偏头痛与脑白质变性

目的探讨偏头痛与脑白质变性的关系及其可能形成机制。方法偏头痛患者(n=55)行头颅MRI检查,部分行脑ECT脑血流灌注显像。同期本院非神经系统疾病并行头颅MRI检查的内科住院病人作为对照组(n=51)。结果偏头痛组中,头颅MRI显示16例脑白质内见小点片样等T1或稍长T1,长T2异常信号,以多发性为主;对照组仅3例患者可见大脑半球白质内异常信号,两者之间差异有显著性意义。偏头痛组中3例患者做头颅ECT脑血流灌注显像检查,在单侧或双侧的额、颞部的脑局部血流灌注下降。对照组中4例行头颅ECT,未见脑局部血流灌注下降。结论反复偏头痛发作可能同脑白质变性具有相关性,其形成机制可能与脑血管舒缩功能异常等有关。     

偏头痛患者脑白质损害的MRI特征

目的探讨偏头痛患者脑白质损害的MRI特征。方法对80例偏头痛患者(偏头痛组)及80例健康体检者(对照组)进行MRI检查。对结果进行比较分析。结果 MRI检查显示偏头痛组中有42例脑白质损害,表现为皮质下脑白质内等T1、长T2信号影,T2Flair高信号;对照组中有9例脑白质损害。偏头痛组脑白质损害的比例(52.5%)明显高于对照组(11.3%)(χ2=31.34,P0.01)。偏头痛组中有先兆偏头痛患者脑白质损害的比例(68.6%,24/35)明显高于无先兆偏头痛患者(40.0%,18/45)(χ2=15.58,P0.01)。结论偏头痛患者脑白质损害的MRI表现与其它原因引起的脑白质病变类似。偏头痛患者脑白质损害的发生率较高,且有先兆偏头痛者较无先兆偏头痛者更高。     

肝型肝豆状核变性患者的头颅MRI表现特点

目的总结肝型肝豆状核变性患者的头颅磁共振成像(MRI)表现特点,提高对该病的认识。方法回顾性分析2009至2017年收治的33例经临床和实验室检查确诊的肝型肝豆状核变性患者头颅MRI检查的临床资料。结果收治的33例患者中,MRI异常发现阳性率为18例(54. 5%)。表现多为稍长或长T1、稍长或长T2信号,抑脂T2像呈低信号,呈对称性的小片状异常信号,边界欠清;病变范围:主要累及豆状核(18/18例)、苍白球(15/18例)、脑桥(13/18例)、中脑(14/18例)、尾状核头(18/18例)、丘脑(10/18例)、齿状核(12/18例)、小脑半球(8/18例)、脑白质(8/18例)等部位,呈近似对称分布。肝型肝豆状核变性头颅MRI异常多见于女性及年长者;头颅MRI异常表现与铜蓝蛋白、肝功能无关。结论肝型肝豆状核变性以肝损伤为主要表现,头颅MRI异常可先于临床症状出现,患者应及时行头颅MRI检查以尽早发现颅脑病变。     

偏头痛脑白质异常的MRI表现

目的探讨偏头痛脑白质异常(WMAs)的MRI表现。方法选取70例偏头痛患者并行MRI检查,女性51例,男性19例,年龄为18~50岁,平均年龄36.21±8.9岁。选取同期健康体检者并行MRI检查70例对照组,女性53例和男性17例,年龄为18~50岁,平均年龄35.32±8.6岁。运用SPSS13.0软件对数据进行分析。结果显示偏头痛组中有23例WMAs,表现为皮质下脑白质内等T1长T2信号影,Flair高信号;对照组中有6例WMAs。偏头痛组WMAs的比例(32.86%,23/70)明显高于对照组(8.57%,6/70)(χ2=12.57,P0.01)。偏头痛组中有先兆偏头痛患者WMAs的比例(48.39%,15/31)明显高于无先兆偏头痛患者(20.51%,8/39)(χ2=6.08,P0.05)。结论偏头痛患者WMAs的发生率较高,且有先兆偏头痛患者较无先兆偏头痛患者更高。     

慢性一氧化碳中毒的临床与MRI表现

目的研究慢性一氧化碳(CO)中毒患者的临床和。MRI表现。方法回顾性分析5例慢性CO中毒患者的临床及MRI资料。结果5例患者早期均表现为间断性头痛、头昏、疲劳等非特异性症状，中晚期3例出现视力严重下降，2例出现认知障碍。5例患者头部MRI均可见双侧基底节区类圆形长T1、长T2改变，3例大脑白质呈弥漫性长T1、长T2改变，2例视神经呈长T1、长T2改变并可见视神经萎缩。结论慢性CO中毒患者早期症状无特异性，晚期主要表现视力减退和认知功能障碍。长期低浓度CO接触史是诊断的可靠依据。MRI检查对本病的诊断有重要意义。     

伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(附一例报告及文献复习)

目的 提高对伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy，CADASIL)临床特点和诊断方法的认识。方法 对2003年4月7日收治的1例CADASIKL患的临床表现、影像学特点及皮肤活检结果等临床资料进行回顾性分析。结果 主要临床表现为偏头痛、记忆力下降，头部MRI检查可见皮质下梗死、脑白质变性；皮肤活检电子显微镜显示小血管内皮下出现嗜锇酸颗粒。结论 对出现反复发作性偏头痛的中年人，MRI检查示皮质下白质或基底节区长T1、长T2异常信号，应高度怀疑为CADASIL，需进一步行皮肤活检及基因检测，以明确诊断。     

头颅CT和MRI对脑白质病变的初步分析

目的 :探讨脑白质病变的原因、脑白质病变与神经功能异常的关系 ,以及头颅CT和 (或 )MRI对脑白质病变的诊断价值。方法 :详细询问病史查体 ,全部病例行头颅CT和 (或 )MRI检查。结果 :10 3例病人中 ,高血压 45例 ,糖尿病 19例 ,高血脂 41例 ,心脏病32例 ,癫 18例 ,脑血管病 5 6例。 10 3例病人均有脑白质病变 ,部分病人有不同程度的神经功能损害。结论 :脑白质病变可能与年龄、高血压、糖尿病、高血脂、心脏病、癫以及脑血管病等发病有关。脑白质病变与神经功能异常有关。头颅CT和 (或 )MRI对脑白质病变的部位及范围有确诊价值 ,对脑白质病变的定性具有重要的参考价值     

偏头痛脑白质病变的相关因素

目的 分析偏头痛脑白质病变(WML)的相关因素.方法 收集135例偏头痛患者(偏头痛组)及118名健康对照者(正常对照组)的临床资料.对入组者进行头颅MRI检查,并采用Fazekas量表评分评价WML情况;采用TCD声学造影检查右向左分流(RLS)情况.结果 偏头痛组WML发生率及深部WML(DWML)发生率显著高于正...     

1,2-二氯乙烷中毒性脑白质病7例报告

目的 报告7例1,2-二氯乙烷(1,2-DCE)中毒性脑白质病的临床及影像学特征.方法 回顾性分析经广东省职业病防治院确诊的7例1,2-二氯乙烷中毒性脑白质病患者的临床资料.结果 患者中男3例、女4例,年龄17～46岁.为散发性发病,提示发病存在个体易感因素.主要临床表现包括头痛、呕吐、意识改变、癫痫发作等,3例仅有头痛,经CT和/或MR检查诊断脑白质病而后确诊.腰穿检查脑脊液压力增高,头颅CT均表现为两侧大脑半球脑白质对称性"佛指状"密度减低、侧脑室变窄、脑回肿胀和脑沟变浅.头颅MRI均表现两侧大脑半球白质广泛受累,T1WI呈略低信号,T2WI明显高信号,FLAIR亦为高信号,脑回肿胀,脑沟模糊不清,脑沟、脑池变浅,脑室变窄.经脱水降颅压及糖皮质激素等治疗,5例患者症状好转,2例死于脑疝.结论 1,2-二氯乙烷中毒性脑白质病,临床表现以颅高压表现为主,头颅MRI检查T2WI及FLAIR上双侧大脑半球白质高信号是主要的影像学特征,结合接触史调查可做出诊断.治疗以脱水降低颅内压及糖皮质激素为主.     

神经元核内包涵体病四例

目的 总结神经元核内包涵体病(NIID)患者的临床表现、影像学特点。方法 对4例NIID患者的临床资料及基因结果进行收集并分析。结果 4例患者均为女性,NOTCH2NLC基因检查GGC重复数>66次。4例患者最初均表现为发作性症状,3例为发作性脑病、1例为发作性头痛。4例患者头颅DWI早期未见异常,头颅MRI平扫可见不同程度的脑白质病变,可累及双侧小脑中脚和蚓旁区。结论NIID患者以发作性症状为主要表现者多见,其中偏头痛为NIID罕见的临床表型。对于不明原因的脑白质病变患者,即使DWI没有皮髓交界处高信号改变,也需考虑NIID的可能。     

A case of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), diagnosed in the age of puberty

We report a 13-year-old boy with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) at an early stage. He showed migraine, cognitive deficits, depressive episodes and areas of white matter hyperintensity on MRI. There were no first-degree relatives accompanied with similar symptoms. T2-and fluid-attenuated inversion recovery (FLAIR)--weighted brain MRI revealed areas of apparently symmetric high intensity in the deep white matter and periventicular caps. On ultrastructural studies of the biopsied skin, there were free granular osmiophilic materials (GOM) between vascular smooth muscle cells in the cutaneous vessels. But there were no excavations in the cell membranes that contained GOM. On immunostaining with Notch3 monoclonal antibodies, granular staining was not observed in vessels of the skin. No mutation was detected on DNA analysis of the Notch3 gene (exon 4 and part of exon 5) in peripheral leukocytes. Although the frequencies of migraine episodes and depressive episodes decreased with amitriptyline and ibuprofen, the cognitive deficits (delayed-recall impairment) and areas of white matter hyperintensity on MRI have been unchanged for the past four     

The role of the clinician in interpreting conventional neuroimaging findings in migraine patients

Neurological Sciences - Changes in cerebral white matter at CT or MRI have been reported in patients with migraine, especially in those with migraine with aura. Similar pictures may be present in...     

Brain MRI white matter lesions in migraine patients: is there a relationship with antiphospholipid antibodies and coagulation parameters?

Brain magnetic resonance imaging (MRI) studies in migraine patients have demonstrated lesions consisting of focal regions of increased signal intensity within the white matter. Antiphospholipid antibodies are known to have a role in many diseases including migraine. The aim of the present study was to ascertain the relationship between MRI-visualized cerebral focal hyperintense lesions and serum antiphospholipid antibody levels, as well as blood coagulation parameters in migraine patients. One hundred and two (77 females, 25 males, mean age 33.8 ± 11.1) consecutive migraine patients and a control group of 94 (70 females, 24 males, mean age 33.2 ± 10.8) healthy subjects were enrolled. All individuals underwent brain MRI. Complete blood examinations, autoantibodies, antiphospholipids antibodies including anticardiolipin and lupus anticoagulant (aCL, LAC), antithrombin III, Protein C and S serum levels were ascertained in the subjects who presented white matter lesions on MRI. Twenty-seven (26.4%) migraine patients and six (6.3%) healthy subjects in the control group showed focal regions of increased intensity signal within cerebral white matter (odds ratio 5.3, 95% CI: 1.98–16.36). In migraine patients with white matter lesions, antiphospholipid antibodies were not detected and serum levels of antithrombin III, and proteins C and S were normal. White matter lesions in migraine patients are fairly common. This finding is not associated with antiphospholipid antibodies or abnormal coagulation parameters. The significance of such lesions at present remains unclear.     

Comparison of MRI white matter changes with neuropsychologic impairment in Cockayne syndrome.

The neuropsychologic function and white matter changes observed on magnetic resonance imaging (MRI) in Cockayne syndrome were studied. MRI with T2-weighted sequences revealed periventricular hyperintensity and white matter hyperintensity in all 3 Cockayne syndrome patients examined; in contrast, 8 age-matched controls had no periventricular or white matter hyperintensity. MRI scans were graded according to the severity of periventricular or white matter hyperintensity using a scale applied to an elderly patient population. There was no difference in the severity of MRI white matter changes in these 3 Cockayne syndrome patients, 2 of whom had severe neuropsychologic functions and one a relatively milder one. There was no correlation between neuropsychologic impairment and MRI white matter changes.     

MRI signal changes in the white matter after corpus callosotomy

Magnetic resonance imaging (MRI) changes reported after corpus callosotomy include hyperintensity in the corpus callosum, perifalcine hyperintensity caused by surgical retraction, and acute changes associated with surgical complications. The authors have observed MRI signal changes in the cerebral white matter of corpus callosotomy patients that are separate from the sectioned callosum and not clearly related to surgical manipulation or injury. Brain MRI scans were retrospectively reviewed in 25 of 38 patients who underwent anterior, posterior, or total callosotomy for refractory seizures between 1988 and 1995. Nine patients had signal changes in the cerebral white matter on postoperative MRI. Six of these patients had preoperative MRI studies available for comparison, and none of the white matter signal abnormalities were evident preoperatively. T2 prolongation or hyperintensity on proton-density images was observed in areas including the centrum semiovale, forceps major, and forceps minor. Three patients had signal changes that had distinct borders extending only to the posterior limit of the callosotomy. MRI signal changes in the cerebral white matter after corpus callosotomy have not been previously reported and may represent distant effects of callosal section. Wallerian degeneration occurring in the neuronal processes cut during surgery could account for the signal changes.     

Two siblings with adult-type metachromatic leukodystrophy: correlation between clinical symptoms and neuroimaging]

We reported two siblings with adult-type metachromatic leukodystrophy (MLD). Patient 1 was a 19-year-old male, and patient 2 was a 20-year-old female. Their initial symptoms were similar. They developed abnormal behavior and personality changes, poor concentration, and inappropriate smiling. In patient 1, his condition deteriorated and he developed incontinence. His attention span and verbal expression severely decreased. He had an inability to engage in meaningful conversation. The siblings were diagnosed as having MLD by marked reduced leukocyte arylsulfatase A activity. T2-weighted MRI of these two cases showed a high intensity area in the cerebral white matter. The high intensity areas of the cerebral white matter gradually spread over one year. However, SPECT of these cases showed only a few abnormal findings in the initial stage. Using SPECT, a reduction of regional cerebral blood flow (rCBF) spreading to the cerebral cortex was seen over one year after it was seen using MRI. The discrepancy between MRI and SPECT findings in the initial stage was characteristic. MLD is an important disease that involves white matter dementia. The discrepancy between MRI and SPECT is helpful to diagnose white matter dementia.     

Diffusion tensor magnetic resonance imaging at 3.0 tesla shows subtle cerebral grey matter abnormalities in patients with migraine

BACKGROUND AND OBJECTIVE: Diffusion tensor (DT) magnetic resonance imaging (MRI) has the potential to disclose subtle abnormalities in the brain of migraine patients. This ability may be increased by the use of high field magnets. A DT MRI on a 3.0 tesla scanner was used to measure the extent of tissue damage of the brain normal appearing white (NAWM) and grey matter in migraine patients with T2 visible abnormalities. METHODS: Dual echo, T1 weighted and DT MRI with diffusion gradients applied in 32 non-collinear directions were acquired from 16 patients with migraine and 15 sex and age matched controls. Lesion load on T2 weighted images was measured using a local thresholding segmentation technique, and brain atrophy assessed on T1 weighted images using SIENAx. Mean diffusivity and fractional anisotropy histograms of the NAWM and mean diffusivity histograms of the grey matter were also derived. RESULTS: Brain atrophy did not differ between controls and patients. Compared with healthy subjects, migraine patients had significantly reduced mean diffusivity histogram peak height of the grey matter (p=0.04). No diffusion changes were detected in patients' NAWM. In migraine patients, no correlation was found between T2 weighted lesion load and brain DT histogram derived metrics, whereas age was significantly correlated with grey matter mean diffusivity histogram peak height (p=0.05, r=-0.52). CONCLUSIONS: DT MRI at high field strength discloses subtle grey matter damage in migraine patients, which might be associated with cognitive changes in these patients.