脑膜转移瘤临床病理与MRI(附1例尸检报告)

目的探讨脑膜转移瘤的病理特点和MRI表现.方法回顾性分析1例脑膜转移瘤患者的临床资料.结果大脑、小脑、脑干、蛛网膜下腔、室管膜、脑膜及脉络丛上可见大量癌细胞浸润.头颅MRI检查示左侧枕叶有不规则小片状稍长T1和稍长T2信号,增强扫描后左枕叶病灶呈环状、线条状强化,且可见软脑膜、硬脑膜、蛛网膜异常强化.结论癌细胞在脑膜和全脑的广泛浸润为其病理特点,增强扫描后脑膜异常强化是其MRI的特征表现.     

脑膜转移瘤临床特征及脑脊液细胞学分析

目的探讨脑膜转移瘤的早期临床特点和脑脊液细胞学特征。方法对79例脑膜转移瘤患者的原发病、临床特点、脑MRI和脑脊液细胞学变化进行回顾性分析。结果79例患者中以原发于肺癌及乳腺癌多见,分别为肺癌30例(37.98%)、乳腺癌18例(22.79%)。早期多出现剧烈头痛(71例,89.87%)和脑膜刺激征(69例,87.34%)。MRI强化检查,52例(69.33%)出现脑膜增厚、结节强化。51例行脑脊液检查,颅内压均有不同程度增高,细胞学分析显示,出现异型细胞和肿瘤细胞30例(58.82%)。结论脑膜转移瘤患者早期多出现剧烈头痛和脑膜刺激征,MRI增强检查可明显提高其早期诊断率。脑脊液细胞学可为诊断提供确诊依据。     

脑膜病变致脑膜强化的MRI表现及其临床意义

目的　研究脑膜病变致脑膜强化的磁共振成像（ＭＲＩ）表现及其与临床的关系。方法　对４３ 例ＭＲＩ增强扫描表现为脑膜强化的患者进行分析。结果　ＭＲＩ脑膜强化见硬膜型强化３１例,软膜型强化１２例;其中化脓性脑膜炎１４ 例,结核性脑膜炎、脑梗死各７ 例,病毒性脑膜炎、脑膜癌病、血管畸形各５ 例,与临床诊断一致;ＭＲＩ平扫所见正常１２ 例,局部脑膜增厚１１ 例,脑内病灶２０ 例。结论　脑膜强化的类型与病因有一定关系,ＭＲＩ增强扫描有助于发现脑膜病变。     

肥厚性硬脑膜炎的临床及影像学特征

目的研究肥厚性硬脑膜炎(hypertrophic cranial pachymeningitis,HCP)的临床表现和MRI特征。方法对9例HCP患者的临床、MRI检查资料进行回顾性分析并总结其特点。结果 HCP多慢性起病,临床以头痛和脑神经麻痹为主要表现。MRI结果示受累硬脑膜可见于小脑幕、鞍旁海绵窦区、大脑凸面等;增厚的硬脑膜多呈条带状或斑块状;T1WI呈与皮质相等或略低信号,T2WI呈低信号,3例患者靠近脑实质面的硬膜呈明显高信号;增强扫描后增厚的硬脑膜明显强化。1例伴邻近脑实质长T1长T2异常信号灶。复查时,病情改善者硬脑膜变薄,累及范围缩小,强化减轻,伴发的脑内异常信号影缩小或消失。结论 HCP以头痛、多脑神经受累为主要临床表现,MRI扫描可见特征性的硬脑膜强化改变。     

粟粒性结核性脑膜脑炎的临床及影像学特点(附2例报告)

目的 探讨粟粒性结核性脑膜脑炎的临床及影像学特点.方法 回顾性分析2例粟粒性结核性脑膜脑炎患者的临床资料.结果 本组患者男、女各1例,发病年龄分别为45、76岁,结核病病程1～5年.临床表现以发热、头痛为主,均为急性起病且有活动性肺结核,其中1例合并有胸椎结核.头颅MRI检查示2例患者脑膜及脑实质内均可见大小相似的粟粒性结核病灶,增强扫描可见病灶强化.经抗结核治疗1个月后,复查头颅MRI示病灶消失.结论 粟粒性结核性脑膜脑炎患者常伴活动性结核病,头颅MRI检查示颅内大量粟粒性结核病灶且增强扫描后明显强化为其特征性影像学表现,抗结核治疗的效果较好.     

2例肥厚性硬脑膜炎的临床和磁共振影像学特征

目的:报道2例肥厚性硬脑膜炎(HCP),探讨其临床和磁共振(MRI)成像特征。方法:分析2例患者临床和MRI特点,结合文献讨论HCP的病因、临床表现和影像学特点等。结果:HCP病因多样。临床以头痛和多组脑神经损害为主。1例低颅压性头痛为HCP罕见症状。MRI增强扫描以颅内硬脑膜弥漫性异常增厚为特点。结论:HCP是以头痛和硬脑膜弥漫性增厚为特点。根据临床缓慢局灶和全脑功能障碍症状,结合增强MRI特点,有利于早期作出较明确的诊断。     

肥厚性硬脑膜炎的临床、病理和影像学特点 (附1例报告)

目的 研究肥厚性硬脑膜炎(hypertrophic cranial pachymeningitis,HCP)的临床表现、病理和MRI特征.方法 对1例HCP患者的临床、病理和MRI检查资料进行回顾性分析并总结其特点.结果 HCP多慢性起病,临床以头痛和多颅神经麻痹为主要表现.MRI可见受累硬脑膜T1相呈等或略低信号,T2相呈高信号,增强扫描后增厚的硬脑膜明显均匀强化,硬脑膜病理检查可见纤维组织内炎症细胞浸润.激素治疗有效,MRI复查硬脑膜变薄,累及范围缩小,强化减轻.结论 HCP以头痛、多脑神经受累为主要临床表现.MRI扫描可见特征性的硬脑膜强化改变.病理学检查是确诊依据.     

自发性低颅压综合征和肥厚性硬脑膜炎的临床及影像特征比较

目的比较自发性低颅压综合征(SIH)和肥厚性硬脑膜炎(HP)的临床及影像特征,为二者鉴别提供参考。方法收集作者医院收治的8例SIH患者和6例HP患者临床特征及影像学资料并进行对比分析。结果 (1)SIH:亚急性起病5例,急性起病3例;所有患者均以体位性头痛为核心表现。6例脑脊液压力低于60mmH H_2O,余2例分别为70和90 mmHH_2O;脑脊液红细胞计数轻度增高1例,蛋白轻度增高2例(分别为0.71和0.84 g/L),余5例脑脊液常规、生化均正常。头颅MRI结果示弥漫均匀硬脑膜增厚强化。(2)HP:急性起病2例,缓慢起病4例;所有患者均以头痛为核心表现并伴有其他神经系统受累的症状体征,其中表现为慢性每日头痛5例,发作性头痛1例。脑脊液压力在正常范围(90～1 50 mmH_2O)5例,另1例压力为75 mmH_2O;5例白细胞数轻度增高[(8～1 2)×10~6/L],4例蛋白增高(1.1～2.7 g/L)。4例红细胞沉降率增高(26～62 mm/h),3例C反应蛋白增高(13.4～36.1 μg/mL),2例类风湿因子增高。头颅MRI结果示硬脑膜局限性增厚强化3例,硬脑膜弥漫增厚强化3例。结论 SIH和HP虽为不同性质的两种疾病,但临床表现、影像改变存在很多相似之处。早期进行影像学检查,收集详尽的临床资料进行对比分析,必要时行纵向随访追踪,将有助于二者的鉴别。     

脑膜癌病

目的 探讨脑膜癌病(MC)的临床表现和诊断依据.方法 采用临床病例分析统计方法,对45例MC患者的临床资料进行回顾性研究.结果 MC以颅内高压和脑膜刺激征为主要临床表现,头CT及MRI平扫检查均无异常发现,脑脊液细胞学检查和头MRI增强扫描可有阳性发现.结论 MC临床表现缺乏特异性,早期诊断困难.头MRI增强扫描对诊断MC有一定的指导意义,反复脑脊液检查找到癌细胞是确诊的依据.     

肥厚性硬膜炎8例分析及文献复习

目的探讨肥厚性硬膜炎的发病机制、临床特点、脑脊液和影像学改变及治疗。方法回顾性分析8例肥厚性硬膜炎患者的临床资料并复习文献。结果 8例患者发病年龄为43～78岁,6例患者均有头痛,2例患者以头晕为主要症状,6例患者存在脑神经受累表现,其中舌咽神经、迷走神经受累4例。血生化检查红细胞沉降率增快5例。腰穿脑脊液检查示压力增高4例,蛋白、细胞数增高;8例患者均未查到结核杆菌、隐球菌、瘤细胞。头MRI及增强扫描示广泛硬脑膜增厚强化。经糖皮质激素治疗后头痛缓解,脑神经受累症状部分好转。结论肥厚性硬膜炎病因复杂,临床多表现为头痛,脑神经易受累,头颅MRI增强发现典型的影像学改变有利于临床诊断,糖皮质激素治疗有效。     

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。     

Hypertrophe kraniale Pachymeningitis als seltene Ursache für Kopfschmerzen

Hypertrophic cranial pachymeningitis is an uncommon, fibrosing, inflammatory process that involves the dura mater. The condition is being reported more frequently owing to the use of cranial MRI. The main clinical feature is headache, whereas cranial nerve lesions, cerebellar symptoms, and epileptic seizures occur more rarely. A variety of autoimmune and infectious diseases can result in this condition, which is labeled as idiopathic in the absence of any definite inciting factor. The diagnosis of hypertrophic cranial pachymeningitis is based on neuroimaging of thickened and enhancing dura mater. It can be defined pathologically on biopsy. A specific treatment is indicated in some cases of secondary hypertrophic cranial pachymeningitis. Mostly, treatment relies on corticosteroids and immunosuppressive agents. This review summarizes the current knowledge on causes, clinical presentation, diagnosis, and treatment of this disorder.     

A case of hypertrophic cranial pachcymeningitis in a patient with lymphocytic hypophysitis]

We report a 67-year-old man of lymphocytic hypophysitis complicated by hypertrophic cranial pachcymeningitis. The hypophysitis presenting with central diabetes insipidus caused isolated adrenocorticotropic hormone (ACTH) deficiency after three years and two months since the onset of his illness. Moreover he suffered from left cavernous sinus syndrome after four years. Brain gadolinium (Gd) enhanced MRI, which was obtained in 2001, showed only enhancement of the pituitary stalk. However, brain Gd enhanced MRI, performed four years later, showed not only a remarkable thickening and enhancement of the pituitary stalk but also abnormal enhancement of the lesion in the left cavernous sinus. In addition, it showed diffuse thickening and enhancement of the dura mater. This clinical course suggested that chronic inflammation of the pituitary had spread to the dura mater, a clinical condition differing from parasellar chronic inflammatory disease (PSCID). In addition, because diffuse thickening and enhancement of the dura mater was present, it was likely that lymphocytic hypophysitis was complicated by hypertrophic cranial pachcymeningitis due to autoimmune reactions. We should carefully observe cases of lymphocytic hypophysitis and assess change over time in the dura mater of the whole brain by Gd enhanced MRI.     

A case of Garcin's syndrome caused by pachymeningitis secondary to otitis media, responsive to antibiotic therapy]

A 55-year-old woman noticed progressive hearing loss, earache and tinnitus in the left side in December 1988, followed by dysesthesia of the left face and hypogeusia. Those symptoms did not respond to the otological treatment of otitis media. In addition, the left eyelid ptosis, double vision and dysphagia appeared in May 1989. On admission, cranial nerves from III to XII were affected exclusively in the left side. The cell counts and the protein levels in the CSF were elevated. The MRI of the head showed hypertrophic dura mater at the left base of the skull covering the temporal lobe. No bone destruction was found in CT. The biopsy revealed the thickened dura mater with microabscess containing Langhans giant cells and lymphocytes. A diagnosis of pachymeningitis was made. After the therapy with antibiotics and then with prednisolone for several months, cranial nerve disturbances disappeared except hearing loss with decrease in cell counts and protein levels of the CSF. The follow-up MRI after one year showed decrease in thickness of dura mater. The MRI, particularly using enhancement with Gd-DTPA, was useful to make a diagnosis of hypertrophic pachymeningitis. It is suggested that the administration of antibiotics should be considered in the treatment of the pachymeningitis even if the causative agents were not identified.     

特发性肥厚性硬脑膜炎临床、实验室检查及影像学特点分析

目的分析6例特发性肥厚性硬脑膜炎(IHP)患者的临床特点及辅助检查特征。以提高对特发性肥厚性硬脑膜炎的认识。方法回顾性分析并总结2014年1月至2017年11月在河南省人民医院神经内科就诊的6例临床诊断为特发性肥厚性硬脑膜炎(IHP)患者的临床、实验室检查结果及影像学特点。结果 6例患者主要临床表现为头痛、颅神经受累、癫痫、精神行为异常和共济失调。实验室检查血沉(ESR)、C反应蛋白(CRP)及脑脊液细胞和蛋白等炎性指标增高。磁共振影像表现为对称或不对称的硬脑膜T1加权等和(或)低信号,T2加权低信号,增强有强化。所有患者均给予激素冲击治疗,预后良好。结论 IHP以头痛及颅神经受累为主要表现,实验室检查炎性指标的升高及影像学硬脑膜增厚强化均有助于临床医师诊断及识别本病。     

Two cases of hypertrophic cranial pachymeningitis associated with infection in the external auditory canal and paranasal sinus]

We here present two cases of hypertrophic cranial pachymeningitis exhibiting unique multiple cranial neuropathies, both of which were associated with otic and paranasal infections. Case 1: A 76-year-old woman developed headache after undergoing surgical dilatation of the external auditory canal, with subsequent development of a bacterial infection. Neurological examination reveled only bilateral hearing disturbance. MRI and CT scans demonstrated thickening of the dura mater and inflammatory granulation around the left cerebellar tentorium. Based on a diagnosis of hypertrophic pachymeningitis associated with previous infection, antibiotics were administered, followed by oral prednisolone therapy. This treatment relieved the headache and improved the MRI findings. However, 2 months later, the headache became worse and impaired movement of the soft palate, atrophy of the left side of the tongue, and atrophy of the sternocleidomastoideus muscle were noted. MRI revealed aggravated inflammatory changes around the left cerebellar tentorium and their expansion into the jugular foramen. Occlusive changes in the transverse and sigmoid sinuses were also seen. Case 2: A 78-year-old man developed bilateral visual loss, right frontal headache, and bilateral restriction of eye movement. He had been treated for phemphigus with prednisolone and azathioprine. MRI showed hypertrophic dura mater spreading continuously from the frontal base and ethmoid and frontal sinuses to the falx and right frontal lobe. Since Pseudomonas aeruginosa was cultivated in biopsy specimens from the dura mater, antibiotic agents were administered. The clinical symptoms resolved and MRI findings gradually improved.     

MRI of aggressive meningiomas.

The authors have attempted to establish by MRI morphological criteria for the so-called "aggressive" intracranial meningiomas. The MRI features of 20 meningiomas histologically aggressive (numerous mitoses and small necrotic foci) or malignant (same plus invasion of the subjacent brain tissue) were compared with those of a control population of 26 patients with benign meningioma. The site of the tumour and its histological type had little predictive value, but there was a remarkably high proportion of male patients in the group with aggressive meningioma (9/20 versus 2/26). More than other varieties, aggressive meningiomas frequently emitted, on both T1- and T2-weighted sequences, a heterogeneous signal due to a necrotic focus (P less than 0.01). The high-intensity signal observed on T2-weighted sequences (11/20) was suggestive of syncitial or angioblastic meningioma. Cystic meningiomas were present in virtually equal proportions (3/20 versus 3/26) in the two populations and could raise problems concerning the diagnosis of nature, especially when intraventricular. Gadolinium injection provided further evidence of aggressiveness, such as irregular tumour outline or even contrast enhancement of brain tissue in malignant cases (3/4), but enhancement of the dura mater was equally frequent in both groups (P greater than 0.2). Massive peritumoral oedema was significantly more frequent in aggressive melanomas (P less than 0.01).     

IgG4-Related Intracranial Hypertrophic Pachymeningitis : A Case Report and Review of the Literature

Hypertrophic pachymeningitis is an uncommon disorder that causes a localized or diffuse thickening of the dura mater. Recently, the possibility that IgG4-related sclerosing disease may underlie some cases of intracranial hypertrophic pachymeningitis has been suggested. We herein report the tenth case of IgG4-related intracranial hypertrophic pachymeningitis and review the previous literature. A 45-year-old male presented with left-sided focal seizures with generalization. Magnetic resonance imaging (MRI) revealed a diffuse thickening and enhancement of the right convexity dura matter and falx with focal nodularity. The surgically resected specimens exhibited the proliferation of fibroblast-like spindle cells and an infiltration of mononuclear cells, including predominantly plasma cells. The ratio of IgG4-positive plasma cells to the overall IgG-positive cells was 45% in the area containing the highest infiltration of plasma cells. On the basis of the above findings, IgG4-related sclerosing disease arising from the dura mater was suspected. IgG4-related sclerosing disease should be added to the pachymeningitis spectrum.     

颅内血管周细胞瘤的MRI诊断

目的探讨颅内血管周细胞瘤（intracranial hemangiopercytoma,HPC）的MRI特点,以提高对该病的诊断水平。方法回顾性分析8例经手术病理证实的颅内血管周细胞瘤患者的MRI表现,总结其MRI特点。结果 MRI特点：8例HPC患者均为单发病灶,平扫均具有颅内脑外肿瘤的征象,边界清晰,周围脑组织受压;平扫8例均表现为信号不均,T1WI、T2WI等信号为主,内可见囊变坏死区,瘤体内可见到流空血管影;2例出现瘤周水肿,6例未见到瘤周水肿;2例与邻近脑膜宽基底相连,6例与邻近脑膜窄基底相连,增强后均表现为明显不均匀强化,邻近硬脑膜未出现鼠尾状强化。结论颅内血管周细胞瘤MRI表现具有一定特征,这对于术前准确诊断该病具有重要意义。     

“脑膜尾征”与脑膜瘤部位及其病理类型的关系

目的分析脑膜瘤MRI上"脑膜尾征"形态学表现与脑膜瘤部位及其病理类型的关系。方法回顾性分析我院自2005年1月至2009年10月资料齐全的135例经手术病理证实的脑膜瘤患者的临床资料,主要包括MRI表现和病理学结果 ,重点分析其"脑膜尾征"形态与肿瘤部位及其病理类型的关系。结果 75.56%的脑膜瘤在MRI T_1WI增强像上表现有"脑膜尾征",其形态上分为单尾、双尾和多尾。不同部位脑膜瘤和不同病理类型的脑膜瘤"脑膜尾征"形态学特点有所不同。结论脑膜瘤"脑膜尾征"的形态与局部硬膜组织结构和肿瘤病理类型有关系。明确认识此种关系对术前提高脑膜瘤良恶性诊断水平,术中选择正确的切除方式,树立正确的手术理念有一定指导意义。