely to require surgery at a later date for control of raised intracranial pressure. New infarctions were only seen in follow-up scans of patients who had presented with disturbed consciousness. Meningeal enhancement, the commonest finding, and intracranial tuberculomata were not related to the severity of disease at presentation. A normal scan in a drowsy patient virtually excludes the diagnosis of tuberculous meningitis. Present address: MRI Centre. Churchill Clinic, London SE1 7PW. UK     

CTA点征在脑出血中的临床应用

脑出血（ICH）的发病率占脑卒中的10％～30％,ICH较缺血性卒中预后更差,致残程度重,死亡率极高,其早期血肿扩大是神经功能恶化及预后不良的重要危险因素。随着影像学的不断发展,大量研究表明cT血管造影（CTA）点征能有效预测ICH早期血肿扩大、评估临床预后。本文旨在探讨CTA点征的相关定义、原理及在脑出血中的临床应用。     

Cerebellar ataxia. Clinical and CT findings in two cases of rare etiology

Summary Two low density lesions of the cerebellum which did not occupy space are reported. The neuropathological diagnosis of one case was subacute leucencephalitis. In the other case, the diagnosis of a Pelizaeus-Merzbacher's disease is discussed, taking into consideration the clinical observation, development and the CT findings.

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Zusammenfassung Zwei Fälle werden beschrieben, in welchen die Computertomographie eine Läsion von niedriger Dichte im Bereiche des Kleinhirnes ergab. In einem Fall war die neuropathologische Diagnose die einer subakuten Leucencephalitis, im anderen wurde eine Pelizaeus-Merzbacher-Erkrankung vermutet. Letztere wurde unter Berücksichtigung der klinischen Besonderheiten und der Entwicklung der CT-Befunde diskutiert.

     

脑白质疏松及其影像学研究进展

随着影像学的发展,有关脑白质疏松的研究越来越多,也越来越深入。该文从定义、影像学特点、相关因素及发病机制、病理学改变、临床表现、临床意义等几方面回顾了近年国内外有关脑白质疏松的一些研究进展。     

Causes of small deep infarcts detected by CT

Clinical data of 83 patients with symptomatic CT detected small deep infarcts in one of the cerebral hemispheres were retrospectively reviewed. 61 Percent had hypertension. In 15 percent a cardiac embolus was the most probable cause of a small deep infarct. In 22 cases angiography had been performed and ipsilateral internal carotid stenosis was present in 6 cases. It is suggested that small deep infarcts visible on CT may be caused by cardiac emboli and artery-to-artery emboli from carotid lesions, besides small vessel disease due to hypertension. Therefore anticoagulation or angiography. if need be. followed by carotid endarterectomy, may be indicated in a number of cases.     

胼胝体病变的临床与CT、MRI表现

目的：分析胼胝体病变临床表现及CT、MRI影像学特征。材料与方法：搜集经CT、MRI检查后发现胼胝体病变37例（其中15例经手术及定向穿刺后病理证实）。结果与结论：37例胼胝体病变包括所胼胝体发育不全6例、脂肪瘤5例，外伤及脑血管意外致血肿11例、肿瘤13例（胶质母细胞瘤3例、Ⅰ～Ⅱ级星形细胞瘤5例、淋巴瘤3例、转移后2例）、血管畸形及多发性硬化各1例。除8例脑外伤以外，其他病人临床上均有长期头晕、头痛、突发意识障碍、癫痫等表现、但非特征性改变。CT、MRI对胼胝体病变（无论是原发或是继发）的发现、诊断及鉴别诊断均有重要的价值，MRI在定位上较CT更为精确．从而为术前手术方式的选择，术后放疗的定位准确提供更多有用信息。     

Correlation of clinical signs with CT findings in patients with cerebellar disease

Summary The severity of cerebellar signs and the degree of cerebellar atrophy depicted by computed tomography (CT) were independently graded in 108 patients with cerebellar disorders. The overall agreement between these independently scaled measures was only 28%. In patients with involvement of the cerebellar hemispheres and anterior lobe, clinical signs tended to be more pronounced than the cerebellar atrophy revealed by CT. The opposite was true for patients with lesions of the caudal vermis. Patients with Friedreich's ataxia had no or only minor CT abnormalities. Close correlation between the degree of infra- and supratentorial atrophy was found only in chronic alcoholics. The poor correlation between changes in cerebellar structure detected by CT and clinical disability suggests the need for caution in CT interpretation.     

Clinical application of CT angiography in acute ischemic stroke

OBJECTIVE: To evaluate the contribution of CT angiography (CTA) in predicting clinical outcome in a broad spectrum of patients presenting with acute neurological deficits suggestive of brain ischemia, to assess its strengths and limitations in this setting, and examine its influence on selection of patients for thrombolytic treatment. PATIENTS AND METHODS: Prospective, observational outcome study of 54 consecutive patients with acute neurological deficits suggestive of brain ischemia who received immediate CTA. Clinical outcome was compared for patients presenting with and without arterial occlusion on CTA. Treatment decisions made by a vascular neurologist blinded to CTA results were compared to CTA cognizant treatment. RESULTS: For patients presenting with slight to moderate neurological deficits, the sensitivity and specificity for predicting good clinical outcome was 0.62 and 0.79, respectively, using the initial NIH Stroke Scale (NIHSS) score alone, and 0.38 and 0.92 if additionally, CTA showed no occlusion. For patients presenting with more severe deficits, the sensitivity and specificity for predicting poor clinical outcome using the NIHSS score alone was 0.79 and 0.60, compared to 0.67 and 0.92 if CTA showed vessel obstruction. CTA correctly identified six stroke mimickers. Selection of patients for thrombolysis made with knowledge of CTA results were more often conservative, and corresponded to CTA blinded decisions in 42/50 cases (84%, r=0.72). CONCLUSIONS: Combining CTA results with the neurological exam allows increased specificity for predicting clinical outcome as compared to predictions based on admission NIH Stroke Scale score alone. Awareness of CTA results was occasionally associated with less aggressive treatment and testing decisions.     

CT在癫(癎)病因诊断中的价值分析

目的探讨CT在癫癎病因诊断中的作用。方法本文分析2007-01-12采用GE1800型CT对75例癫癎患者的检查结果。结果CT结果显示正常46例(61.3%),异常29例(38.7%)。结论CT泛应用使脑部疾病引起的癫癎阳性率大为提高,降低了原发性癫癎的诊断率,在癫癎病因诊断及定位诊断中起相辅相成的作用。