50例脑囊虫病的诊治体会

通过50例脑囊虫病的诊治,体会到脑囊虫病临床表现复杂,以癫痫发作及高颅压多见;CT 见脑实质有单发或多发的圆或椭圆形的低、高密度区及脑脓肿样病灶,强化扫描能增强小病灶效应,有脑室扩大、脑萎缩者应考虑脑室囊虫;脑脊液免疫学阳性率占78%,淋巴细胞不同程度升高,偶见单核及嗜酸细胞,蛋白轻度升高,糖和氯化物正常。本病应反复长期治疗,有高颅压者先降颅压后抗囊虫,囊虫性小脓肿需抗囊虫及抗感染联合治疗,脑室囊虫需手术治疗。     

高颅压型脑囊虫病术后服吡喹酮的组织病理学

目的 从组织病理学方面研究手术并服吡喹酮治疗高颅压型脑囊虫病的优越性。方法 对从1984年-2002年收治的230例高颅压型脑囊虫病人进行手术并服吡喹酮治疗并摘出囊虫进行病理观察。结果 随访6个月，脑室型囊虫术后复查CT示：脑室系统对称性扩大，梗阻脑积水影像消失，皮肌内囊虫阴影消失90％以上者92例，血常规及血生化检查正常，癫痫发作减少75％以上，高颅压症状完全消失。总有效率96．7％，病死率3．3％。结论 术后服嘴喹酮是治疗高颅压型脑囊虫病较为有效的方法。     

脑囊虫病的影像学诊断

目的:探讨脑囊虫病的影像学诊断及鉴别诊断.方法:脑囊虫病患者60例经临床治疗及实验室检查确诊,对影像学表现进行回顾性分析.结果:按脑囊虫寄宿部位将脑囊虫病分为脑实质型51例、脑室型2例、脑膜型1例和混合型6例.结论:脑囊虫病CT、MRI表现多种多样,X线、CT、MRI是诊断脑囊虫病最常用的影像技术之一,可显示各型脑囊虫病改变,尤以非活动性脑囊虫病更佳.CT、MRI增强扫描可发现脑实质更多病灶.     

施甸县226例脑囊虫病治疗期的CT观察及临床护理

目的 为正确诊断脑囊虫病并为其治疗提供依据.方法 对施甸县2004年～2009年间收住院的226例脑囊虫病患者治疗期的CT临床观察及护理.结果 226例脑囊虫病CT确诊病例中,脑实质型213例、脑室型13例.其中:脑囊虫寄生于右侧大脑半球者有108例、左侧大脑半球91例、双侧小脑半球14例、脑室系统13例.结论 脑囊虫侵犯部位、数目、病理不同而临床表现不同,若能早期确诊及时治疗预后较好,但因对其认识不足乃至延误诊断,可能造成终生残疾或因颅压升高处理不及时而危及生命.     

脑囊虫病30例临床分析

目的 讨论总结脑囊虫病的临床特点.方法 对30例在我院诊断为脑囊虫病患者的临床表现|、检查资料以及治疗方法进行回顾性分析总结.结果 经治疗,本组患者临床症状及体征都逐渐恢复正常.结论 脑囊虫病临床表现复杂多样,MRI对脑囊虫病的诊断具有重要意义,发病率本地傣族高于其他民族,农村高于城市,吡喹酮具有很高的疗效.     

脑囊虫病86例临床分析

目的探讨不同类型脑囊虫病的治疗方式选择及治疗效果。方法对86例各种类型脑囊虫病患者行不同的外科治疗手段,随后给予药物灭囊,术前术后分别查CT、MRI、囊虫酶联免疫试验,术后随访3～6个月。结果本组无死亡病例,高颅压症状缓解30例,癫完全控制36例,好转20例,肢体瘫痪恢复8例,无效2例。结论脑囊虫病的治疗如经保守治疗无效,应及时选择外科手术治疗,尤其是伴有高颅压、癫频发型、大囊型,外科治疗可使患者安全渡过治疗期。     

以颅内压增高为主症的肺癌脑转移12例

目的探讨以颅内压增高为主症的肺癌脑转移的临床及诊断。方法对12例以颅内压增高为主症的肺癌脑转移患者的临床表现、CT、MRI、脑脊液检查进行回顾性分析。结果颅内压增高为主症的肺癌脑转移亚急性起病，进行性加重，主要表现为颅高压及脑膜刺激症，增强CT、MRI有肿瘤增强效果，结合脑脊液检查及原发肿瘤灶可明确诊断。结论肺癌脑转移以颅内压增高为主要表现多见，增强CT、MRI检查有一定指导意义，脑脊液检查是重要的诊断依据，高颅压表现是早期诊断肺癌脑转移的重要线索。     

脑囊虫病26例临床分析

目的：探讨脑囊虫病的诊断与治疗。方法：对26例脑囊虫病进行临床分析。结果：该病以青壮年发病为多；农村与城镇发病构成比约为2：1；临床以癫痫和颅压增高表现多见：脑脊液及血清用ELISA方法检测囊虫抗体阳性具有确诊意义：部分患者临床表现不典型，易致误诊，其中发生脑梗塞者以腔隙性梗塞多见：在全身整体治疗的基础上，吡喹酮可有效地治疗脑囊虫病。结论：流行区需重视早期诊断与治疗。     

脑实质型脑囊虫病的MRI诊断

目的提高对脑实质型脑囊虫病的MRI诊断。方法回顾性总结分析16例脑囊虫病的病例,包括临床表现、影像学检查。所有病人均采用Philips1.5T核磁共振扫描机扫描,脑平扫加增强扫描。结果全部患者表现不一,基本病程2d～3个月。头胀者12例,其中8例合并发热头痛,5例有肢体抽搐,4例经体检偶尔发现。脑囊虫病的MRI表现表现为脑内单发或多发结节状异常信号,部分类似转移瘤、脑脓肿、脑结核等。确诊需依靠脑脊液和免疫学检查（血清囊虫红细胞凝集试验（IHA）及酶联免疫吸附试验（ELISA）。结论 MRI诊断脑囊虫病敏感性高、准确率高,影像表现有特征性,图像直观,直接显示病灶大小、形态,可准确分型、分期,是一种可靠的诊断方法,协助临床选择更好的治疗方案。     

脑囊虫病的诊断与鉴别

目的探讨脑囊虫病的诊断与鉴别。方法根据患者临床表现结合检查结果进行诊断并鉴别。结论流行地区,有绦虫史或食用生猪肉史,大便检查发现绦虫妊娠节片。在流行区,凡有癫痫发作、颅内压增高、精神症状者应考虑脑囊虫病的可能。皮下无痛性结节活检证实为囊虫。血、脑脊液囊虫免疫试验阳性,皮下结节活检证实为囊虫,CT/MRI、脑室造影等特殊检查资料,患者有便绦虫史或食用＂痘猪肉＂史等均可作为诊断的重要证据。     

颅内结核MRI表现及分型的研究

目的探讨颅内结核MRI的表现及分型。方法回顾性地分析32例颅内结核的MRI表现及分型,全部病例均根据临床表现、PPD试验、胸片、脑脊液检查以及手术病理或药物治疗随访等建立诊断。结果其中结核性脑膜炎19例,颅内结核瘤13例,颅内结核瘤并脑膜炎5例。结核性脑膜炎的MRI主要表现为脑梗塞、脑积水、脑膜及脑基底池的异常增强等。结核瘤MRI可表现为占位、脑水肿,可见钙化,在T2WI上呈低信号以及环形或结节状的异常增强为其特征表现。结论 MRI对颅内结核具有较高的诊断价值,并可对其进行分型指导临床治疗。     

颅内结核MRI诊断

目的探讨颅内结核MRI的表现。方法回顾性分析23例颅内结核患者的MRI表现,全部病例均根据临床表现、胸片、脑脊液检查以及手术病理或药物治疗随访等建立诊断。结果其中单纯结核性脑膜炎4例,颅内结核瘤并脑膜炎3例,粟粒型脑结核5例,颅内结核瘤11例。结核性脑膜炎的MRI主要表现为脑梗塞、脑积水、脑膜及脑基底池的异常增强。结核瘤MRI平扫在T2WI上呈等、低信号或高信号,增强扫描环形或结节状强化为其特征表现。结论 MRI对颅内结核具有较高的诊断价值,并可对其进行分型及治疗后的随访。     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

颅内静脉窦血栓形成65例临床报告

目的探讨颅内静脉窦血栓形成(CVST)的临床和影像学特点及与预后关系。方法回顾性分析2006年1月至2011年5月哈尔滨医科大学附属第一医院诊断的65例CVST患者的病因,临床表现,影像学特征,治疗及预后。结果 65例患者的平均年龄(33.3±11.4)岁,男女比例为1∶1.95。感染和围生期是最常见的病因(63.46%)。头痛为最常见的临床表现(80.00%),其次为肢体无力等局灶性神经功能缺损症状(27.69%)及癫痫发作(21.54%)。颅脑CT及磁共振成像证实静脉窦内血栓影分别为15.38%(10/65)、24.19%(15/62);显示脑实质内局部或广泛水肿缺血损害者分别为30.77%(20/65)、32.26%(20/62)。61例行磁共振静脉血管成像(MRV),有不同程度的静脉窦病变,表现为受累静脉窦狭窄或闭塞;19例进行数字减影血管造影(DSA),均证实为一支或多支静脉窦狭窄或闭塞,静脉期延迟;14例行头MRV、DSA造影检查的患者,均予以证实为静脉窦血栓,两者改变基本相符。经低分子肝素抗凝、脱水降颅压等治疗后,65例患者中临床痊愈25例(38.46%),部分好转35例(53.85%),死亡5例(7.69%)。结论 CVST以进行性头痛为主要表现,可伴有神经功能缺损或癫痫发作。MRV结合腰椎穿刺检查是诊断的主要手段。抗凝及降颅压治疗具有良好的治疗效果,上矢状窦血栓及脑组织有大面积水肿缺血损害者预后不良。     

无症状脑梗死患者颅内动脉磁共振血管成像的临床应用价值

目的:探讨无症状脑梗死患者颅内动脉MRA检查的影像学特点及其临床应用价值。方法:对60例经CT、MRI诊断明确为无症状脑梗死患者行颅内动脉MRA检查,并对影像结果进行统计分析。结果:60例均获得了清晰的血管图像,其中有51例显示脑血管异常改变,主要表现为动脉血管走行僵硬、管腔狭窄或粗细不均、病变血管分支减少或突然中断等。结论:无症状脑梗死患者颅内动脉狭窄发生率较高,因此应重视检测无症状脑梗死患者可能存在的颅内动脉狭窄,常规MRA可以对无症状脑梗死患者进行颅内动脉病变的筛查,对指导临床治疗具有重要的临床应用价值。     

Treatment of intracranial hydatid cysts

Background  Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

Methods  We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

Results  Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

Conclusions  Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

     

肾上腺节细胞神经瘤21例临床分析

回顾性分析我院治疗的21例肾上腺节细胞神经瘤的临床表现、影像学、内分泌检查等临床资料.9例腰部不适,4例阵发性头晕乏力（其中1例高血压）,1例向心性肥胖,7例为体格检查发现.5例术前诊为肾上腺节细胞神经瘤,其余诊为肾上腺占位病变.术后病理检查证实均为肾上腺节细胞神经瘤.随访1～7年,1例仍有头晕,血压150/95 mm Hg（20.0/12.6 kPa）,余患者均康复.提示肾上腺节细胞神经瘤的诊断主要靠影像学检查和病理检查诊断,手术是主要治疗手段,大部分患者可完全康复.     

脑缺血灶和脑梗死的CT、MRI图像比较分析

目的:通过分析脑缺血灶和脑梗死的CT及MRI相关图像的区别及关系,寻找能够有效协助诊断的影像检查方法,为临床医生提供最有价值的诊断资料.方法:选取武汉大学人民医院收治的174例初诊为脑缺血或者脑梗死患者临床资料,所有患者均行CT及MRI检查,对其影像表现进行对比分析.结果:CT共显示病灶总数为131个,诊断115例脑梗死,71例有脑软化,59例未见明显异常;MRI共显示病灶数为305个,MRI诊断163例脑梗死,其中97例有脑软化,114例有脑缺血灶;11例未见明显异常.MRI对于脑梗死病灶的敏感率是CT的2.33倍,MRI检出率为93.6%,CT检出率为66.1%,经比较其差异有统计学意义.结论:MRI检查不仅有助于早期诊断急性脑梗死,而且对颅内缺血灶有极高的诊断价值.缺血灶CT影像显示不佳,MRI可清楚显像;梗死灶CT、MRI均能成功显像,MRI能清楚显示早期变化.     

肾血管平滑肌脂肪瘤的CT诊断及鉴别诊断

[目的]探讨肾血管平滑肌脂肪瘤的螺旋CT表现,提高诊断水平.[方法]回顾性分析21例肾血管平滑肌脂肪瘤的临床和螺旋CT表现,并与病理结果对照.[结果]18例诊断正确,瘤体内可见脂肪及软组织成分;因瘤体内未见脂肪3例误诊为肾细胞癌.[结论]肿瘤内没有脂肪组织不能除外肾血管平滑肌脂肪瘤,需仔细分析螺旋CT动态增强扫描表现,与肾细胞癌及其他肾脏良性肿瘤鉴别.     

颅内静脉系统血栓形成的早期诊断及治疗

目的探讨颅内静脉系统血栓形成的早期诊断及治疗方法。方法分析8例颅内静脉系统血栓形成的病因、症状、体征、头颅CT和MR检查、脑电图、脑脊液及血液流变学的特点。结果病因多为产褥期及感染,常表现为颅内高压征及局灶神经功能缺损,头颅CT和MR检查可确诊。结论对于临床有颅内高压和局灶神经功能缺损表现,尤其是产褥期或有感染者,应警惕颅内静脉系统血栓形成,需行头颅CT和MR检查确诊,并尽早抗凝治疗。