海络因白质脑病的临床特征及影像学观察

目的　分析和探讨海络因白质脑病 (heroin leukoencephalopathy,HLE)的临床特点、诊断规律、发病机制及防治经验。方法　对 2例男性 HLE患者的临床症候进行观察 ,均行头颅 CT及磁共振 (MRI)检查 ,其中 1例行弥散加权成像 (DWI)。结果　 2病例均为急性起病 ,以言语含糊、行走不稳等小脑共济运动障碍表现为主 ,反应迟钝 ,锥体束征阳性。头颅 CT及 MRI可见双侧小脑、内囊后肢、枕顶叶深部白质、胼胝体、脑干等白质区域异常信号 ,CT示低信号 ,MRI呈长 T1、长 T2信号影 ,DWI为高信号影。结论　 HLE可根据有吸毒史 ,并结合临床及影像学特点进行诊断 ,对于戒毒者戒毒时应在神经保护的前提下进行 ,或许能减少或避免 HLE的发生。

The Clinical Manifestations and Imaging Observation of Heroin Leukoencephalopathy

Objective To analyse and investigate the clinical characters, diagnostic criteria, pathogenesis and prevention of heroin leukoencephalopathy (HLE).Methods Observing the clinical symptom and signs of 2 male cases of HLE were observed with computed tomography (CT) and magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) examination was performed in addition to one case. Results Acute onset,progressive dysarthria,cerebellar ataxia,delayed reaction and pyramidal sign were the main clinical manifestions. Brain CT and MRI revealed diffused and symmetrical white matter abnormal signal especially in the cerebellum, posterior limbs of the internal capsule, splenium of the corpus callosum, white matter of posterior cerebrum and brainstem along the corticospinal tract. The lesion were shown with low density on CT, longer T1 and T2 signals on MRI, and hyperdensity on DWI. Conclusions HLE could be diagnosed according to clinical manifestations and imaging features in combination with history of inhalation of heated heroin vapor.