脑无症状性脱髓鞘病变MRI及其病因分析(附52例报告)

对52例颅脑MRI显示脱髓鞘病变的患者进行了影像学特征及病因分析,结果表明本组患者脑部双侧脑室周围白质在MRI的T_2加权像上显示条索状或斑片状的不规则高信号影;T_1加权像相应显示低或等信号影,而临床表现无特异性症状。病因是多数病例(40例)可能继发于脑缺血或多发性脑梗塞后的皮质下白质脑病,少数病例(12例)不能排除原发性脱髓鞘病变如MS的诊断。     

1例Creutzfeldt-Jakob病的神经影像学与脑电图长期跟踪研究

目的探讨散发性Creutzfeldt-Jakob病(sCJD)患者神经影像学、脑电图的特点和动态规律性。方法利用CT、MRI以及动态脑电图设备先后对1例病理确诊的sCJD患者行5次神经影像学和6次脑电图监测,并分析其规律性。结果①在辅助诊断CJD方面,弥散加权像(DWI)较头颅CT、常规MRI的T1加权像(T1WI)、T2加权像(T2WI)、FLAIR像以及MRI增强扫描更敏感;②CJD患者DWI表现为双侧底节区及皮层的异常高信号;病程晚期,皮层DWI异常信号可以消失;③CJD患者脑电图周期性尖慢复合波(PSD)的出现有明显的病程区间性及正弦曲线性特征;PSD在病程早期可以不出现,病程晚期可以消失。结论反复监测DWI和脑电图,对于确诊CJD是十分重要的。     

Tolosa-Hunt氏综合征(附九例报告)

Tolosa-Hunt氏综合征又称痛性眼肌麻痹,现报告9例。 资料 一般资料:男5,女4,年龄12～63岁,病程11     

可逆性后部白质脑病综合征的临床特征及影像学分析

目的:探讨可逆性后部白质脑病综合征(RPLS )的临床表现及影像学特征.方法:分析5例RPLS患者的临床及影像学资料.总结该病的临床表现及影像学检查方法在疾病的诊断、治疗及预后中的作用.结果:主要临床表现为头痛,视觉障碍,恶心、呕吐,痫性发作,意识状态改变,精神异常和行为改变.影像学检查显示双侧大脑后部白质水肿,额叶、顶叶、颞叶、脑干、小脑、基底节区和大脑皮质亦可累及.MRI T1WI为略低或等信号,T2WI和FLAIR为高信号,ADC图呈高信号.结论:RPLS的发病机制为急性大脑白质血管源性水肿.绝大数RPLS患者的症状、体征和影像学检查可以完全恢复至病前水平.DWI和ADC图对于早期明确诊断和指导治疗具有非常重要的意义.     

神经梅毒颞叶内侧损害的MRI表现

目的 探讨颞叶内侧损害的神经梅毒患者的MRI表现,以提高对该病的认识.方法 报道5例表现为颞叶内侧损害的、经临床证实的神经梅毒患者的临床资料及MRI表现.结果 本组神经梅毒患者临床表现为认知功能障碍及精神障碍.5例表现为单侧或双侧颞叶内侧长T2及FLAIR高信号,2例DWI像呈高信号,4例伴不同程度脑萎缩.经过正规抗梅毒治疗后症状好转.结论 MRI表现为颞叶内侧损害是神经梅毒影像学特征表现之一,对临床诊断及治疗预后有重要意义.     

马尾神经鞘瘤的临床特点与外科治疗

目的探讨马尾神经鞘瘤的临床特点与外科手术治疗方法。方法回顾性分析2007年6月-2009年3月经手术治疗的32例马尾神经鞘瘤患者的临床症状、影像学改变和外科手术治疗效果。结果多数患者术前出现下肢疼痛麻木的症状(30例),其中18例为双下肢疼痛麻木,体检时25例表现为双侧神经损害或单侧多根神经损害。12例患者首发症状为单纯腰痛。10例误诊为腰椎间盘突出症。6例行CT扫描,但均未能做出正确诊断。所有患者均经MRI确诊,神经鞘瘤表现为圆形或椭圆形病灶,T1加权像呈等或稍低于脊髓信号,T2加权像25例呈不均匀高信号,2例呈稍高信号,5例呈均匀高信号。13例行钆增强扫描,10例呈不均匀强化或环形强化。所有患者均完整切除肿瘤,除1例巨大马尾神经鞘瘤术后症状加重外,其他患者术后功能均改善,短期随访未见复发。结论马尾神经鞘瘤的特征性表现为双下肢疼痛麻木;查体显示双侧或单侧多根神经损伤,但首发症状可不典型;MRI有助于早期诊断;外科手术完整切除肿瘤效果良好。     

急性Marchiafava-Bignami病临床特点及MRI表现

目的分析急性Marchiafava-Bignami disease(MBD)的临床特点及磁共振表现。方法回顾性分析6例急性MBD临床资料及磁共振影像学表现。结果 6例均为男性,年龄47~68岁,患者均有长期饮酒史,临床表现以不同程度的意识障碍、行为异常最为常见。颅脑MRI结果:4例胼胝体全部受累,1例为胼胝体压部受累,1例胼胝体全部受累伴有双侧脑室旁白质受累;病变主要为T1加权低信号,T2加权高信号,弥散加权(diffusion-weight imagine,DWI)高信号,液体衰减反转恢复成像(fluid attenuated inversion recovery,FLAIR)表现为高信号,全部患者均给予维生素B1、B12肌肉注射治疗,5例患者预后良好,1例遗留肢体抽搐。结论急性MBD临床表现缺乏特异性,诊断主要依据慢性酗酒病史和颅脑影像学表现,早期诊断对于急性MBD患者预后有重要意义。     

低颅压综合征的影像学和诊治研究进展

低颅压综合征是以体位性头痛、腰穿脑脊液压力减低为典型表现的一组疾病,影像学,特别是MRI在其诊断中的作用越来越受到重视.对低颅压综合征的病因、临床表现、影像学表现及治疗进行简单综述.     

Miller-Fisher综合征7例临床分析

目的分析Miller-Fisher(MFS)综合征的临床特点。方法回顾性分析7例Miller-Fisher综合征患者的临床资料。结果 MFS主要表现为眼肌麻痹,共济失调及腱反射减弱三联征,眼肌麻痹是本病特征性表现。脑脊液:蛋白-细胞分离。肌电图呈神经源性损伤,神经传导速度减慢,F波潜伏期延长。5例使用免疫球蛋白治疗,1例使用免疫球蛋白+甲泼尼龙治疗,1例使用甲泼尼龙治疗,均明显好转出院。结论当患者出现眼外肌麻痹,共济失调,腱反射减弱或消失时,应高度怀疑Miller-Fisher综合征,可进一步行脑脊液及肌电图检查确诊,使用免疫球蛋白和激素治疗有效,预后良好。     

无症状性脑梗塞的研究进展

无症状性脑梗塞是指临床症状轻微或一过性易被忽略,或只有神经系统症状体征,影像学上见到非责任病灶。危险因素与症状性脑梗塞一致。可能影响急性脑卒中的病程、临床表现和预后,是症状性脑梗塞的预兆,可能发展为假性球麻痹、多发梗塞性痴呆。所以对患高血压病或糖尿病的老年人,如发生眩晕、头痛、语言障碍等症状,虽未发现明显体征,也应及时作颅脑CT或MRI检查,以早发现、早治疗。其治疗方案除恢复期缺血性脑血管病的治疗方法外,主要是采用脑卒中二级或三级预防措施。另外,补充维生素B6、B12及叶酸可以降低高同型半胱氨酸血症性缺血性脑血管病的发生。以头痛为首发症状的无症状性脑梗塞脱水剂治疗无效反而加重,加用镁剂后效果明显。     

MR imaging of Tolosa-Hunt syndrome

The Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by cavernous sinus inflammation, which is responsive to steroid therapy. The MR features of 11 patients with the clinical diagnosis of Tolosa-Hunt syndrome were studied. Two patients had normal MR studies of the orbit and cavernous sinuses. In nine patients, abnormal signal and/or mass lesions were seen in the cavernous sinuses; in eight cases, the abnormality was hypointense relative to fat and isointense with muscle on short TR/TE images and isointense with fat on long TR/TE scans. Extension into the orbital apex was seen in eight cases. In six of nine cases the affected cavernous sinus was enlarged; in five of nine it had a convex outer margin. One patient had a thrombosed cavernous sinus and superior ophthalmic vein in addition to a cavernous sinus soft-tissue mass. The signal intensity of Tolosa-Hunt syndrome in this limited series was similar to that of orbital pseudotumor and is confined to a limited differential diagnosis, which includes meningioma, lymphoma, and sarcoidosis.     

Pseudotumor of the orbit. Clinical, pathologic, and radiologic evaluation

Pseudotumor, Graves' disease, and lymphoproliferative disease are the most common ophthalmologic disease entities requiring evaluation by CT and MR imaging. A history of acute onset, pain, swelling, proptosis, and response to steroids are the classical findings. The radiologic findings are categorized according to location into dacryoadenitis, myositis, and sclerouveitis, with and without associated infiltrations. The inflammatory infiltrate, which is composed of polymorphic leukocytes, lymphocytes, and plasma cells interspersed with a variable amount of fibrovascular tissue, may be diffuse or localized. The preferred radiologic method used for assessment of pseudotumor is CT. MR imaging, however, is indicated for evaluation of the Tolosa-Hunt syndrome, which is characterized by an inflammatory infiltrate in the orbital apex and cavernous sinus leading to cranial nerve involvement with ophthalmoplegia. The clinical and radiologic constellation of findings allows a definitive diagnosis in most cases.     

Gadopentetate dimeglumine-enhanced MR in the diagnosis of the Tolosa-Hunt syndrome.

A 54-year-old man first was admitted with a right oculomotor nerve palsy that ameliorated spontaneously. Two months later, he was readmitted with right proptosis, ophthalmoplegia, and optic nerve involvement. MR showed an enlarged right cavernous sinus. There was dramatic improvement after high doses of steroids. MR findings 10 months later were normal. Thus, the diagnosis of the Tolosa-Hunt syndrome was established.     

MRI findings in Tolosa-Hunt syndrome before and after systemic corticosteroid therapy

Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to a granulomatous inflammation in the cavernous sinus. Corticosteroid therapy dramatically resolves both the clinical and radiological findings of THS. We present MRI findings of six patients with a clinical history of at least one episode of unilateral or bilateral orbital-periorbital pain, clinical findings of associated paresis of one or more of 3rd, 4th, 5th or 6th cranial nerves. All of the patients revealed an enlargement of the symptomatic cavernous sinus on magnetic resonance imaging (MRI) scans. Five patients revealed total resolution of the clinical findings within 1-8 weeks, following systemic corticosteroid treatment. One patient revealed only minor regression of clinical findings within 2 weeks after the initiation of the treatment, so the cavernous sinus lesion was reevaluated as meningioma on MRI, and the patient underwent surgical resection of the mass with resultant histopathological finding of cavernous sinus meningioma. A follow-up MRI scan was performed for five patients at the end of 8-weeks of steroid therapy. Three of these five patients showed total resolution of the cavernous sinus lesions whereas two of them revealed a partial regression of the cavernous sinus lesions. MRI findings before and after systemic corticosteroid therapy are important diagnostic criteria to put the definitive diagnosis of THS and to differentiate it from other cavernous sinus lesions that simulate THS both clinically and radiologically.     

Tolosa-Hunt syndrome revisited: not necessarily a diagnosis of exclusion

The Tolosa-Hunt syndrome (THS), a steroid-responsive painful ophthalmoplegia secondary to idiopathic granulomatous inflammation, historically has been categorized as a diagnosis of exclusion because of its nonspecific radiologic presentation. Five patients who satisfied the anatomic and clinical criteria of this syndrome underwent high-resolution CT of the orbital apex/cavernous sinus region. Two patients were diagnosed as having orbital apex pseudotumor, two as having cavernous sinus inflammation, and one as having a cavernous sinus epidermoid by the characteristic CT and clinical findings. Follow-up studies while the patients were asymptomatic demonstrated complete resolution of the CT abnormalities in four patients and clinical improvement in all five patients. Our data suggest that orbital apex pseudotumor and granulomatous inflammation of the cavernous sinus have similar clinical features and should be considered as part of the spectrum of THS. With the advent of high-resolution CT, THS may now be a diagnosis of inclusion. Symptomatic improvement after steroid therapy is an essential but not absolute proof of the syndrome, since lesions such as lymphomas may also respond to steroids. Resolution of the soft-tissue inflammation of CT is an additional criterion for diagnosis.     

A rare case of Tolosa-Hunt syndrome imaged with FDG PET/CT and MRI

We report on the imaging findings of Tolosa-Hunt syndrome in a 59-year-old patient. Clinical findings included periorbital pain, ptosis, disordered eye movements, and blurred vision. Treatment with intravenous administration of steroid resolved all symptoms. Currently, magnetic resonance imaging plays a key role in the diagnosis of Tolosa-Hunter syndrome for locating the inflammatory tissue and follow-up. This case of Tolosa-Hunter syndrome with representative (FDG PET/CT) images may imply that FDG PET/CT is a useful tool in detecting and monitoring of this disease.     

Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome).

Twenty-six patients with painful ophthalmoplegia were classified as having the Tolosa-Hunt syndrome on the basis of their clinical findings and response to steroid therapy. All patients underwent orbital venography, a review of which forms the contents of this investigation. Orbital venography, a review of which forms the contents of this investigation. Orbital venograms were normal in 16 patients and abnormal in 10. The major abnormalities were (1) obstruction of the superior ophthalmic vein in its third segment without displacement; (2) collateral venous flow through small venous channels or collateral veins; and (3) poor opacification of the ipsilateral cavernous sinus.     

Tolosa-Hunt syndrome in a patient with systemic lupus erythematosus

We report a case of Tolosa-Hunt syndrome (THS) in a patient with systemic lupus erythematosus studied with MRI. Magnetic resonance showed enlargement of the cavernous sinus and compression of the carotid syphon by enhancing tissue. In particular, fat-suppressed T1-weighted images before and after contrast agent injection and MR angiography showed extension of the abnormal tissue to the apex of the orbit and narrowing of the internal carotid artery. A presumptive diagnosis of THS was made and steroid treatment was started with rapid relief of symptoms. Follow-up MR study after steroid therapy demonstrated sub-total resolution of the neuroradiological findings. Neuroradiological findings in THS are quite typical but they may be subtle; furthermore, the presence of a systemic disease may suggest secondary involvement of the cavernous sinus. Utilization of the appropriate MR techniques and follow-up exams may contribute to the diagnosis of THS even in the presence of other systemic diseases.     

CNS involvement in AIDS: spectrum of CT and MR findings

The brain may be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Knowledge of their existence and characteristic imaging features are important to radiologists for detection, diagnosis, and initiation of an appropriate treatment. Although there is a considerable overlap in the imaging characteristics of different entities, some findings are found to be very suggestive of a particular disease. The CT and MR imaging techniques are commonly used in the diagnosis of neurological disorders in acquired immunodeficiency syndrome (AIDS) patients, to verify treatment response and to guide brain biopsy. This review attempts to describe CT and MR features of infectious and malignant brain disorders in HIV-seropositive patients. Received 1 July 1996; Revision received 21 October 1996; Accepted: 28 November 1996     

CNS sarcoidosis: evaluation with contrast-enhanced MR imaging.

Reports of findings on unenhanced MR images and contrast-enhanced CT scans in patients with intracranial sarcoidosis have suggested that MR imaging without contrast enhancement may miss meningeal involvement, which is a frequent and prominent finding in neurosarcoidosis. We studied 14 patients with CNS sarcoidosis with T1- and T2-weighted pre- and postcontrast sequences and T1-weighted postcontrast sequences. Eight of 12 patients with intracranial sarcoidosis and one of two with spinal sarcoidosis had meningeal involvement that was not apparent on the unenhanced scans. Eight of 12 patients had intraaxial areas of high signal intensity on T2-weighted images, although only two of these lesions enhanced. Three patients had enhancing extraaxial masses mimicking meningiomas on postcontrast T1-weighted images. In two patients, the lesions decreased markedly in size after steroid treatment. In one patient with sarcoidosis of the optic nerve, the lesion decreased in size and the patient's vision returned to normal after Cytoxan therapy. In five of 14 patients, CNS findings were the initial clinical manifestation of the disease. In nine of 14 patients, the diagnosis of neurosarcoidosis was suggested only after administration of contrast agent. Use of gadopentetate dimeglumine greatly enhances the sensitivity of MR imaging in the detection of CNS sarcoidosis.