结核性脑膜炎和缺血性卒中脑梗死的MRI特点

目的：评价结核性脑膜炎和缺血性卒中腔隙性脑梗死在基底节区的MRI影像分布特点。方法：回顾性分析我院2006年5月至2012年1月住院治疗的结核性脑膜炎和缺血性卒中导致基底节区腔隙性脑梗死的患者资料。根据梗死位置,将基底节区梗死MRI表现分为前部和后部。评价累及基底节区前部和后部的结核性脑膜炎和缺血性卒中腔隙性脑梗死的MRI影像分布特点。结果：将78例结核性脑膜炎和206例缺血性卒中患者纳入本研究。在结核性脑膜炎的腔隙性脑梗死患者中,有44例仅累及基底节区的前部;在缺血性卒中的腔隙性脑梗死患者中,有148例仅累及后部。结核性脑膜炎腔隙性脑梗死累及豆状核和内囊膝部明显高于缺血性卒中。在结核性脑膜炎腔隙性脑梗死累及基底节区后部的34例患者中,有26例有卒中危险因素。结论：腔隙性脑梗死的分布取决于疾病的病理、生理机制。基底节区前部的受累,尤其是尾状核和内囊膝部以及病变的多发性常提示结核性脑膜炎的可能性;而后部受累,多提示缺血性卒中的可能性。

MRI features of infarcts in patients with tuberculous meningitis or ischemic strokes

Objective：To evaluate the MRI imaging features of infarct in basal ganglia region in tuberculous meningitis and ischemic strokes.Methods：The clinical data of the patients with tuberculous meningitis or ischemic strokes treated in our hospital from May 2006 to January 2012 were retrospectively analyzed.MRI findings were grouped into anterior and posterior basal ganglia region according to location of infarcts.MRI imaging features of infarcts in anterior and posterior basal ganglia region in tuberculous meningitis and ischemic strokes and demographic data and risk factors were evaluated.Results：There were 78 patients in tuberculous meningitis group and 206 patients in ischemic strokes group.Infarct in tuberculous meningitis was purely anterior in 44 patients and in ischemic stroke purely posterior in 148.The frequency of infarcts in caudate and genu of internal capsule was significantly higher in tuberculous meningitis than in ischemic stroke.In tuberculous meningitis patients,posterior infarcts were present in 34 patients and 26 had associated risk factors of ischemic stroke.Conclusion：The distribution of infarcts depends on the underlying pathomechanism.The location of infarcts in anterior region especially caudate nucleus and genu of internal capsule and their multiplicity should suggest the possibility of tuberculous meningitis;and posterior location should suggest the possibility of ischemic stroke.