脑桥旁正中梗死的误诊分析

目的探讨临床脑桥旁正中梗死误诊的原因。方法对2008~2010年本院住院的20例误诊为大脑半球病变的脑桥旁正中梗死的临床症状、体征及超早期头颅CT平扫,48 h内的头颅MR影像学特点及相关辅助检查进行回顾性分析。结果 20例误诊为大脑半球病变的脑梗死,经MR检查确诊为脑桥旁正中动脉梗死。结论脑桥旁正中梗死临床常见,但易漏诊,早期行MR有助于确诊。对早期有一过性头晕,临床表现为一侧偏瘫患者,要注意病灶有可能在脑干。     

先天性遗传性蛛网膜囊肿引发对橄榄体脑桥小脑萎缩的临床研究

目的初步探讨橄榄体脑桥小脑萎缩（olivopontocerebellar atrophy，OPCA）的显微解剖结构、病因和发病机制。方法对近5年北京天坛医院神经外科28例OPCA的患者作临床、分子遗传学及影像学特征研究。结果OPCA是主要累及小脑、脑干和脊髓的进行性神经变性病。结论OPCA有遗传和散发两类，临床有多种类型和变异型。对OPCA所采用的基因诊断可以直接在DNA水平上鉴定突变基因。SCA1、SCA2、SCA7的CAG可作为基因诊断的标志。在临床上凡有小脑性共济失调，特别是以此为首发症状者，均应首选做MR检查，这对OPCA的诊断及鉴别诊断具有重要意义。     

易误诊为大脑半球梗死的脑干梗死28例诊治分析

目的：探讨貌似大脑半球病变的脑干梗死的临床和影像特点,并分析定位错误的原因。方法：对28例貌似大脑半球病变的脑干梗死患者的危险因素、临床表现及影像学特点进行分析。探讨该病的临床特点,提高确诊率。结果：28例貌似大脑半球病变的脑干梗死患者中,糖尿病或糖耐量异常者16例,单纯运动性瘫痪19例,中枢性面舌瘫8例,偏瘫伴感觉减退3例,头晕18例,应激性溃疡13例;经核磁共振证实,病灶在脑桥23例,中脑5例。结论：对有糖尿病或糖耐量异常、起病有头晕、临床表现为单纯运动性瘫痪、有应激性溃疡的患者,要注意病灶可能在脑干,应尽早做核磁共振检查明确诊断。     

脑干脑炎24例分析

目的探讨脑干脑炎的临床特点以及其与脑干其他病变的鉴别要点。方法对24例脑干脑炎患者的临床资料进行回顾性分析。结果该病以青壮年为高发病人群,主要临床表现为颅神经核团、网状上行激活系统以及锥体束受损的症状,脑脊液检查以及头颅MRI有阳性发现。结论脑干脑炎早期诊断困难,脑脊液检查和头颅MRI有助于与其他脑干病变鉴别诊断。     

脑干梗死MR成像的临床价值

目的：探讨脑干梗死的病理机理及MR表现特点。方法：本组72例，男42例，女30例，年龄21～86岁，平均66岁。采用GE 2．OT超导型磁共振仪。SE序列，T1加权，轴位；FSE序列，T2加权，轴位和冠状位。结果：72例中，中脑梗死16例，脑桥梗死52例（合并中脑梗死13例），延髓梗死4例。梗死灶在T1WI上表现为低信号、低～等信号或等信号，在T2WI上表现为高信号，随着病程的发展，T1和T2的延长愈明显，T2WI对脑干梗死灶最敏感。结论：MRI是诊断脑干梗死的最好检查方法，能够显示脑干梗死的部位、数目和大小。     

脑干梗死72例临床分析

目的探讨脑干梗死的临床特征、病理基础及影像学特点，提高对本病的诊断及疗效。方法72例脑干梗死患者均经头颅CT和MRI确诊，并分析探讨本病的临床特点及疗效。结果延髓和中脑梗死均具有交叉性瘫痪，脑桥梗死则有不同的临床征象，可概括为四种类型：交叉性瘫痪、四肢瘫、纯偏身感觉障碍、偏瘫并偏身感觉障碍。结论脑干梗死的主要临床表现复杂多样，不典型病例早期诊断困难，MRI对脑干早期诊断最有意义，CT不能确诊脑干梗死，但有助于排除脑干出血。     

脑干脑炎临床及影像学特点研究

目的探讨脑干脑炎的临床及影像学特点,以减少临床误诊误治。方法回顾性分析15例脑干脑炎的临床资料。结果本组4例存在前驱感染病史,临床常见症状为头晕、步态不稳,相对特异症状为呃逆及延髓性麻痹;病灶以侵犯脑桥、延髓为主;脑脊液检查缺乏典型表现,压力轻度升高2例,3例可见蛋白-细胞分离现象。结合患者临床表现、发病特点及相关医技检查结果诊断为脑干脑炎。1例自行痊愈,余给予糖皮质激素和(或)免疫球蛋和(或)抗病毒治疗,13例明显好转,1例复发。结论脑干脑炎病因尚不明确,诊断需结合临床表现、发病特点及相关医技检查结果综合分析,动态头颅MRI检查可帮助诊断;本病予糖皮质激素、丙种球蛋白及抗病毒药物治疗有效,大多预后良好。     

不典型脑干梗死16例分析

目的分析不典型脑干梗死的临床症状、体征及影像学特点,探讨其诊断特点与误诊原因。方法经MRI证实的脑干梗死40例,选择其中检查前未确诊或诊断有误的16例,就其病因危险因素、临床表现、体征进行分析,并与头颅CT及MRI对照,分析探讨不典型脑干梗死的特点。结果误诊病例多为桥脑梗死,多有卒中危险因素,部分病例有前驱症状,体征多样化,均无典型交叉瘫等脑干症状和体征。结论部分脑干梗死患者可无典型症状体征,在没有特殊确诊手段的情况下,诊断时要考虑到脑干病变的可能性,尽快完善MRI检查。     

貌似幕上病变的脑干梗死的临床分析

目的:回顾性分析拟为幕上病变的脑干梗死的临床和影像学特点。方法:选拟为幕上病变的脑干梗死病例 31例,对其临床症状、体征及影像学特点进行分析。结果:貌似幕上病变的脑干梗死有27例(占87%)为桥脑梗 死,且都表现为纯运动性偏瘫。结论:表现为纯运动性偏瘫的桥脑梗死易误诊为幕上病变,头颅MRI检查对脑干 梗死的明确诊断有决定作用。     

小儿手足口病合并中枢神经系统损害的MRI表现

目的：探讨小儿手足口病（Hand-foot and mouth disease,HFMD）合并中枢神经系统损害的MRI表现,以提高对本病的认识。方法：回顾性分析有阳性MRI表现的30例HFMD患儿的影像学资料。结果：脑干脑炎9例,其中6例合并颈段脊髓炎;单纯脊髓炎21例。脑干脑炎MRI表现为脑桥延髓交界处偏背侧斑片状异常信号,T1WI呈等或低信号、T2WI呈高信号,其中2例中脑受累,1例右侧丘脑受累。脊髓炎MRI表现为单侧或双侧脊髓前角区等或长T1长T2信号,病变多集中于C2~C5和/或T11~L1。结论：MR检查能清楚显示HFMD患儿中枢神经受损情况,为临床诊断、治疗提供可靠的影像学依据。     

闭锁综合征的临床和影像学表现(附10例分析)

目的　探讨闭锁综合征的临床和影像学变化。方法　 10例患者均在发病 72h内行头颅CT、MRI检查 ,并应用经颅多普勒 (TCD)检测大脑中动脉平均血流速度 (MCAVm)和基底动脉的平均血流速度(BAVm)及其频谱变化。结果　头颅CT示 3例单侧桥脑基底部梗死 ,6例为双侧桥脑基底部梗死 ,1例为双侧桥脑基底部出血。MRI均显示为双侧桥脑广泛受损的长T1、T2 异常信号。MCAVm和BAVm分别为5 1.3cm/s和 15 .1cm/s,与正常对比降低 9.4 %和 5 1.6 %。结论　闭锁综合征患者后循环血流速度比前循环降低更明显 ,与头颅MRI表现一致 ,与CT相比 ,MRI对闭锁综合征的检出率更高。     

Clinical analysis of ten cases with surgically treated brain stem cavernous angiomas.

Ten cases of surgically treated brain stem cavernous angiomas are reported in this paper, and their clinical and radiological features are reported. There were 9 males and 1 female with ages ranging from 9 to 69 years (average 36 years). Four of the cavernous angiomas were located in the dorsal pons, two in the middle cerebellar peduncle, two in the hypothalamus, and one each in the cerebral peduncle and the superior colliculus. All the ten patients came to medical attention because of the sudden onset of neurological abnormalities following brain stem hemorrhage. Six of the 10 patients showed neurological deterioration due to rebleeding at various intervals ranging from 10 days to 2 years. After intravenous injection of iodinated contrast materials, negative contrast enhancement was commonly seen. In a few cases, there was faint enhancement of the nodule at the periphery of the hematoma. Serial computed tomography (CT) scans over a period revealed an unchanged hyperdense mass lesion, which was thought to be a most characteristic and indicative CT feature of the cavernous angioma. On magnetic resonance imaging (MRI), the combination of a mixed signal intensity with a surrounding rim of decreased signal intensity (hemosiderin rim) suggested the presence of a cavernous angioma. Enhanced MRI, using gadopentate dimeglumine, was thought to be more sensitive than contrast enhanced CT in detecting cavernous angiomas. All these cases underwent surgery with good results. Abnormal vascular tissue in the wall of the hematoma cavity was recognized at operation and pathological confirmation was obtained in all cases. These data indicate that brain stem cavernous angiomas can be surgically removed with acceptable morbidity.     

Organizing posterior fossa hematomas simulating developmental cysts on prenatal imaging: report of 3 cases.

OBJECTIVE: We encountered 3 organizing tentorial hematomas simulating posterior fossa lesions such as Dandy-Walker, dermoid, or arachnoid cysts. We sought to correlate the clinical and pathologic features that allow distinction of developmental cysts from hematomas in the posterior fossa on imaging. METHODS. Prenatal sonograms in all fetuses and fetal magnetic resonance scans in 2 of the 3 were reviewed. One case proceeding to term had serial imaging up to age 11 months. Two cases had complete neuropathologic evaluation after termination. Maternal records were reviewed. RESULTS: In each case, the ultrasonographic findings were reminiscent of a developmental cyst but with echogenic debris, a rim, or both. Magnetic resonance imaging suggested tentorial hemorrhage in 2, 1 also with falcine hemorrhage. Serial prenatal and postnatal imaging showed resolution in the surviving case. Pathologically, 2 fetuses had organizing tentorial hematomas causing brain displacement. Calcifications, white matter damage, germinal matrix hemorrhage, and brain stem necrosis were also present. One mother had von Willebrand disease. CONCLUSIONS: Tentorial hematomas, with or without maternal coagulopathy, should be considered in the prenatal ultrasonographic diagnosis of cystlike posterior fossa abnormalities containing echogenic material. Fetal magnetic resonance imaging can suggest blood products. Hypoxic-ischemic brain damage may be concurrent; however, resolution of the hematoma, with no apparent neurologic sequelae, can occur.     

MRI评估儿童异基因造血干细胞移植导致后部可逆性脑病综合征

目的分析后部可逆性脑病综合征（reversible posterior leukoencephalopathy syndrome, RPLS）患者的临床特征及影像学表现,以提高对该病的认识。方法回顾性分析2012年4月至2013年4月在我院接受异基因造血干细胞移植治疗后发生RPLS的10例患者的临床资料和影像学特征,总结其临床及影像学特征。结果8例患者有头痛、呕吐或高血压等前驱症状。9例患者出现抽搐发作,其中8例出现不同程度的视物模糊,1例抽搐后双眼失明1周。另1例仅表现为双眼失明。所有病例均做头颅MRI检查。MRI上都有具有特征性的后部皮层下脑白质内的融合性异常信号,在常规自旋回波T1WI及T2WI上表现为不确定的低信号及高信号,在FLAIR序列结合DWI序列上显示明显高信号,病灶边缘模糊不清,增强扫描未见明显异常强化。治疗后,所有患者在2周内症状缓解,得到MRI影像学证实,无永久后遗症。结论RPLS在儿童异基因造血干细胞移植治疗中并不罕见;头颅MRI检查和特征性临床表现能及时诊断、及时干预,复查MRI对判断治疗效果有较大帮助。     

肝豆状核变性腹部B超、腹部CT、脑CT和MRI表现

目的分析肝豆状核变性(WD)病例的腹部B超、肝脾脑CT和脑MRI特点,初步探讨WD影像学检查意义和方法选择.方法回顾69例WD,依据最主要症状分为脑型、肝型和肾型3组,分析各组中腹部B超、肝脾脑CT和脑MRI检查的主要特点.结果 60例患者进行了腹部B超检查,其中59例(98.3%)发现异常声像,以肝实质异常声像、脾大和门脉高压声像为特点,声像结果与临床表现有一定相关性.5例肝脾CT检查以小结节性肝硬化改变和脾大为主要特点.11例患者行脑CT检查,无神经症状者脑CT无异常,有神经症状者50%发现异常病灶,主要特点是基底节区和丘脑对称性低密度灶和脑萎缩.7例患者进行MRI检查,6例发现异常信号,均为对称分布斑片状长T1长T2信号,分布部位主要为基底节、丘脑和脑干,5例发现脑萎缩.结论影像学检查对WD诊断有重要意义,可用于病情判断和鉴别诊断.WD脑CT或MRI检查以基底节区和丘脑改变为特点.     

椎-基底动脉延长扩张症患者颅内动脉影像学测量对照研究

目的分析和探讨椎-基底动脉延长扩张症（VBD）患者颅内动脉扩张程度,并观察脑干受压情况。方法回顾性分析26例经临床确诊VBD患者和30例正常对照组磁共振血管造影（MRA）及CT血管造影（cTA）图像,观察脑干受压情况,并利用MRA图像对基底动脉、颈内动脉、大脑中动脉直径测量分析。结果26例VBD患者中,8例可见脑干不同程度受压,其中桥脑受压5例,延髓受压3例,但临床均未发现相应症状及体征。利用MRA图像对VBD组和正常对照组颅内大动脉进行测量,两组间基底动脉、颈内动脉（颅内段）比较差异具有统计学意义（P〈0．05）,两组间大脑中动脉差异无统计学意义（P〉0．05）。结论部分VBD患者,脑干可见明显受压,但临床症状不明显。VBD患者椎-基底动脉扩张以外,颅内其他动脉也同时存在不同程度扩张,临床应给予高度重视。     

磁共振成像在多系统萎缩诊断与鉴别诊断中的应用价值

目的:探讨磁共振成像(MRI)在诊断多系统萎缩(MSA)及鉴别MSA与帕金森病(PD)中的应用价值。方法:对26例MSA患者(MSA组)、20例PD患者(PD组)及18例健康对照者(对照组)进行MRI检查,观察脑实质萎缩、脑桥十字征、壳核外侧缘裂隙征、MCP高信号、壳核低信号,并测量所有受试者的MCP宽度。结果:所有MSA患者均可见不同程度的小脑、脑桥、延髓、壳核萎缩,四脑室及桥延池扩大,其中15例(57.7%)可见脑桥十字征,6例(23.1%)可见T2像轴位MCP高信号,8例(30.8%)可见裂隙征,4例(15.4%)可见T2像壳核低信号。MSA组MCP宽度(6.4±1.4)mm明显小于PD组(9.2±1.1)mm与对照组(9.4±0.8)mm(P均<0.01),PD组MCP宽度与对照组差异无统计学意义。15例MRI有脑桥十字征的MSA患者MCP宽度平均为(5.3±1.0)mm,11例MRI无脑桥十字征的MSA患者MCP宽度平均为(7.2±1.6)mm,两者比较差异有统计学意义(P<0.05)。结论:MRI有助于MSA的诊断;MRI测定MCP宽度可作为鉴别MSA与PD的一个指标。     

Magnetic resonance imaging of the kinked fetal brain stem: a sign of severe dysgenesis.

OBJECTIVE: Magnetic resonance imaging (MRI) allows visualization of the fetal brain stem in a manner not previously possible. A "kinked" brain stem is a sign of severe neurodysgenesis. The purpose of this series was to describe cases of a kinked brain stem detected on prenatal MRI and to discuss the possible genetic and syndromic etiologies. METHODS: Seven cases of a kinked brain stem on fetal MRI (gestational age range, 18-34 weeks) were reviewed and correlated with other clinical, genetic, imaging, and autopsy findings. RESULTS: In all cases, there was associated cerebellar hypogenesis. Additional findings were ventriculomegaly (4 cases), cerebral hypogenesis (3 cases), microcephaly (4 cases), schizencephaly (1 case), cephalocele (1 case), hypogenesis of the corpus callosum (1 case), and hydrocephalus (1 case). In 2 cases, prenatal sonography misidentified the kinked brain stem as the cerebellum. CONCLUSIONS: A kinked brain stem is an indicator of severe neurodysgenesis arising early in gestation. Magnetic resonance imaging provides the necessary resolution to detect this sign and delineate any associated anomalies in utero to assist with further genetic evaluation, management, and counseling.     

椎-基底动脉延长扩张症的临床及影像学特征分析

目的:探讨椎-基底动脉延长扩张症(VBD)的临床表现和影像学分型的关系。方法:回顾性分析2008年1月至2014年8月我院收治的VBD31例的临床及影像学资料。结果 :临床表现为后循环缺血9例,脑干压迫8例,颅神经卡压症状5例,脑出血2例,脑积水1例,无症状6例;影像表现为椎基底动脉呈S型、U型和螺旋型迂曲、扩张,基底动脉上端超过鞍上池或床突平面6 mm以上,位置在鞍背或斜坡旁正中至边缘以外,直径大于4.5 mm;S型主要见于无症状患者或表现为脑干压迫,U型主要表现为神经卡压症状,螺旋型主要表现为后循环缺血症状。结论:熟悉VBD的影像学分型和临床症状的关系,有助于对该病进行早期干预、治疗,对评估预后亦有重要指导意义。