非酒精性Wernicke脑病主要特点和MRI表现

Wernicke脑病是硫胺素缺乏所致的可治愈的一种急性神经系统疾病。酗酒者容易发病,营养不良、妊娠剧吐、消化道手术、长期肠外营养等影响维生素B1吸收的因素也可引起。除了基础疾病和并发症,其预后主要取决于硫胺素开始补充治疗的早晚,早期诊断非常重要。一般来说,根据酗酒病史和临床眼肌麻痹、共济失调和意识障碍三联症,可以诊断典型的Wernicke脑病。     

急诊抢救非酒精性Wernicke脑病20例临床分析

目的 探讨非酒精性Wernicke脑病的临床特点,以提高对该种脑病的认识.方法 对20例非酒精性Wemicke脑病患者的相关临床资料进行回顾性分析.结果 经补充维生素B1治疗后,20例患者中,10例患者治愈;7例患者好转,但遗留不同的神经系统后遗症;2例患者死亡;1例胃癌术后复发患者放弃治疗.结论 Wernicke脑病起病隐匿,临床表现不典型且多样化,容易被漏诊及误诊,早期诊断、及时有效地补充维生素B1能有效改善此病预后.     

儿童Wernicke脑病的临床特点及MRI表现

目的:分析儿童Wernicke脑病的临床特点及MRI特征性表现.方法:回顾性分析2015年6月-2019年11月我院7例Wernicke脑病患儿的临床和M RI资料.结果:7例患儿均出现不同程度意识障碍,1例伴有眼肌麻痹,2例有共济失调.主要MRI为脑实质内多部位受累,病变部位包括丘脑内侧(7例)、中脑导水管周围灰质(...     

非酒精性Wernicke脑病的MRI表现

目的探讨非酒精性Wernicke脑病的MRI特点,以提高对该种脑病的认识。方法回顾性分析5例非酒精性Wernicke脑病的MRI表现。结果 5例非酒精性Wernicke脑病中,3例显示为导水管周围、四叠体、第三脑室旁、双侧丘脑对称性稍长T1长T2信号,FLAIR、DWI呈高信号;1例显示为双侧丘脑、侧脑室旁、脑桥被盖对称性稍长T1长T2信号,脑沟旁大脑皮质等T1长T2信号,FLAIR、DWI呈均为高信号,1个半月后头颅MRI复查,两侧丘脑略增大,FLAIR序列见少许对称性稍高信号改变;1例T1WI、T2WI、FLAIR未发现异常,DWI序列显示四叠体边缘少许高信号。结论非酒精性Wernicke脑病具有典型的MRI表现,对临床诊断及治疗有重要意义。     

非酒精性急性Wernicke 脑病的临床及MRI特点

目的 探讨非酒精性急性Wernicke 脑病的临床及MRI表现.方法 回顾分析6例非酒精性急性Wernicke 脑病的临床与MRI所见.均为女性,年龄21~75岁,平均45岁.无嗜酒史.使用GE 1.5T MR扫描仪,行常规T1WI、T2WI、T2FLAIR、DWI扫描,2例行增强扫描.结果 6例均有2周以上呕吐及不能进食史.起病急,首发症状均为精神异常及意识障碍,其中2例发病后即进入昏迷状态.其他症状有眼部症状4例,共济失调1例.MRI表现:6例均有双侧对称性第三脑室旁、丘脑内侧、大脑导水管周围、中脑被盖长T1长T2异常信号.其他部位信号异常的有第四脑室底部4例,桥脑延髓3例,乳头体3例.DWI病灶区呈扩散受限的高信号.增强扫描病灶边缘有强化.经大剂量维生素B1治疗,临床好转5例,死亡1例.结论 非酒精性急性Wernicke 脑病有特征性的MRI表现,是诊断本病的重要影像学方法.     

Wernicke脑病1例

患者男,41岁。记忆力下降2月,头晕、复视、走路不稳、精神障碍2天入住我院消化科。经过3天对症治疗,消化系统症状好转,但意识障碍无好转,转入神经内科。患者既往有饮酒史16年,平均每日饮啤酒9瓶。曾诊断为酒精性肝硬化。专科查体示:意识清晰,精神萎靡不振,回答不切题。双眼球向上注视时可见垂直及水平眼震,并伴有复视。     

Wernicke 脑病的MRI表现与临床

目的 探讨Wernicke脑病的MRI与临床表现,以提高诊断水平. 方法 收集经临床证实的Wernicke脑病患者的临床和影像学资料进行回顾性分析.结果 Wernicke脑病的MR表现主要为双侧丘脑、第三脑室周围对称性异常信号(7例) ,导水管周围异常信号( 5例) ,双侧基底节区异常信号(6例),双侧大脑脚异常信号(5例),脑桥异常信号(3例),小脑萎缩(1例),乳头体萎缩(6例).临床上可见精神异常6例,眼球震颤、凝视4例,进行性记忆力减退8例,走路不稳4例及双侧病理征阳性3例.结论 Wernicke 脑病具有典型的影像表现,早期诊断需要与临床表现、病理及相关检查相结合.     

Wernicke脑病的MRI表现

目的 探讨Wernicke脑病(Wernicke's encephalopathy,WE)的MRI表现,以提高诊断水平.方法 收集临床确诊并具有完整MRI资料的11例WE进行回顾性分析.结果 5例病变对称性分布于丘脑内侧、第三脑室周围灰质及乳头体.3例病变位于第三脑室周围灰质、中脑导水管周围灰质.2例病变位于中脑导水管周围灰质、丘脑内侧并乳头体萎缩.1例病变位于丘脑内侧、第三脑室周围灰质及顶枕叶皮质区.病变于T1WI为等或低信号,T2WI表现为高信号;FLAIR序列呈高信号;4例急性期病变DWI图像呈高信号.2例增强扫描病例示乳头体呈结节状强化.结论 WE具有典型的MRI表现,对临床诊断有重要意义.     

MRI对Wernicke脑病的临床诊断价值

目的：探讨MRI对Wernicke脑病（wE）的临床诊断价值。方法：回顾性分析16例经临床诊断为WE患者的临床及MRI影像资料。结果：16例患者中表现为意识障碍及精神症状者13例,视力障碍或眼肌麻痹者7例,共济失调者9例;12例患者脑部MRI图像可见第三、四脑室旁、中脑导水管周围、乳头体、四叠体、丘脑等部位不同程度对称性水肿,9例DWI（b=1000s／mm2）图像病灶呈高信号,增强扫描病灶部分区域可强化。4例患者脑部MRI无异常表现。结论：MRI可为Wernicke脑病的临床早期诊治及判断预后提供有效信息,但部分病例MRI可无异常表现,故临床有相关病史且出现类似症状却无异常MR征象时,也应考虑到本病。     

Wernicke脑病典型MRI表现并复习文献

目的探讨Wernicke脑病的典型MRI表现。方法结合文献复习,分析13例Wernicke脑病的临床表现与MRI表现。结果 Wernicke脑病典型MRI表现为第三、四脑室旁、中脑导水管周围、乳头体、四叠体、丘脑内侧对称性异常信号,T1WI呈稍低信号,T2WI呈高信号,T2FLAIR呈高信号。结论 Wernicke脑病的MRI表现具有特征性,结合临床,往往能够得出正确诊断。     

Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy

BACKGROUND AND PURPOSE: Nonalcoholic Wernicke encephalopathy (WE) is prone to be underestimated in clinical practice. The purpose of this study was to improve its awareness and early accurate diagnosis.Materials and METHODS: We conducted a retrospective review of the cases of 12 patients with nonalcoholic WE, consisting of clinical characteristics and MR imaging features as well as follow-up after administration of thiamine.RESULTS: Patients with mild coma or lethargy (7/12) exhibited typical MR features of symmetric brain paraventricular damage. Patients without disturbances of consciousness or who only had drowsiness (3/12) exhibited a lesion of the periaqueductal area only. In addition to typical MR manifestations, symmetric cortical involvement was observed in 2 of 12 patients with deep coma. Gadolinium enhancement of the mammillary bodies was observed in 2 of 3 patients. No atrophy of the mammillary bodies and cerebellar vermis was found in any patients. Of 10 patients without deep coma and cortical damage, 2 missed the follow-up and 8, who recovered clinically, also showed accordant resolution of abnormal hyperintense signal intensity on T2-weighted and fluid-attenuated inversion recovery images within 2 weeks to 1 year after thiamine supplementation. Two patients with deep coma and cortical damage showed a poor prognosis:1 patient died 15 days after being diagnosed with WE, and the other entered a persistent vegetative state during a follow-up of 2 years.CONCLUSION: Typical symmetric damage of the mammillary bodies and brain paraventricular regions may permit a specific diagnosis of nonalcoholic WE. In all patients, no atrophy of the mammillary bodies and cerebellar vermis was found. Cortical involvement in patients with nonalcoholic WE may be indicative of irreversible lesions and a poor prognosis.

Wernicke encephalopathy (WE) is a serious but curable neurologic disease caused by thiamine deficiency that occurs most commonly in people with alcoholism. In addition to the conditions with basic diseases and complications, the prognosis of patients with WE depends on the commencing time of thiamine supplementation, the most important factor relative to a curative effect. Therefore, early accurate diagnosis on WE is critical in clinical practice. In general, it is straightforward that we diagnose typical WE according to the background on alcoholism and a triad of neuro-ophthalmologic manifestations, ataxia, and global confusion. However, in clinical practice, the typical course of WE is limited and constitutes less than 16%.^1–2 Some cases of WE become irreversible because they are often delayed in diagnosis or are misdiagnosed based on ambiguous symptoms such as dizziness, weakness, indifference, anorexia, and disturbance in memory. The diagnosis of nonalcoholic WE is usually more difficult than that of alcoholic WE. Some studies reported that only 20% or less of patients with nonalcoholic WE were definitely diagnosed premortem.³ It shows that nonalcoholic WE requires more awareness and heightened clinical suspicion. In addition, most clinical data about WE are from the studies of alcoholic WE, and nonalcoholic WE has been reported only in isolated cases.^4–6 Herein, we report the cases of 12 patients with nonalcoholic WE diagnosed in our hospital from 1999 to 2006. The aim of our study was to improve awareness and early accurate diagnosis of nonalcoholic WE.     

MR脑血流灌注成像在亚临床肝性脑病中的应用

目的用MR灌注成像技术评价亚临床肝性脑病(SHE)患者的脑血流灌注模式。方法对12例经神经心理试验诊断为SHE的患者和10例年龄和教育程度相匹配的健康志愿者进行MR平扫和灌注成像,分别测量双侧尾状核头、苍白球、壳核、丘脑和额叶白质的脑血容量(CBV)、脑血流量(CBF)和平均通过时间(MTT),并以同侧额叶脑白质作为参照进行统计分析。结果SHE患者各感兴趣区与白质的比值:CBV值分别是1.32±0.25、1.19±0.46、1.51±0.20、1.69±0.53;CBF值分别为1.64±0.50、1.61±0.65、2.06±0.61、2.23±0.75;MTT值分别是0.83±0.17、0.76±0.20、0.78±0.19、0.78±0.17。志愿者相应部位CBV值为1.32±0.33、1.02±0.29、1.44±0.37、1.66±0.57;CBF值为1.36±0.24、1.08±0.28、1.55±0.51、1.58±0.64;MTT值为0.95±0.18、0.91±0.19、0.93±0.15、0.93±0.13。SHE患者较正常组MTT明显缩短,双侧丘脑、右侧尾状核头达到统计学意义的降低(P<0.05);CBF明显升高,左侧苍白球达到统计学意义的升高(P<0.05);CBV无明显变化。结论SHE患者基底节区灌注增加是血流从皮质到基底节区的重新分布,这是对运动前区、运动区功能缺陷及注意力缺陷的代偿反应,与皮质-基底节-丘脑-皮质环路密切相关。     

脊髓亚急性联合变性的MRI诊断要点分析

目的分析脊髓亚急性联合变性(SCD)的MRI诊断要点。资料与方法回顾性分析15例临床确诊SCD的病人临床及MRI资料,分析其脊髓MRI表现特点,统计分析SCD病人受累脊髓节段数与血清VB12水平、发病时间的相关性。结果 15例SCD病人均于横断面影像上显示颈胸段脊髓对称性等或长T1、长T2信号,13例病变主要位于颈胸段水平脊髓后索,2例同时累及后索、侧索及前索。但于横断面T2WI上颈段与胸段脊髓异常信号形态各具特点。颈段脊髓受累时于横断面T2WI上呈脊髓内"倒V"形或"反兔耳"形的对称性高信号。胸段脊髓受累时于横断面T2WI上呈脊髓内"哑铃"形的对称性高信号。统计学分析显示15例SCD病人脊髓受累节段数与血清VB12水平呈负相关,而与病程长短无相关性。结论脊髓MR成像对于SCD脊髓疾病的诊断有重要价值。     

磁共振弥散加权成像在新生儿早期缺氧缺血性脑病的临床应用

目的探讨磁共振弥散加权成像(DWI)在新生儿早期缺氧缺血性脑病(HIE)的应用及价值。方法收集本院经临床确诊为HIE共72例,对其进行常规T1W、T2W和DWI扫描,并对影像学进行分析,评价DWI在早期HIE的诊断优势。结果 DWI出现高信号病灶53例,T1W信号异常25例,T2W信号异常4例,其中DWI高信号病灶多见于大脑皮层、基底节区、侧脑室体旁及前后角周围白质区、半卵圆中心,T1W高信号以侧脑室周围白质区多见,出血性病变在T1W呈高信号而T2W和DWI表现为低或无信号。结论 DWI可作为HIE早期检测的重要手段,在显示病灶范围、数目等方面明显优于常规T1W、T2W,能对临床HIE早期诊断、早期干预治疗提供可靠的客观依据,对评估预后有重要价值。     

一氧化氮中毒导致脊髓变性的临床及影像特征分析

目的探讨一氧化碳(笑气)中毒的临床表现、实验室指标及影像学改变,以提高临床对笑气中毒所致脊髓亚急性变性的认识。方法收集我院2018至2020年收治的4例笑气中毒患者临床资料,分析其血清同型半胱氨酸水平、血清维生素B₁₂水平及影像学改变。结果1例患者维生素B₁₂水平下降,4例患者中血清同型半胱氨酸水平均有不同程度升高,4例患者均伴有颈髓磁共振成像-T₂加权成像(MRI-T₂WI)异常信号改变。结论笑气中毒所致脊髓亚急性联合变性多见于青壮年,血清同型半胱氨酸水平升高及磁共振T₂WI颈髓异常信号改变对该病诊断具有重要意义。     

新生儿缺氧缺血性脑病的MR诊断及随访观察

目的：研究新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy HIE)MR影像学表现发展规律及其预后情况。方法：选择有围产期窒息史，头颅MRI诊断为不同程度的HIE新生儿150例，30例患儿分别于3、6月，1、2、4岁以前进行头颅MRI复查。结果：3个月65％病例有头颅MR异常，大部分表现为外部性脑积水，28％病例有神经系统的症状和体征。6个月时40%病例有MR异常，33％病例有临床表现。1岁后约25％病例MR异常，表现为局限性脑软化和脑萎缩，并有相应的临床表现。结论：①HIE所致脑内小淤斑稍长T2信号于生后2－3个月内吸收消散。②HIE在3个月时有半数病例头颅MR表现异常，可见有髓鞘化不良，大部分表现为外部性脑积水，1岁以后外部性脑积水愈合，约20％病例留有局限性脑白质软化和脑萎缩等严重后遗症。③HIE的预后与MR分度密切相关，轻度预后良好，中及重度预后差。     

Brain MR imaging in acute hyperammonemic: Case report

Acute hyperammonemic encephalopathy is rare and generally is not widely known; only a few pediatric cases were found in the literature. These lesions’ clinical presentation differs significantly so they can mimic other lesions. In this case report, we discuss a 5-year-old boy who presented with generalized seizures and was unconscious in an apyretic context, for which she had a cranial computed tomographic and magnetic resonance imaging, both objectified an acute hyperammonemic encephalopathy resulting from an enzyme deficiency. Magnetic resonance imaging revealed lesions throughout the cortex, with the perirolandic and occipital cortices spared. This distribution of cerebral signal abnormalities on magnetic resonance imaging with an abrupt and profound neurological disorder is secondary to hyperammonemic. The knowledge of the magnetic resonance imaging results of this entity is essential to accelerate the diagnosis, and treatment, also to prevent sequelae.     

磁敏感加权成像在新生儿缺氧缺血性脑病中的应用

目的：探讨磁敏感加权成像（SWI）在新生儿缺氧缺血性脑病中的应用价值。方法：对临床拟诊缺氧缺血性脑病（HIE）的105例新生儿行头颅横断面液体衰减反转恢复序列（FLAIR）、快速自旋回波（FSE）、扩散加权图像（DWI）及磁敏感加权成像（SWI）,重点观察SWI对新生儿HIE出血性病灶检出的敏感性。结果：SWI能很好显示HIE伴发的出血灶,尤其是在室管膜生发基质以及脑室内出血的显示率明显高于其他扫描序列。结论：SWI对新生儿HIE伴发的出血,尤其慢性期、微小出血灶以及静脉病变的显示优势明显,而这些信息直接与患儿的预后密切相关,因此它是常规扫描序列的重要补充,有必要将SWI列为HIE的扫描序列。