高血糖致中枢神经系统影像学改变2例分析及文献复习

目的探讨高血糖致脑基底节区影像学改变的临床表现、疗效及其病理生理机制。方法选择2例典型患者进行临床表现、治疗经过及影像学改变的回顾性分析,并学习相关文献。结果 2例糖尿病患者,1例为非酮症高血糖,1例为酮症高血糖,临床表现不同,1例表现为偏侧舞蹈症,1例表现为肢体抽搐、偏侧肢体运动障碍。影像学改变有特征性,早期CT表现为对侧纹状体高密度影,MRI表现为病灶区T1高信号,T2等信号,边界清晰,无水肿征象。结论高血糖致中枢神经系统影像学改变最常见的临床表现为偏侧舞蹈症,发病部位以纹状体为主,CT早期表现为高密度影,易与脑出血相混淆,MRI异常信号有助于早期诊断,降低误诊率。

Hyperglycemia induced changes in the central nervous system imaging: report of two cases and literature review

Objective To investigate the clinical manifestations, efficacy and the pathophysiology of the basal ganglia on brain imaging of hyperglycemia. Methods Retrospectively analyze the clinical manifestations, the treatment and the neuroimaging changes of the two typical patients with hyperglycemia, and review the literatures about this disease. Results Two cases of diabetes, one case of non-ketotic hyperglycemia and the other case of ketotic hyperglycemia, were different clinical manifestations. The first case showed hemichorea, the second case showed the limbs twitch, unilateral limb movement disorder. The imaging findings were classic. There were hyperdensities of the contralateral striatum on the early CT. T1 weighted MR images in all cases showed the high-signal intensities. While the T2 weighted images showed equal signal intensities without edema. Conclusion Hyperglycemia induced changes in central nervous system imaging the most common symptom is hemichorea. In the major affected region-corpora striata, CT shows hyperdense lesions, confuses easily with cerebral hemorrhage. MRI abnormal signals contribute to early diagnosis and reduce the misdiagnosing rate.