可逆性后部白质脑病综合征13例临床及影像学分析

目的探讨可逆性后部白质脑病综合征(RPLS)的病因、病理机制、临床及影像学特点,提高临床医师对RPLS的认识,减少漏诊和误诊。方法回顾性分析13例RPLS患者的临床资料。结果本组患者的原发病为:妊高征子痫或子痫前期6例,嗜铬细胞瘤1例,IgA肾病1例,慢性肾炎伴肾功能不全1例,系统性红斑狼疮3例,吸食"K粉"1例。发病时血压多升高,主要临床表现为头痛、癫痫发作、视觉障碍、不同程度意识障碍。神经影像学典型改变是大脑后部、皮质下为主的、双侧对称性、斑片状的血管源性水肿。一般预后较好,死亡1例。结论 RPLS的病因、发病机制并不相同,早诊断、早治疗很重要,控制血压和终止癫痫发作是治疗的关键。     

可逆性后部白质脑病综合征临床分析

可逆性后部白质脑病综合征（RPLS）是一种与常见脑白质病不同的,以头痛、癫痫、视觉异常、意识和精神障碍为主要症状和可逆性后部白质损害为主要神经影像学表现的临床综合征.该病临床相对少见,临床医生认识不足,现就我院收治的1例RPLS患者做相关报道并总结如下.     

子痫前期并可逆性后部白质脑病综合征分析

目的:探讨子痫前期并可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)的临床表现、影像学特点,以便早诊断、早治疗,获得良好的预后。方法:回顾性分析57例病例报道及同仁医院发生的1例子痫前期并可逆性后部白质脑病综合征。结果:产前46例,产后9例,3例发生时间不详。58例均有高血压、蛋白尿伴头痛、视物不清、进而皮质盲。58例中30人行头颅CT检查,2l例未发现异常,7例表现为局灶性低密度改变,以双侧枕部多见,2例表现为病灶广泛、弥漫性水肿。19例行头颅MRI,5例未发现异常,12例提示后部脑白质血管源性水肿。积极治疗、及时终止妊娠视力完全恢复47例,2例视力未恢复,8例未报结局,1例入院后未及时终止妊娠19 h死于脑出血。结论:高血压、蛋白尿伴头痛、皮质盲是子痫前期伴RPLS常见的临床表现,其特点是可逆性大脑皮质性视觉障碍,MRI是诊断的首选方法;早期诊断,及时终止妊娠,合理治疗,预后良好。     

妊高征并发可逆性后部白质脑病综合征的影像学诊断及转归

目的 探讨妊娠高血压综合征(妊高征)的并发症-可逆性后部白质脑病综合征(RPLS)的影像学诊断和转归。方法 在86例临床最后诊断为妊高征合并RPLS中,首次对其中68例行颅脑CT检查,45例行MRI检查,同时行CT及MRI检查者27例;于7d~1a内1~4次复查CT/MRI。回顾性分析全部首次和复查的颅脑CT/MRI表现。结果 ①86例RPLS中,轻度35例,中度41例,重度10例。②病灶分布:左枕顶叶77例,右枕顶叶82例,左额叶45例,右额叶50例,左颞叶14例,右颞叶11例,小脑7例,基底节区3例,脑干2例,丘脑2例。③复查(最后一次CT/MRI)所见,正常75例,CT/MRI留有低密度灶或异常信号11例。35例轻度者全部恢复正常,41例中度者6例留有异常,10例重度者5例留有异常。结论 ①妊高征并发RPLS以轻、中度为主。②RPLS病变主要分布于后循环供血区,常见双侧枕顶叶对称性的皮质下白质脑水肿,其次是额颞叶,小脑、基底节、脑干或丘脑可受累。③RPLS经过积极有效的治疗大多数病例影像学明显改善或完全恢复。少数留有不可逆脑局部损伤征象,以重度RPLS为主,造成不同程度的神经系统后遗症。     

脑后部可逆性脑病综合征的影像学及临床表现

目的探讨脑后部可逆性脑病综合征的影像学及临床表现。方法回顾分析6例脑后部可逆性脑病综合征患者的影像学表现及临床资料。结果6例患者CT示病灶呈低密度,边界不清。1例患者MRI显示双侧顶枕叶多发异常信号,在T1WI病灶呈等或略低信号,T2WI及FLAIR呈高信号。随访CT显示所有患者病灶范围、数目逐渐变小、减少,甚至消失。结论脑后部可逆性脑病综合征好发于顶枕叶脑白质,也可见于基底节、额颢叶。顶枕叶呈双侧对称性,影像学表现具有特征性,临床上均有血压突然升高。一般患者经适当治疗后,影像学表现恢复正常,临床症状消失。     

可逆性后部脑病综合征8例报道并文献回顾

目的：探讨子痫前期、子痫期患者合并可逆性后部白质脑病综合征（RPES）的 MRI 特征,以提高放射科及临床医生对该病的认识。方法回顾性分析8例子痫前期、子痫期合并 RPES 患者的临床表现、影像学资料及随访结果。8例均行颅脑 MRI 扫描,其中4例行 MRV 检查,4例颅脑 MRI 检查前行头颅 CT 平扫。结果8例临床症状均出现剧烈头痛,6例出现视物模糊,5例癫痫发作。影像学特征主要表现为对称性皮质下脑水肿, MRI 检查 T2WI 及 T2-FLAIR 上呈高信号,8例分布于双侧枕叶,伴双侧顶叶异常信号3例,伴双侧额叶异常信号1例,伴底节区及胼胝体压部异常信号1例。4例患者 MRV 检查均为阴性。DWI 上病变呈等或高信号,ADC 图上呈高信号7例,DWI 上病灶中见高信号,ADC 图提示扩散受限1例。4例颅脑 CT 所见：左侧枕顶叶、双侧底节区低密度影1例,双侧枕叶低密度影1例,2例未见明显异常改变。6例分别于首次 MRI 检查后5～10 d 复查颅脑 MRI,结果发现病变完全吸收4例,病变大部分吸收2例。结论子痫或子痫前期合并 RPES 的患者的 MRI 检查具有特征性表现,即双侧枕叶皮层下对称性血管源性水肿,经及时积极治疗,病变范围迅速减少甚至完全吸收。     

新生儿低血糖脑病的核磁共振(MRI)诊断价值

目的探讨新生儿低血糖脑病(HE)的核磁共振(MRI)影像特点及临床应用价值。方法回顾分析我院2010年1月~2015年12月临床确诊的29例新生儿低血糖脑病的核磁共振影像资料。结果双侧顶枕叶皮质及皮质下白质T1W1稍低信号,T2稍高信号20例,基底节区、胼胝体、海马T1W1稍低信号,T2稍高信号11例,左颞叶后部皮层下T2稍高信号2例,弥散加权序列(DWI)高信号25例。16例在3月~2年内追踪复查,其中4例严重新生儿低血糖脑病,3例为双侧枕叶后部皮质萎缩表现,脑沟增宽改变。结论新生儿低血糖脑病脑损伤最常受累部位顶枕叶皮质及皮质下白质,其次为胼胝体,基底节区,海马等,对称分布,弥散加权序列(DWI)对早期新生儿低血糖脑损伤更敏感。     

子痫前期及子痫并发可逆性后部白质脑病患者的影像学与临床分析

目的:探讨子痫前期及子痫并发可逆性后部白质脑病(RPLS)患者临床表现与影像学的关系。方法:回顾性分析盛京医院2008年1月～2011年6月20例子痫前期及子痫并发RPLS患者的影像学及临床资料。结果:20例患者均行头部MRI或CT检查,其中出现顶叶病变18例、枕叶病变10例、额叶病变5例、基底节病变6例、颞叶病变2例、侧脑室旁病变3例、小脑病变2例、岛叶皮层及半卵圆区各1例。20例患者中,4例患者行增强扫描,均显示病灶无强化;6例患者行磁共振静脉血管成像(MRV),未发现静脉窦血栓形成;3例行磁共振动脉血管成像(MRA),未见动脉血管异常;11例在初次行头部MRI后4～47天复查头部MRI,10例患者完全恢复,1例患者绝大部分恢复。所有患者临床症状均恢复良好,无严重后遗症出现。结论:结合患者病史特点、临床表现及影像学改变,RPLS诊断并不困难,早期积极治疗患者预后良好。     

妊娠期可逆性后部白质脑病患者的临床特点及处理

可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)这一概念是1996年由Hinchey等[1]首次提出的,是一种近年逐渐被临床医生所认识的以神经系统受损为主要表现的影像学综合征,虽然其病因多种多样,但在影像学上有共同的特点,以对称性的大脑白质后部弥漫性水肿为特征的突出改变,对诊断起重要作用.     

儿童型肾上腺脑白质营养不良24例MRI分析

目的通过对儿童型肾上腺脑白质营养不良（ALD）图像上病变分布和信号特点进行分析，提高MRI对ALD诊断的准确性。方法本组收集笔者所在医院及其他医院2002年至2008年10月间，经生化和临床证实的儿科门诊及住院ALD患者共24例，所有病例均在笔者所在医院进行MRI检查。结果24例患者均表现为对称性双侧脑室三角区白质病变，T1Wi低信号，他wi高信号。其中10例（42％）累及顶枕叶，4例（16％）累及枕叶，10例（42％）累及到顶枕颞叶，24例（100％）累及到胼胝体后部和脑干皮质脊髓束，8例累及到丘脑的后半部。有3例增强扫描表现为病灶周边环状强化，脑干病灶也强化。结论ALD典型表现为双侧对称性侧脑室三角区白质病变并累及脑干和胼胝体压部。MRI为一种无创性的敏感方法，能准确反映ALD的病变和病程。     

Toxoplasma meningoencephalitis in HIV-seronegative patients: clinical patterns, imaging features and treatment outcome

We evaluated the clinical and imaging features of cranial toxoplasmosis in patients without HIV infection. Between 1995 and 2005, 15 patients with serologically proven cranial toxoplasmosis were selected for clinical and imaging study from 233 patients with chronic meningitis and 364 patients with seizures/psychosis. All patients had poor immune status due to nutritional and metabolic causes. Neurological presentations included focal encephalitis, multifocal encephalitis and diffuse meningoencephalitis. The three groups had distinct symptoms and imaging features, with some overlap. Magnetic resonance imaging showed single or multiple nodular or ring-enhancing lesions often at the grey-white junction with subcortical white matter perifocal oedema. Within the large diffuse lesions there were discrete small haemorrhagic lesions and contrast medium administration showed fine-beaded parallel lines or small discrete nodules traversing the white matter suggesting perivenous spread. Complete clinical recovery was noted in 12 patients after several 6-week courses of pyrimethamine and sulfonamide/clindamycin. Five patients required two such courses, three patients required three courses, three patients required five courses and two patients required six courses for the final radiological healing, which was complete in nine patients. One patient was lost to follow-up and one patient died of cardiomyopathy. Knowledge of these three distinct initial presentations may help in the early diagnosis of cranial toxoplasmosis in HIV-seronegative patients. Prognosis in early cases is generally good but complete recovery may need several courses of treatment.     

小儿流行性乙型脑炎的临床及MRI特征分析

目的探讨小儿流行性乙型脑炎（乙脑）的临床特点与颅脑MRI影像特征及其与预后的关系,为临床早期诊治提供依据。方法回顾性分析本院收治的145例流行性乙型脑炎患儿的临床及MRI资料。98例行0．35TMRI检查获得常规T1WI、T2WI及FLAIR序列,47例行1．5TMRI检查除采集常规序列外,还采集了DWI序列。分析脑部MRI表现：病灶累及的部位、范围和MRI信号特征。结果MRI平扫中106例（73．1％）发现脑实质异常信号影,其病灶不同程度的累及丘脑,87例同时累及中脑大脑脚,同时累及基底节、脑皮质及小脑受累分别为32例、43例和2例;15例累及脑白质。病灶表现为不同范围的T2WI高信号病变,T1WI多呈低信号,少数呈等信号。FLAIR上全部可见高信号灶,少数高信号灶中心可见低信号影。38例FLAIR显示脑实质异常信号灶较T2WI更多。DWI上28例可见脑实质高信号病灶,12例可见低信号病灶,7例在DWI及ADC图均呈等信号改变。1．5TMRI阳性率（87．2％）明显高于0．35TMRI（66．3％,X^2=7．06,P〈0．01）。结论MRI能显示乙脑患儿颅脑病变的部位及范围,累及丘脑及中脑大脑脚为其特征性表现。FLAIR及DWI对乙脑的早期诊断具有很高的价值。     

Progressive multifocal leukoencephalopathy in AIDS]

This study was carried out to determine clinical features, abnormalities on CT scan and MRI, and course in patients with HIV-I-related progressive multifocal leukoencephalopathy (PML). There were 14 patients with a presumptive diagnosis of PML among 500 HIV-I infected patients with neurological complaints, examined between September 1982 and May 1991 in the University Medical Centre in Amsterdam by a neurologist. In these 14 patients clinical features, imaging abnormalities and course of the disease were analysed retrospectively. All patients presented with progressive focal neurological abnormalities. Cerebrospinal fluid analysis revealed aspecific abnormalities in 5/13 patients. CT scanning of the brain showed hypodense areas in the white matter, without mass effect and with contrast enhancing in only one patient. MR Imaging of the brain showed high signal intensity areas in white matter and in gray matter (10/13), without mass effect, and with contrast enhancement in two. Specimens for neuropathological examination were obtained from 7 patients; in all these cases the diagnosis of PML was confirmed. In patients with AIDS a presumptive diagnosis of PML can be based on clinical features, brain imaging abnormalities and course. However neuropathological confirmation remains the gold standard. Usually the course in these patients was steadily progressive. Most patients died within one year.     

Clinical reasoning and decision making in practice. A depressive foreign woman with symptoms of malaise

A 27-year-old woman was admitted to the hospital with a depression, anaemia and fatigue. She had come from Angola to the Netherlands as a refugee 2 years before this evaluation. As an explanation for her symptoms tropical infectious diseases of parasitic origin were considered, but no clues were found in this direction. The test for trypanosomiasis was considered to be suggestive for an infection in the past (persistent titre 1:200). She was discharged but readmitted 6 months later because of a deterioration of her clinical condition. Magnetic resonance imaging showed bilateral signal abnormalities within the white matter of the brain. On examination no neurological signs or abnormalities were found. Again, no definite diagnosis could be made and the patient was discharged. Because of a further deterioration of her clinical condition she was readmitted a short time later for the third time. On the MRI the white matter lesions had increased. The serum protein electrophoresis was markedly abnormal with an elevated IgM Level. Finally, at a repeated lumbar puncture mobile trypanosomes were found. The diagnosis of 'West African sleeping sickness' was made and the patient was treated with eflornithine. She recovered completely during the next 18 months.     

剖宫产术后卵巢静脉血栓诊治分析及文献复习

目的 探讨剖宫产术后卵巢静脉血栓(OVT)的临床特征和诊治过程.方法 选择2019年8月23日,上海市闵行区中心医院收治的1例剖宫产术后OVT患者为研究对象.采用回顾性分析方法,收集该例患者的临床病例资料,对其影像学资料、诊断、治疗方案进行分析.本研究对剖宫产术后OVT相关文献进行复习,设定检索策略以"剖宫产术后""卵...     

海洛因所致海绵状脑白质病的MRI表现

目的 观察海洛因所致海绵状脑白质病的MRI 表现及其诊断价值.方法 对本院收治的13 例吸食海洛因所致海绵状脑白质病的患者用0.2T 永磁型MR 仪进行MRI 检查,检查序列为自旋回波（SE）T1WI、快速自旋回波（FSE）T2WI 及反转恢复FIR,观察患者MRI表现特征.结果 13 例患者均可见脑内白质双侧对称性异常病变,累及部位包括小脑半球、大脑半球脑白质、内囊后肢、胼胝体压部和膝部;MRI 检查T1WI 均呈低信号,T2WI 与FIR 序列均表现为均匀或不均匀的高信号;受累部位以小脑半球白质最为严重,而灰质核团则未见受累.结论 海洛因所致海绵状脑白质病在MRI 检查中具有典型特征表现,结合临床病史,MRI 对此病的诊断具有特异性.