神经肌炎--附26例临床及病理改变

目的 通过研究神经肌炎患者的临床及病理特点来探讨神经肌炎能否作为一种独立的疾病实体。方法 分析26例神经肌炎的临床和病理改变。结果 神经肌炎的主要临床表现为肢体无力、疼痛、肌萎缩。15例肌酶正常，11例肌酶增高，以CK增高为主。肌电图可表现为神经源性损害和／或肌源性损害。病理活检可见神经肌肉大量炎性细胞浸润，神经脱髓鞘改变。结论 神经肌炎与多发性肌炎相比有其独特之处，神经肌炎作为一种独立的疾病，诊断主要依靠肌电图和病理。     

16例MELAS临床、神经影像与肌肉病理研究

目的探讨线粒体脑肌病并乳酸血症与卒中样发作(MELAS)的临床、影像学及肌肉病理特点。方法对16例MELAS患者的临床表现、影像学及肌肉病理特点进行分析。结果患者主要临床表现为卒中样癫发作(87.5%),其次为头痛、呕吐和智能减退等;头颅MRI提示脑实质片状异常信号,不按血管供应区分布;肌肉活检见破碎红纤维(RRF)。结论MELAS是一种具有特殊临床、影像学表现的线粒体脑肌病,其诊断依赖于肌肉活检病理和基因诊断。     

MELAS型线粒体脑肌病1例临床病理

目的分析1例MELAS型线粒体脑肌病的临床病理特点。方法对该患者的临床、实验室、影像学及肌肉病理特点进行回顾性分析。结果血和脑脊液乳酸高,头颅CT、MRI显示病灶局限于颞顶枕部,肌肉活检证实患者的骨骼肌存在大量典型的不整边红纤维。结论对年轻患者反复表现为卒中样发作、局限性或全面性癫痫,病灶局限于颞顶枕部,应行肌肉活检,避免误诊。     

Nonaka肌病临床病理及肌肉磁共振特点分析

目的探讨Nonaka肌病的临床、肌肉病理及肌肉磁共振特点。方法入选2例患者,女性1例,男性1例,临床表现均以双下肢远端肌肉无力、萎缩为主,双上肢仅轻度受累。血清肌酸激酶轻度升高,肌电图提示肌源性损害,神经传导速度均正常。对患者完善大腿及小腿肌肉磁共振检查,并予以左上肢肱二头肌活检,进行组织学、酶组织化学及免疫组织化学染色,抽取外周静脉血2mL送基因公司进行遗传性肌肉病相关基因测序。结果肌肉病理提示,肌纤维肥大、萎缩、再生,肌纤维内可见镶边空泡,符合肌病样病理改变。肌肉MRI提示,大腿股四头肌脂肪化程度较轻,尤其是股外侧肌未受累及,大腿后组肌群及小腿胫前肌、胫后肌脂肪化程度严重。基因结果均提示GNE基因突变。结论 Nonaka肌病是一种与GNE基因突变相关的常染色体隐性遗传性远端肌病,临床表现特点为胫前肌首先受累,而股四头肌早期不受累。病理改变特点为肌纤维内镶边空泡形成。肌肉MRI可提示肌肉脂肪化的程度及分布规律,为诊断提供依据。     

多微小轴空病1例报道和文献复习

目的探讨多微小轴空病(MmD)的临床表现、病理特点、诊断标准及预后。方法总结1例MmD患儿的临床表现和肌肉病理改变等临床资料,结合复习国内外文献进行综合分析。结果 MmD多于婴儿或儿童期起病,表现为肌肉无力、运动迟缓,肌肉病理呈典型微小轴空样改变,目前无特效疗法。结论 MmD可根据临床表现、辅助检查确诊,肌肉活检是诊断MmD并与其他类似肌病相鉴别的重要手段。     

26例脂质沉积性肌病的临床特点

目的 总结脂质沉积性肌病（lipid storage myopathy LSM）的临床特征.方法 回顾性分析本院2009-2013年确诊的26例LSM患者的临床资料.结果 LSM主要临床特点为近端无力和运动不耐受,肌酶谱轻中度升高,肌电图呈肌源性损害或神经源性损害,肌肉MRI检查早期选择性累及大腿后组肌群,尿和血代谢可出现特异性改变,病理检查油红O染色显示空泡为大量脂滴充填,电镜证实肌纤维内脂滴堆积;积极治疗可好转,但病情易反复.结论 LSM临床表现不特异,肌活检是目前诊断LSM的重要方法,LSM患者肌肉MRI、尿和血代谢有特征性改变,基因检查可进一步明确病因.     

成人杆状体肌病(附1例临床及肌肉活检报告)

目的探讨成人杆状体肌病的临床及病理特点。方法报道１例成人杆状体肌病患者的临床及病理资料，并结合文献对本病的临床及病理进行讨论。结果本病的临床表现为肢体近端无力及疼痛。肌肉活检ＭＧＴ染色可见肌纤维中央或肌膜下有紫色的杆状体，电镜下杆状体为条索状无包膜的高密度小体。结论本病的早期诊断十分困难，肌活检是确诊本病的唯一手段     

NEB基因新复合杂合突变致儿童型杆状体肌病的临床特点(附1例报告)

目的 探讨杆状体肌病的临床特点、肌肉MRI改变和基因突变.方法 回顾性分析1例NEB基因新复合杂合突变致儿童型杆状体肌病患者的临床资料.结果 本例患者为男性,6岁发病,以双下肢远端无力起病,逐渐向近端发展,14岁行肌肉活检在肌纤维内发现大量杆状体而被确诊,29岁复诊时做基因检测明确为NEB基因突变.双下肢肌肉MRI提示...     

成人杆状体肌病

目的 探讨成人杆状体肌病的临床及病理特点。方法 报道１例成人杆状体肌病患者的及病理资料，并结合文献对本病的临床及病理进行讨论。结果 本病的临床表现为肢体近端无力及疼痛。肌肉活检ＭＧＴ染色可见肌纤维中央或肌膜睛有紫色的杆状体，电镜下杆状体为条索状无包膜的高密度小体。结论 本病的早期诊断十分困难，肌活检是确诊本病的唯一手段。     

关节挛缩伴强直脊柱综合征1例报道并文献复习

目的报道1例以关节挛缩伴强直脊柱综合征为主要表现的肢带型肌营养不良2A(LGMD2A)病例,提高对以关节挛缩及强直脊柱综合征为主要表型的肌肉疾病的认识。方法收集1例以关节挛缩伴强直脊柱综合征为表征最终确诊为LGMD2A患者的临床资料、肌肉活检(病理染色、Western blot)、基因检测和肌肉影像学等资料,结合文献复习进行分析。结果患者除早期出现的全身关节挛缩伴强直脊柱外,合并有四肢近端肌肉萎缩、无力,明显翼状肩。家族史提示常染色体隐性或X连锁隐性遗传可能;肌肉MRI示大腿后群、内侧群,小腿后群显著受累;肌肉病理检查示肌营养不良表现;Western blot检测示calpain-3条带完全缺失,CAPN3基因检测示患者携带c.534AG(I178M)及c.411dupC(C137fs)双杂合突变,并均为新发突变。最终诊断为LGMD2A。结论临床中对于早发关节挛缩伴强直脊柱综合征的患者,需考虑LGMD2A可能,肌肉MRI可为LGMD2A的诊断和鉴别诊断提供重要线索。     

不典型的远端肌病（calpainopathy）1例研究

目的：分析1例表现为“远端肌无力”的calpainopathy患者的临床、影像学及病理学特点,并与其他远端肌病相鉴别。方法：以“双下肢远端肌无力”起病的患者1例,完善体格检查、血生化、肌电图和肌肉MR检查。肌肉活检后应用免疫组化染色法观察肌细胞各种胞膜蛋白表达情况,采用免疫印迹法半定量法分析dysferlin蛋白及calpain-3蛋白水平。结果：肌肉MRI示患者以臀中肌、臀小肌、大腿后群及小腿内侧群肌肉受累为著,肌肉病理提示“肌病样”改变,组化染色未发现胞质内存在镶边空泡,免疫组化染色提示dysferlin蛋白无缺失。最终经免疫印迹检测发现该患者肌肉组织calpain-394000／60000谱带完全缺失,诊断为calpainopathy。结论：远端肌病包含疾病种类繁多,calpainopathy亦可为其中之一。肌肉影像学可为其鉴别提供一定的线索,确诊需依赖免疫印迹检测。     

A case of sarcoid myopathy presenting muscle pain and muscle weakness and with muscle MRI abnormality]

We experienced a 70-year-old female diagnosed as sarcoidosis. She complained bilateral femoral pain from 70-year-old. 3 months after the onset, she developed muscle weakness extending to her upper extremities with high fever of 38-39 degrees C. The erythema appeared at the right femoral region 4 months after the onset. She admitted to our hospital because of further evaluation. When she was admitted, she had tenderness on grasping the femoral muscles, proximal limb muscle weakness and Gowers' sign. On laboratory examination, CRP, aldorase, myoglobin, lysozyme were increased mildly. The EMG demonstrated a myogenic pattern. Muscle biopsy performed from the left quadriceps femoris muscle revealed non-caseating granuloma and muscle fiber necrosis. A diagnosis of muscle sarcoidosis was made from the biopsy findings and the clinical features. With oral prednisolone administration, muscle weakness and other clinical features improved gradually. On muscle MRI, multiple small high intensity areas were scattered in the femoral muscles. Muscle MRI is considered to be useful for differential diagnosis of muscle sarcoidosis.     

Muscle magnetic resonance imaging abnormalities in X‐linked myopathy with excessive autophagy

Introduction: X‐linked myopathy with excessive autophagy (XMEA) is an X‐linked recessive myopathy due to recently reported mutations in the VMA21 gene. Methods: Four men from 2 separate families were studied. The clinical presentation, genetic data, muscle biopsy, and muscle MRI were analyzed. Results: A known VMA21 mutation, c.163+4A>G, and a new mutation, c.163+3A>G, respectively, were found in the 2 families. The clinical course was characterized by onset in childhood and progressive muscle weakness with a limb‐girdle pattern. Muscle biopsy revealed a mild myopathy with an increased number of giant autophagic vacuoles. Whole‐body muscle MRI showed that pelvic girdle and proximal thighs were the most and earliest affected territories, with sparing of rectus femoris muscles. Muscle changes essentially consisted of degenerative fatty replacement. Conclusions: This study highlights a distinctive MRI pattern of muscle involvement, which can be helpful for diagnosis of XMEA, even before muscle biopsy or genetic analysis. Muscle Nerve 52: 673–680, 2015     

Case of 12-year-old boy with idiopathic recurrent neuralgic amyotrophy

Here we report a 12-year-old boy with idiopathic neuralgic amyotrophy who had two episodes of shoulder pain followed by shoulder muscle atrophy and weakness at the age of 7 and 11 years, respectively. These symptoms were self-limited and disappeared within 9 months. During the second episode, electromyograph (EMG) revealed neurogenic changes in the deltoid muscle. Muscle imaging showed the right deltoid muscle atrophy with slightly high intensity areas on T1 and T2 weighted images in MRI. Muscle biopsy from the right deltoid muscle revealed neurogenic changes with denervating and reinnervating processes. Neuralgic amyotrophy is characterized by neuralgic pain followed by weakness and atrophy at a unilateral extremity and is usually self-limited. EMG and imaging studies showed focal neurogenic abnormalities, which were confirmed by muscle biopsy. Neuralgic amyotrophy usually occurs in young adults and it is very rare in children.     

Adult-onset lower extremity weakness caused by venous malformation detected by magnetic resonance imaging

Introduction: Symptomatic venous malformation (VM) of muscle in adults is rare and usually presents in childhood or adolescence as the individual is growing. We describe an atypical presentation of a malformation affecting the gastrocnemius muscle asymmetrically with onset in adulthood, which created a diagnostic challenge. Electromyography (EMG) and muscle biopsy did not fit clinically and MRI of the gastrocnemius led to the diagnosis. Methods: The setting for the patient studied was a neuromuscular outpatient clinic. Results: EMG showed decreased insertional activity and motor unit potential recruitment in the right gastrocnemius muscle. Muscle biopsy showed mild neurogenic changes. MRI demonstrated VM in the contralateral gastrocnemius muscle. Conclusions: This case represents a rare cause of atrophic weakness in adults, but muscle MRI should be considered when other tests are equivocal. Muscle Nerve 46:129–133, 2012     

Sporadic late-onset nemaline myopathy: clinical,pathology and imaging findings in a single center cohort

Sporadic late-onset nemaline myopathy (SLONM) is a rare acquired myopathy characterized by rapid-onset proximal weakness in late adulthood, and the presence of nemaline bodies on muscle biopsy. In recent years, several therapeutic interventions, including immunomodulating agents and autologous stem cell transplantation, have shown variable degrees of efficacy in different patients, but no consensus has been reached to allow an effective tailoring of treatments in this severe disease. We performed a retrospective evaluation of clinical, pathological, laboratory, muscle MRI, and follow-up data of SLONM patients diagnosed in the period 2010–2015 in our neuromuscular center. Six patients (three males and three females) were identified. Average time elapsed from the onset of symptoms to referral to the neuromuscular specialist was 23.7 months. Monoclonal gammopathy was detectable in five patients. Nemaline bodies were detected in all the patients, and their abundance correlated with clinical severity. Signs of cardiac involvement were present in all the patients to different extents. Muscle MRI showed a preferential involvement of neck extensors, paraspinal, gluteal, hamstring and soleus muscles. All patients were treated with prednisone and repeated courses of intravenous immunoglobulins, and a favorable outcome was reached in five patients. Our experience confirms that SLONM is clinically characterized by subacute proximal and axial muscle weakness. Time to referral was relatively long and should be reduced with increasing awareness of the disease. Muscle MRI could be of help as a diagnostic tool to identify this potentially treatable myopathy. Cardiac evaluation should be warranted in all SLONM patients to detect subclinical heart involvement.     

Myopathy secondary to intravascular large B-cell lymphoma

We report a case of a 78-year-old woman presenting with progressive proximal muscle weakness mainly to lower limbs and myopathic EMG associated with intravascular large B-cell lymphoma.Muscle biopsy showed myopathic changes, intravascular large B-cell lymphoma but no inflammation or fibre necrosis; the patient’s serum cross-reacted with an unidentified nuclear antigen of approximately 45 kDa present in muscle and lymphoma cells.Our case illustrates a myopathy associated with intravascular large B-cell lymphoma probably mediated by antibodies cross-reacting with a nuclear protein expressed by neoplastic cells and normal muscle. The nature of this nuclear antigen remains unidentified.     

Sodium and chloride channelopathies with myositis: Coincidence or connection?

Introduction: A proximal myopathy develops in some patients with muscle channelopathies, but the causative molecular mechanisms are unknown. Methods: We reviewed retrospectively all clinical and muscle biopsy findings of 3 patients with channelopathy and additional myositis. Direct DNA sequencing was performed. Results: Pathogenic mutations were identified in each case. Biopsies demonstrated inflammatory infiltrates. Conclusions: Clinicians should consider muscle biopsy in channelopathy patients with severe myalgia and/or subacute weakness and accompanying elevated creatine kinase. Chance association of myositis and channelopathy is statistically unlikely. An alternative hypothesis suggests that inflammatory insults could contribute to myopathy in some patients. Muscle Nerve, 2011     

脂质沉积性肌病的临床和病理特点

目的从临床和肌肉病理的角度分析脂质沉积性肌病（ＬＳＭ）的特点。方法收集２０例ＬＳＭ病人的临床资料，并做肌肉活检，采用常规组织学方法和组织化学方法染色，并在电镜下观察。结果结合临床和病理特点可将病例分为两组，第一组为急性或亚急性起病，四肢近端肌无力，肌酶谱明显升高，对激素治疗敏感；第二组呈慢性迁延性病程，表现肌无力和对运动不耐受，对激素治疗不敏感，肌纤维内线粒体异常比较明显。对２０例病人的肌肉活检发现Ｉ型肌纤维为主的肌纤维空泡样变，油红“Ｏ”染色示脂滴明显增多，电镜也证实肌纤维内脂滴堆积，部分病例伴有异常线粒体增多。结论脂质沉积性肌病是一组生化方面十分复杂的疾病，属于线粒体肌病的一个类型，临床上以不能耐受运动和近端肌无力为主，病程呈波动性，部分可有自发缓解，肌肉病理检查有助于确诊。两组的临床病理差异可能提示脂肪代谢障碍的不同环节或不同酶的缺陷。