分水岭梗死的临床分析

血栓形成性脑梗死的分类中大面积梗死、出血性梗死、多发性梗死人们较为熟悉，分水岭梗死（CWI）较少见，现将我院收治的脑分水岭梗死（CWI）临床资料总结如下。     

分水岭梗死的临床分析

血栓形成性脑梗死的分类中大面积梗死、出血性梗死、多发性梗死人们较为熟悉,分水岭梗死(CWI)较少见,现将我院收治的脑分水岭梗死(CWI)临床资料总结如下.     

小脑前下动脉梗死的临床及影像学特点

目的探讨小脑前下动脉（AICA）梗死的临床及影像学特点。方法回顾性分析32例患者的临床资料。结果AICA梗死绝大多数以眩晕、小脑性共济失调为首发表现，第Ⅷ对颅神经受累是其特征性表现。MRI上表现为桥脑外下侧或（和）小脑中脚区域的梗死。AICA梗死预后较好，但有可能进展为基底动脉梗死。结论AICA梗死的诊断主要依靠MRI，预后较好。     

脑分水岭梗死40例临床分析

脑分水岭梗死(CWL)是指脑内相邻的较大血管供血区之间即边缘带局限性缺血并出现相应的神经功能障碍,本病约占全部脑梗死的10%[1]。本文对40例脑分水岭梗死的临床特征进行分析,报告如下。1临床资料1.1一般资料40例CWL中,男22例,女18例,年龄40~78岁,平均55岁。患者均经头颅CT或MR     

脑分水岭梗死42例临床分析

目的对42例经颅脑CT或MRI证实的脑分水岭梗死(CWI)的分析探讨。方法给予扩容,改善脑血循环,增加脑血流量,活血化瘀。结果单侧分水岭梗死36例,双侧6例,皮层前型23例,皮层后型9例,皮层下型10例。结论随着CT、MRI的广泛应用,CWI是不可忽视的脑梗死类型,及时发现和治疗CWI具有重要的临床意义。     

脑分水岭梗死的临床特征（56例资料分析）

目的探讨脑分水岭梗死（CWI）不同于一般脑梗死（GCI）的临床特征。方法对我院同期收治的脑分水岭梗死与其他类型脑梗死进行回顾性比较研究。结果在脑分水岭梗死组56例患者中,行MRA检查47例（83．93％）,颅内血管异常31例（65．96％）,血管异常发生率明显高于一般脑梗死（28．29％）。CWI不同类型之间的NIHSS评分及颅内血管异常情况,无显著统计学差异。在急性期病死率上,CWI组略高于GCI组,在严重心律失常的检出率上,CWI组显著高于GCI组（x2=16．86,P〈0．001）。在进展性卒中的发生率上,CWI组总体上高于GCI组,但两组在统计学上差异无显著性;在CWI亚组中,皮层下型和混合型显著高于GCI组（xz=4．24,P〈0．05）。结论CWI的发生与颅内大血管狭窄或闭塞密切相关,严重心律失常所致血液动力学障碍是CWI发生不容忽视的重要危险因素。CWI不同于一般的小灶性脑梗死,在临床上应重视CWI,尤其是皮质下型CWI。     

小脑各动脉梗死的临床及影像学研究

目的 研究小脑各动脉梗死的临床表现及MRI、MRA(DSA)特征。方法 对我院2001年6月1日～2003年5月31日2年间经MRI确诊的45例小脑梗死患进行临床及MRI观察。结果 小脑梗死占同期急性脑梗死的7．1％。主要危险因素为高血压、糖尿病、高脂血症、冠心病。88．9％首发头晕，11．1％首发意识障碍，82．2％急性起病，17．8％进展性起病，进展病程5～14天。可伴有颅神经受累等脑干损害。大部分小脑梗死患预后尚好。结论 应提高对小脑梗死临床表现及小脑各动脉灌注区MRI特征的认识，起源动脉(如椎动脉或基底动脉)粥样斑块延伸，或分支区域低灌注可能是引起后循环多条动脉灌流区梗死的主要原因。     

脑分水岭梗死30例临床分析

脑分水岭梗死(CWSI)是指脑内相邻的较大血管供血区之间局限性缺血,主要位于大脑皮质动脉供血区之间和基底节区小动脉供血区之间的边缘带组织,国外报道发病率占缺血性脑血管病的10%,国内报道发病率为2.6%～16.6%.     

成人Moyamoya病导致皮质下型脑分水岭梗死

1病例简介患者,男,50岁,急诊以“右侧肢体活动不利、口齿不清加重12h”、“脑梗死”于2006-04-15 8:45收入同济大学附属同济医院神经内科。现病史:2006-04-14上午9时左右,患者家属发现其口齿不清,右下肢行走时抬起困难较前明显加重,不伴头晕、头痛、恶心、呕吐、视物模糊、饮水呛咳、意识障碍等,逐至我院急诊。急查颅脑CT示“左侧基底核区腔隙性脑梗死”,     

静脉性脑梗死的临床和影像特点分析

目的 分析静脉性脑梗死的临床与影像学特点,旨在提高认识以利于早期诊断和治疗。方法 回顾性分析2例静脉性脑梗死的临床表现、影像特征。结果 1例急性起病,以偏瘫、癫痫发作为主要表现,头MRI示双侧多发梗死或出血性梗死灶,且随着病情的好转病灶可缩小甚至消失。1例亚急性起病,进行性加重,主要表现为意识水平的下降,头MRI示双侧弥漫分布的多发DWI高信号病灶,增强示脑膜强化,脑表面血管增多。2例患者病初均有头痛症状。结论 早期头痛症状、头MRI示双侧多发梗死或出血性梗死灶、双侧多发DWI高信号病灶、增强示脑膜强化、脑表面血管增多等临床和影像特点有助于静脉性脑梗死的早期诊断。     

小脑分水岭梗死患者临床及影像学特点分析

目的分析小脑分水岭梗死患者的临床特点及影像学特征。方法收集房山区第一医院神经内科2011-09-2014-12住院的小脑梗死患者147例,均行头颅MRI、椎动脉彩超、经颅多普勒(TCD)、颅内动脉核磁血管造影(MRA)检查,必要时进行计算机断层摄影血管造影(CTA)和/或数字减影血管造影(DSA)检查。根据小脑梗死部位将患者分为小脑区域性梗死组和小脑分水岭梗死组,比较两组患者的危险因素、临床及影像学特点。结果 (1)小脑区域性脑梗死109例,小脑分水岭梗死38例(25.9%),两组在年龄、性别构成以及合并高血压、糖尿病、高脂血症、吸烟及心房纤颤比例比较无统计学差异。(2)与区域性脑梗死比较,小脑分水岭脑梗死组失水状态、晕厥等前驱症状发生率较高(21.1%比9.2%,P=0.026),后循环多发病灶发生率较低(21.1%比38.5%,P=0.002),NHISS评分低(2.7±1.9比6.1±2.5,P=0.000)。(3)两组小脑梗死患者发生后循环大血管病变比例无统计学差异(52.6%比36.7%,P=0.085);分析非心源性脑梗死病例发现,分水岭梗死存在大动脉狭窄几率高于区域性脑梗死(47.4%比30.2%,P=0.002)。结论小脑分水岭梗死与区域性脑梗死相比危险因素相同,病因略有不同。分水岭梗死患者临床症状轻,但前驱症状发生率高。     

急性基底动脉尖综合征临床及MRI表现

目的探讨急性基底动脉尖综合征（TOBS）的临床与MRI特征。方法对2009—06～2010—0510例急性TOBS患者的临床及MRI资料进行回顾行分析。结果TOBS的临床主要表现为意识障碍、眩晕、瞳孔变化及眼球运动障碍、肢体瘫痪、偏盲或皮质盲,记忆功能损害;MRI提示病灶发生在小脑、脑桥、丘脑、中脑、枕叶及颡叶内侧面,DWI全部显示为高信号,检出率100％;MRA显示为基底动脉及椎动脉闭塞或狭窄。结论临床表现和MRI特征相结合,尤其是DWI及MRA的应用对明确诊断具有重要意义。     

MELAS综合征的临床和功能MRI分析

目的探讨MELAS综合征的临床和功能MRI特点,提高早期诊断率。方法收集39例最终确诊为MELAS综合征患者的临床表现、实验室检查及影像学资料。结果患者首发症状为癫痫、语言障碍、偏瘫、头痛等。病灶区DWI呈高信号,ADC图随病程发展可呈高信号、低信号及高低信号并存。10例MRA均无明显血管狭窄。PWI急性期灌注增高,慢性期灌注减低。6例氢质子波谱(1~H-MRS)病变区均可见倒置双乳酸峰。SWI部分患者双侧基底节区在磁敏感加权图像中呈低信号影。结论 MELAS综合征临床表现复杂多样,缺乏特异性,常规MRI检查对于病变的筛选有很大的意义,功能MRI具有特征性表现,有助于提高该病早期诊断率。     

低场MRI和MRA在成人烟雾病诊断中的价值探讨

目的探讨低场MRI和MRA对成人烟雾病的诊断价值。方法回顾性分析24例成人烟雾病的临床与低场MR资料。结果 MRI表现：双侧放射冠区、基底节区多发脑梗死、软化14例,顶、枕叶大面积脑梗死2例,其中梗死合并出血6例;单纯脑出血8例,其中放射冠区、基底节区出血6例,左顶枕叶出血1例,脑室内出血1例。MRA表现：单侧大脑前动脉、大脑中动脉近段狭窄或闭塞16例,双侧大脑前动脉、大脑中动脉近段闭塞8例,丘脑-基底节区有异常血管网12例。结论 低场MRI可显示成人烟雾病的脑实质及血管病变,可作为烟雾病的筛选方法。     

中枢神经细胞瘤的MRI表现

目的探讨中枢神经细胞瘤(central neurocytoma,CNC)的MRI的表现特征。方法回顾性分析11例经手术病理证实的CNC的MRI表现。结果 6例位于右侧脑室,4例位于左侧脑室,2例跨越双侧脑室生长并突入三脑室,位于侧脑室体部前2/3区域10例,侧脑室体部后2/3区域3例,均与透明隔呈宽基底相连。肿瘤呈分叶状,边界较清。呈肥皂泡样或蜂窝状囊实性12例,实性1例,DWI呈花斑状高低混杂信号11例,呈等或稍低信号2例。增强呈丝瓜瓤状不均匀轻中度强化10例,不均匀明显强化2例,呈环状强化1例,病灶边缘与侧脑室壁间见多发条索状影10例,牵拉粘连侧脑室壁。结论CNC具有典型发病部位及MRI特征,MRI对于CNC的术前诊断与鉴别诊断具有重要价值。     

特发性肥厚性硬脑膜炎的临床和影像学特征

目的 通过对6例特发性肥厚性硬脑膜炎临床资料的分析及文献回顾,总结该病的诊断及治疗方法,以期降低其误诊误治率. 方法 结合文献对2005至2006年我科收治的6例该病患者的临床特点、影像学表现及随访结果进行分析. 结果 特发性肥厚性硬脑膜炎均存在不同程度的免疫功能异常.头痛几乎是首发、必发的症状,大多为隐匿起病,反复发生或迁延不愈.患者可出现神经系统受损的各种表现.本病的头颅MRI可见小脑幕和(或)大脑镰等处的硬脑膜局部或弥漫性增厚,增强扫描可见强化.皮质类固醇治疗有效. 结论 特发性肥厚性硬脑膜炎可能是一种自身免疫性疾病.本病临床表现多样,应注意与其它疾病鉴别.应重视头颅MRI的诊断意义.     

Clinical and magnetic resonance imaging characteristics of sporadic cerebellar ataxia

BACKGROUND: It is unknown whether multiple system atrophy of the cerebellar type (MSA-C) and idiopathic cerebellar ataxia with extracerebellar presentation (IDCA-P) represent distinct entities. OBJECTIVE: To investigate the discriminative validity of magnetic resonance imaging in sporadic cerebellar ataxia. DESIGN: Basal ganglia and infratentorial structures were screened for signal abnormalities and atrophic changes. Magnetic resonance imaging raters were masked to the clinical diagnosis. SETTING: Outpatient clinic of a university hospital. PATIENTS: Forty-one individuals were diagnosed as having MSA-C (n = 30) or IDCA-P (n = 11) based on their clinical features. RESULTS: Shrinkage of the cerebellar vermis and hemispheres was found in both groups. Atrophy of the brainstem and middle cerebellar peduncles was significantly more frequent in patients with MSA-C (P<.001). Hyperintensities of infratentorial structures were common in patients with MSA-C (middle cerebellar peduncles: 87%; pons: 97%) but were absent in patients with IDCA-P. Hypointensities or hyperintensities of basal ganglia structures did not reliably differentiate the groups. CONCLUSIONS: Patients with MSA-C were characterized by a higher frequency and severity of magnetic resonance imaging abnormalities (atrophic changes and additional hyperintense signal changes) of the middle cerebellar peduncles and pons. The presence of these magnetic resonance imaging features points to the diagnosis of MSA-C and helps differentiate MSA-C from other types of sporadic cerebellar ataxia with extracerebellar features.     

Status epilepticus and periictal imaging

Peri- and postictal changes on both anatomic and functional imaging examinations have been recognized for many years. With the wide availability of magnetic resonance imaging and positron emission tomography, a growing range of recognized acute imaging findings have been described. Periictal and postictal findings can be classified as either local or remote, with respect to the site of maximal ictal EEG abnormality. Although many of the findings described are reversible, the factors that determine whether findings will resolve are incompletely understood. This article considers the range of findings that have been described, places them into the context of known or hypothesized pathophysiologic mechanisms, and considers their clinical significance. A framework is proposed for considering the relation between ictal duration and severity, the characteristics of imaging abnormalities, and the mechanism of their underlying pathophysiology.     

Development of vigabatrin-induced lesions in the rat brain studied by magnetic resonance imaging, histology, and immunocytochemistry

Vigabatrin, the gamma-aminobutyric acid transaminase (GABA-T)-inhibiting anticonvulsant drug, was given orally at a dose of 275 mg/kg/day to rats (n = 6) in their feed for a period of 12 weeks, during which T2-weighted magnetic resonance images (MRIs) and diffusion-weighted MRIs (DWIs) were collected at weeks 1, 3, 6, 9, and 12. Half the rats (n = 3; and half their age-matched littermate controls; n = 3) were then killed for histopathological confirmation of the observed VGB-induced cerebellar and cortical white-matter lesions. VGB was removed from the diet and additional MRIs of the remaining rats taken at weeks 14, 17, 20, and 24, at which time they (n = 3), along with remaining controls (n = 3), were also killed for histopathology. The T2-weighted MRIs acquired were used to compute T2 relaxation time maps. Statistically significant VGB-induced T2 increases were observed in the frontal and occipital cortices and in the cerebellar white matter (CWM). The cerebellar lesions were more clearly discerned by eye in the DWIs than by T2-contrast alone. During the recovery period the VGB-treatment group CWM-T2 and CWM-DWI hyperintensity greatly decreased as the reversible lesion disappeared. As expected, histological and immunocytochemical examinations demonstrated the presence of intra-myelinic edema, microvacuolation, and reactive astrocytosis in the CWM and cortex after 12 weeks VGB-treatment. In the remaining animals microvacuolation of the white matter had not completely resolved during the 12-week recovery phase. The data show that quantitative MRI T2-relaxometry can be used to detect VGB-induced CNS pathology, and also suggest that DWI is particularly sensitive to the cerebellar lesion. The reversible neurotoxicity of global GABA-elevation in experimental animals is discussed.