脑淀粉样血管病相关炎症的临床诊断

目的总结脑淀粉样血管病相关炎症(CAA-RI)患者的临床表现及辅助检查的特点,探讨临床诊断的要点。方法本研究纳入2016-07—2018-07在河南省人民医院诊治的10例CAA-RI患者,总结其临床表现、诊治经过及随访情况。分析头颅MRI上白质病变和CAA相关出血病变的特点及分布情况。结果本组CAA-RI患者临床症状上以认知障碍最为常见,头痛发生率较国外高,临床表现多样化,无诊断特异性。头颅MRI显示,脑白质病变特征均符合血管源性水肿,以FLAIR序列显示最佳,皮质下白质(U型纤维)均受累。CAA相关出血影像,以脑微出血发生率最高(100%),SWI序列对诊断非常重要。结论CAA-RI临床表现多样化,无诊断特异性。头颅MRI特征性白质病变合并CAA相关出血影像特征为诊断核心。

Clinical diagnosis of cerebral amyloid angiopathy-related inflammation

Objective To summarize the clinical manifestations of cerebral amyloid angiopathy-related inflammation(CAA-RI)and the characteristics of auxiliary examination,and to explore the key points of clinical diagnosis.Methods This study enrolled 10 CAA-RI patients who were diagnosed and treated in Henan People's Hospital from July 2016 to July 2018.The clinical manifestations,diagnosis,treatment and follow-up were summarized.We analyzed the characteristics and distribution of white matter lesions and CAA related bleeding lesions on MRI.Results Cognitive impairment is the most common clinical symptom of CAA-RI patients.The incidence of headache is higher than that of other published data.The clinical manifestations of CAA-RI patients are diverse and there is no diagnostic specificity.On brain MRI,the characteristics of white matter lesions were consistent with vasogenic edema.Subcortical white matter fibers were all involved and best shown on FLAIR sequence.Cerebral microbleeds were the most common hemorrhagic findings among CAA related hemorrhagic imaging features(100%).Conclusion The clinical symptoms of CAA-RI were diverse and not specific for diagnosis.Unique white matter lesions with CAA related hemorrhagic imaging features on MR were critical for clinical diagnosis.