三叉神经病的CT／MRI评估与手术

三叉神经(第V颅神经)病并不十分罕见。自1986年1月至1996年1月对150例有三叉神经病可疑者作CT/MRI评估。本研究的目的：回第V颅神经病的临床表现；②建立一种对第V颅神经痛有效的检查方法；③通过第V颅神经的节段性解剖建立一种鉴别诊断并采用相应的手术治疗。方法：采用规范式的CT／MRI检查。研究结果表明：97例发现有病变且说明第V颅神经的临床定位诊断是非常不准确的，对有第V颅神经病的人应考虑根据作者所报定的方法进行MRI评估。     

三叉神经瘤的影像学分析

目的通过三叉神经瘤CT及MRI的影像分析，提高术前对此病的准确诊断。方法回顾性分析17例手术病理证实的三又神经瘤CT及MRI检查。结果颅后窝5例，颅中窝8例，位于颅中窝、颅后窝的肿瘤呈椭圆形或伴分叶状改变：跨颅窝4例，呈哑铃形或不规则形。CT及MPd表现有以下特点：①肿瘤实性部分多呈略高密度或略低密度改变，常伴有囊状低密度区。②T1WI呈均匀或不均匀等低信号，T2WI多呈不均匀高信号。③CT及MRI增强不均匀明显强化。④肿瘤沿着三叉神经生长，跨颅窝“哑铃状”为特征性表现，三叉神经根部增粗与瘤体相连续是诊断三叉神经瘤的可靠征像。⑤常伴有岩骨骨质吸收，肿瘤边界清，周围脑组织多无水肿厦钙化。结论CT和MRI是诊断三又神经瘤可靠方法，术前仔细分析其影像表现可达到准确诊断，为手术方式的选择提供依据。     

Sturge-Weber综合征的CT和MRI表现

Sturge-Weber综合征又称颅面血管瘤病、脑三叉神经血管瘤病[1-4].病变的主要特点为软脑膜血管瘤及三叉神经分布区的面部血管痣[5].CT与MRI是诊断本病的主要检查手段[6-7].笔者收集2006-2010年经临床及CT、MRI诊断为Sturge -Weber综合征8例,分析其临床特点及CT、MRI 表现,以提高对该病的认识.     

Garcin综合征30例临床分析

目的 探讨Garcin综合征的病因、临床表现及诊断，提高对本病综合征病因的认识。方法 对30例本综合征患者的临床表现、头颅CT、MRI和病理资料进行分析。结果 发现鼻咽癌20例、听神经瘤6例、三叉神经瘤2例、转移瘤2例。颅神经以三叉神经损害最早出现，继依次为Ⅵ、Ⅷ、Ⅶ、Ⅸ、Ⅹ、Ⅺ，颅神经害均在一侧，为不完全型（部分颅神经损害）。曾误诊为血管性头痛、三叉神经痛、美尼矣病等。CT和MRI显示咽隐窝变浅或消失，局部软组织肿物，并侵犯咽旁间隙、翼内肌，均有不同程度颅底骨质破坏。结论 Garcin综合征多半由肿瘤等较严重疾病引起。早期易误诊为其他疾病，故早期确诊至关重要，对一侧颅神经损害者应高度警惕，排除此病的可能，头颅CT和MRI对其病因诊断具有独特的优势。     

三叉神经瘤的影像学分析

目的通过三叉神经瘤CT及MRI的影像分析,提高术前对此病的准确诊断。方法回顾性分析17例手术病理证实的三叉神经瘤CT及MRI检查。结果颅后窝5例,颅中窝8例,位于颅中窝、颅后窝的肿瘤呈椭圆形或伴分叶状改变;跨颅窝4例,呈哑铃形或不规则形。CT及MRI表现有以下特点:①肿瘤实性部分多呈略高密度或略低密度改变,常伴有囊状低密度区。②T1WI呈均匀或不均匀等低信号,T2WI多呈不均匀高信号。③CT及MRI增强不均匀明显强化。④肿瘤沿着三叉神经生长,跨颅窝“哑铃状”为特征性表现,三叉神经根部增粗与瘤体相连续是诊断三叉神经瘤的可靠征像。⑤常伴有岩骨骨质吸收,肿瘤边界清,周围脑组织多无水肿及钙化。结论CT和MRI是诊断三叉神经瘤可靠方法,术前仔细分析其影像表现可达到准确诊断,为手术方式的选择提供依据。     

MRI探讨颅神经疾病的发生机制及其对微血管减压手术的指导意义

目的 利用MRI检查探讨颅神经疾病的发生机理以及对微血管减压手术的指导价值.方法 观察手术治疗251例颅神经疾病患者与60例正常对照组核磁共振检查结果,评价异位血管压迫在颅神经疾病发生发展中的作用,观察脑池段三叉神经、面神经长度及蛛网膜下腔宽度,以及面神经和脑干位置关系对手术难易程度的影响.结果 颅神经疾病患者患侧与健侧,患者患侧与健康人群血管神经接触关系有显著差异;三叉神经、面神经长度,蛛网膜下腔宽度以及面神经与与脑干位置关系都对手术的难度产生影响.结论 MRI-3DFFE序列检查能清晰显示生理状态下神经血管关系.神经血管压迫与颅神经疾病发生发展有密切关系.术前MRI检查对指导微血管减压手术及预测手术难度有重要的指导意义.     

腓浅神经与腓骨短肌联合活体组织检查的诊断意义初探及15例临床病理报告

目的 开展单一切口下的腓浅神经与腓骨短肌联合活体组织检查,通过回顾相关病例的临床和病理资料,分析联合活体组织检查的诊断意义.方法 共15例患者,女性7例,男性8例,年龄14 ～72岁,其中亚急性6例、慢性9例,均患有周围神经病,3例临床上合并肌肉病.周围神经病的临床类型包括对称性感觉和运动性神经病7例、多发性单神经病5例、对称性感觉性神经病3例.在外踝前上方纵切口,取材腓浅神经与腓骨短肌.神经和肌肉病理结论的意义评价分为3级:(1)具有确诊意义;(2)对诊断有帮助:(3)对诊断无帮助.结果 活体组织检查病理结论有确诊意义者7例,包括血管炎5例、炎性脱髓鞘性周围神经病1例和淀粉样变性1例.有帮助者5例:病理改变分别为:慢性髓鞘性神经病伴洋葱球样肥大纤维;小血管病变伴轻度炎性反应;轻度间质炎性反应;脂褐素沉积等.无帮助者3例.最终12例通过活体组织检查得以确诊.结论 联合活体组织检查的诊断阳性率较高,血管炎周围神经病和淀粉样变性等适用联合活体组织检查.     

脑桥小脑角区病变CT与MRI的诊断效果比较

目的探讨脑桥小脑角区病变电子计算机断层扫描(CT)与核磁共振检查磁共振成像(MRI)的应用价值。方法选取2015-08—2016-04我院诊治的脑桥小脑角区病变患者65例为研究对象,均经病理活检确诊,对其实施CT、MRI检查,对比两种检测方式的诊断结果。结果在本组神经瘤、脑膜瘤、动脉瘤、星型细胞瘤、淋巴瘤、淋巴瘤、三叉神经瘤患者的影像学检测中,MRI的诊断准确率高于CT,差异有统计学意义(P0.05)。其中,MRI对于动脉瘤的定位诊断率、动脉瘤位置的诊断准确率为100.0%,高于CT,差异有统计学意义(P0.05)。两种影像学检测法在其余脑桥小脑角区病变的定位诊断率比较差异无统计学意义(P0.05)。结论脑桥小脑角区病变应用MRI检查的诊断准确率高于CT,临床应重视这一点。     

三叉神经鞘瘤的诊断和手术治疗

目的 探讨三叉神经鞘瘤的临床特点、诊断及手术治疗方法.方法 回顾性分析我院自1990年1月至2008年12月采用手术治疗的29例三叉神经鞘瘤的临床及影像学表现、手术方式及治疗效果.结果 临床表现最常见为患侧三叉神经麻痹.肿瘤可位于中颅窝、后颅窝或骑跨中后颅窝呈哑铃形.本组中肿瘤全切除19例,次全切除7例,大部分切除3例.术后颅神经功能障碍较术前改善20例,无明显变化4例,加重5例,主要表现为面部麻木和眼球外展受限.结论 三叉神经鞘瘤起源部位和生长方向复杂.MRI对临床诊断及选择手术入路有重要意义.合适的手术入路及显微手术相结合能取得最佳治疗效果.     

糖尿病性颅神经病变7例临床分析

临床资料 :本文 7例病人中 ,男性 4例 ,女性 3例 ;年龄42～ 70岁。既往有糖尿病病史者 5例 ,另 2例出现颅神经病变后经检查确诊为糖尿病。症状与体征 :4例患者因突发性单侧眼睑闭合不全 ,口角流涎入院 ,其中 1例伴同侧面部感觉减退。 3例患者以复视 ,上眼睑下垂就诊。受累颅神经为面神经麻痹 3例 ,面神经合并三叉神经病变 1例 ,动眼神经麻痹 2例 ,动眼神经合并滑车神经病变 1例。影像学检查 :头颅 CT、颅底片及鼻咽部拍片均未见异常。2例头颅 MRI检查提示脑萎缩脑白质脱髓鞘改变。实验室检查 :7例患者入院时空服血糖 7.8～ 14.7mmol/L ,…     

Lung cancer presenting with trigeminal neuropathy

The purpose of this case report is to describe MR imaging and CT findings of a patient in whom the first clinical and neuroradiological manifestation of a metastatic lung adenocarcinoma was unilateral trigeminal neuropathy caused by a presumed metastasis involving cisternal and Meckel’s cave segments of ipsilateral trigeminal nerve. MR imaging and CT scan differential diagnosis of expansive lesions of the intracranial trigeminal nerve must include metastases. Physicians and neuroradiologists must be aware of metastases as an uncommon cause of trigeminal neuropathy, even as the presenting condition of cancer.     

Clinical analysis of trigeminal neuropathy as initial manifestations--an etiological study

The differential diagnosis of trigeminal neuropathy is quite challenging because there is a significant variety of causes for the disorder. We reviewed our cases of trigeminal neuropathy by studying first the initial manifestations in order to evaluate their underlying disorders. Sixty-four patients with trigeminal neuropathy came to our Out-Patients clinic. We have excluded from our analysis any patients with atypical pain, facial migraine, nasal sinusitis, pain from inflammation of dental pulp or facial bones, and pretrigeminal neuralgia. In 53 cases (83%) we identified the causes; 35 of them were cases of symptomatic trigeminal neuritis and 18 were trigeminal neuralgia while, in the remaining 11 cases, no definitive causative disorder was identified. Among the 35 patients with symptomatic neuritis, 10 cases were found to have malignant neoplasms including 5 cases of squamous cell carcinoma, 6 had a virus infection, 5 had traumatic origin, 4 had multiple sclerosis, 2 exhibited Tolosa-Hunt syndrome, 2 had MCTD, and there were single cases of sarcoidosis, serpentine aneurysm, cavernous sinus thrombosis, maxillary cyst and trigeminal neurinoma. The remaining 11 cases of neuritis whose causes were undetermined showed clinical features similar to trigeminal sensory neuropathy, an analogue of Bell's palsy, a benign self-limiting condition. Since the cases shared symptoms of impairment of taste, and, occasionally, of facial palsy, vestibular insufficiency, hearing disturbance, hypoglossal palsy or signs of cerebellar lesion, we strongly suspected a virus origin.(ABSTRACT TRUNCATED AT 250 WORDS)     

Linear pontine trigeminal root lesions in multiple sclerosis: clinical and magnetic resonance imaging studies in 5 cases

BACKGROUND: Magnetic resonance imaging (MRI) is useful for demonstrating demyelinating lesions in patients with multiple sclerosis (MS). Magnetic resonance imaging studies show that MS lesions are generally not uniform in shape, size, or distribution. Linearly shaped lesions at the trigeminal root entry zone have been occasionally reported in single cases of MS, but, to our knowlege, the frequency and the clinical features of such patients have not been comprehensively characterized. OBJECTIVE: To describe the frequency and the clinical and laboratory features of patients with MS who had linearly shaped lesions at the trigeminal root as seen on MRI. DESIGN AND SETTING: A retrospective review of medical records and MRI films of Japanese patients with MS admitted to a university hospital and its affiliated hospital in Sendai, Japan. PATIENTS AND METHODS: Brain MRI films of 74 consecutive Japanese patients with MS (51 females and 23 males) were studied retrospectively and the clinical and laboratory features of the patients with linearly shaped lesions at the trigeminal root were also investigated retrospectively. RESULTS: Five patients (6.8%) were shown to have T1-weighted-hypointense, T2-weighted-hyperintense, nonenhanced linear lesions in the pons on MRI, and these were uniformly localized in the intramedullary portion of the trigeminal root. All of these patients had clinically definite MS and had various types of facial sensory disturbances, such as neuralgia (1 patient), hypesthesia (2 patients), or paresthesia (3 patients). No other clinical or laboratory feature was characteristic in these 5 patients. CONCLUSIONS: Linear pontine trigeminal root lesions were common in our patients with MS. They were associated with various facial sensory symptoms. Since similar lesions are formed in animal models of herpes simplex virus infection, further study is needed to clarify whether these MS lesions are virally induced.     

单纯疱疹病毒脑炎的非典型临床表现

目的对临床表现和实验室检查结果不具典型特征的单纯疱疹病毒脑炎患者进行回顾性总结，以提高对本病的诊断水平。方法对142例单纯疱疹病毒脑炎患者的病史、临床表现、脑脊液细胞学检查、脑脊液及血清病毒学、脑电图及神经影像学资料进行分析。结果142例中38例(26．76％)为非急性起病，受损部位除常见的额、颞叶外，还可侵及脑干。50例(35．21％)脑脊液细胞学检查以中性粒细胞升高为主，而非淋巴细胞占优势。69例行脑脊液特异性1型单纯疱疹病毒IgM抗体检测，阳性者12例(17．39％)，余57例(82．61％)均呈阴性。17例行双份血清和脑脊液标本特异性IgG抗体检测，其中恢复期标本1型单纯疱疹病毒IgG抗体水平增高4倍以上者5例，无明显变化者9例，恢复期抗体水平降低4倍者3例。68例中65例(95．59％)脑电图未见典型的局灶性尖、棘波。52例患者接受影像学检查(MRI检查10例，CT检查42例)，其中28例未见典型影像学改变，分别占受检者的30．00％(3／10)和59．52％(25／42)。结论单纯疱疹病毒脑炎的起病、临床表现和实验室检查可呈不典型表现，明确诊断有赖于对各项资料进行综合分析。对于亚急性或慢性起病患者，建议检测双份血清和脑脊液标本中的特异性1型单纯疱疹病毒IgG抗体，以对病毒抗体水平进行连续和动态观察。     

伴有周围神经病变的多发性硬化

目的分析5例伴周围神经病变的多发性硬化的临床电生理、实验室检查和MRI改变,探讨多发性硬化合并周围神经损害的临床特点和发病机制。方法回顾性总结5例伴发周围神经病损的多发性硬化的脑脊液生化,免疫学检查、寡克隆带,电生理检查,MRI及其它有助于鉴别诊断的检查。结果5例均为伴有周围神经病变的多发性硬化,电生理提示广泛周围神经病损,既有脱髓鞘改变,又有轴突变性。结论由于中枢神经系统与周围神经系统髓鞘存在着共同的抗原性成分,故MS患者的中枢神经系统与周围神经系统可以同时发生脱髓鞘改变。     

Idiopathic trigeminal sensory neuropathy with gadolinium enhancement in the cisternal segment

The authors report two patients with idiopathic trigeminal sensory neuropathy who showed gadolinium enhancement of the cisternal segment of the corresponding trigeminal nerve in cranial MRI. The resolution of these lesions in a repeat MRI suggests a similarity to Bell's palsy.     

CT呈高密度的垂体Rathke囊肿的MRI影像学特征

目的探讨CT高密度垂体Rathke囊肿的MRI影像学特征。方法回顾性分析2013年1月至2018年1月手术治疗的1 104例垂体病变的临床资料,其中Rathke囊肿186例,而术后病理证实为垂体Rathke囊肿、术前CT为高密度的Rathke囊肿9例。结果 9例CT呈高密度的垂体Rathke囊肿中,垂体柄上型5例,垂体柄下型4例;MRI T1像呈等信号6例、高信号3例,T2像呈等信号5例、低信号2例、高信号2例;垂体柄上型囊肿囊壁未见强化,垂体柄下型囊肿周围呈现明显的环形强化征。结论 CT呈高密度的垂体Rathke囊肿可分为垂体柄上型和垂体柄下型,以前者多见;该类囊肿MRI平扫缺乏恒定的影像学信号,动态增强影像显示垂体柄上型囊壁无明显增强,垂体下型囊壁呈现明显的环形强化征。     

Peripheral and central neurologic complications in type 2 diabetes mellitus: no association in individual patients

Diabetes mellitus is associated with end-organ complications in the peripheral and central nervous system. It is unknown if these complications share a common aetiology, and if they co-occur in the same patient. The aim of the present study was to relate different measures of peripheral neuropathy in patients with type 2 diabetes mellitus (DM2) to cognition and brain MRI. A standardized neurological examination and questionnaire, neuropsychological examination and brain MRI were performed in 122 patients with DM2 and 56 matched controls. Measures of peripheral neuropathy were vibration threshold, a sensory examination sum score and the Toronto Clinical Neuropathy Scoring System. Neuropsychological test scores were expressed in standardized z-values across five predetermined cognitive domains. White matter lesions and cortical and subcortical atrophy were rated on MRI. Overall 38% of the patients with DM2 and 12% of the controls were classified as having any neuropathy (p<0.001). Patients with DM2 had a lower performance on the neuropsychological tests, more white matter lesions (p<0.01) and more atrophy (p<0.01) than controls. Within the DM2 group none of the measures of peripheral neuropathy was related to MRI abnormalities or cognitive dysfunction (linear regression analyses, adjusted for age, education, sex). We conclude that peripheral neuropathy in patients with DM2 is not related to cognitive dysfunction and brain abnormalities. This indicates that central and peripheral neurological complications of DM2 might have different etiologies.     

TRIGEMINAL SENSORY NEUROPATHY IN SYSTEMIC LUPUS ERYTHEMATOSUS

Five women are presented who had the unusual picture of trigeminal neuropathy affecting the sensory function. In 4 of the cases the symptoms were bilateral and fairly symmetrical, but not corresponding to the trigeminal branches. In 4 of the cases the trigeminal neuropathy was the only neurological finding. Three of the patients suffered from systematic lupus erythematosus (SLE), in the 2 others this diagnosis was strongly suspected. It is suggested that the neuropathy was caused by vascular lesions in the medulla oblongata. The bilateral engagement may depend upon the anatomic arrangement of the arterial supply to the trigeminal decussation and lemniseus. The distribution of the sensory loss can be explained by the somatotopic localisation in the nerve tracts. Reports on cases with isolated sensory trigeminal neuropathy have been published in the last two decades. It is suggested that the neuropathy, at least in some of these cases, may have been an early symptom of SLE.     

颅内黑色素瘤的诊断与治疗

目的 分析颅内黑色素瘤的临床表现、影像学特点及诊治要点。方法 回顾性分析5例颅内黑色素瘤的临床和影像学资料，结合文献讨论其CT和MRI特点，诊断及目前治疗颅内黑色素瘤的观点。结果 CT可以显示肿瘤的大小、部位及数目，但特异性差，定性困难。肿瘤因含有黑色素细胞数量的不同而MRI表现为不同的信号。3例颅内黑色素瘤术前曾分别考虑为转移瘤、脑膜瘤或胶质瘤。部分颅内黑色素瘤的术前影像学检查证实为多发性病灶。结论 颅内黑色素瘤，尤其是原发性颅内黑色素瘤术前诊断困难，病理是确诊黑色素瘤的最后手段，综合治疗有望提高疗效。