多发性硬化的临床、磁共振成像及诱发电位的综合研究

目的：研究多发性硬化患者的临床表现，起病形式，类型，分析磁共振成像和三种诱发电位的诊断价值。方法：回顾性分析51例确诊为多发性硬化患者的临床特征，头颅和脊髓磁共振成像，视觉诱发电位，脑干听觉诱发电位和体感诱发电位的结果及相互间关系。结果：本组患者以视神经脊髓炎和东方型多发性硬化为多见，头颅和脊髓磁共振成像均有病灶，视觉诱发电位的敏感性最高。结论：本组患者的临床特征符合亚洲多发性硬化的特点。磁共振成像和诱发电位相结合，能提高诊断的阳性率。     

磁共振成像在多发性硬化中的应用:解读2010年西班牙神经科学协会关于磁共振成像对多发性硬化检查推荐规范

近20年来,由于磁共振成像对多发性硬化病灶最为敏感,其被广泛应用于多发性硬化的诊断和治疗监控.但是,在多发性硬化的日常临床实践中还是存在磁共振成像技术应用不尽合理的问题.为此,2010年西班牙神经科学协会多发性硬化专家组基于大量文献回顾和其自身经验,制定了多发性硬化磁共振成像应用指南,针对不同类型、不同时期的多发性硬化...     

多发性硬化新旧诊断标准比较(附60例临床分析)

多发性硬化(multiple sclerosis,MS)是中枢神经系统脱髓鞘疾病,既往诊断多发性硬化主要根据临床表现和体征,随着医学影像学技术的发展,尤其是磁共振成像的出现,多发性硬化的检出率增高,使以往的诊断标准受到挑战.2000年7月国际多发性硬化诊断专家组在英国伦敦召开会议并于10月发表了多发性硬化新的诊断标准.现对新旧诊断标准进行比较,并结合我院1994年至今收治的60例多发性硬化患者进行分析,以探讨新旧诊断标准的异同.     

多发性硬化36例临床分析

目的探讨多发性硬化（MS）的临床特点。方法回顾性分析36例多发性硬化患者的一般临床表现及辅助检查。结果MS多见于青壮年,起病多为急性或亚急性,首发症状以肢体无力、感觉障碍及视觉障碍为主要表现,临床表现、影像学特点及诱发电位对MS的诊断具有重要意义。结论根据临床特点,磁共振成像及诱发电位可提高临床确诊率。     

多发性硬化MRI研究进展

磁共振检查在监测多发性硬化的病程进展和临床治疗中发挥着越来越重要的作用.近年来出现的磁共振新技术如磁共振波谱成像、扩散张量成像、磁化传递成像等为早期显示病灶和判断病理类型提供了新的视角.本文对近年来MRI在多发性硬化中的应用作一综述.     

磁共振中央静脉征在多发性硬化方面的作用

多发性硬化的诊断通常比较困难,及时、正确的诊断对疾病的早期治疗和预后有重要的作用。磁共振成像是常规用于检测脑白质病变的较敏感的工具,但其诊断特异性仍不理想,故临床上经常出现诊断不明确的病例。MRI对颅内静脉周围的病灶的检测提高了诊断的特异性,对颅内中央静脉征的发现有望成为诊断的标志物。研究证明,白质病灶中中央静脉征的存在有助于区分多发性硬化和与其类似的炎性疾病及自身免疫性疾病。该文系统分析中央静脉征在头颅磁共振的特征及其在多发性硬化诊断和鉴别方面的作用,为临床提供重要线索。     

多发性硬化49例临床分析

目的 探讨多发性硬化(MS)的临床特点。方法综合分析49例多发性硬化患者的一股临床资料，病变部位，重要辅助检查及治疗转归。结果MS多见于青壮年女性，起病较急，病程缓慢易复发，多以上呼吸道感染为其主要诱因之一，脊髓、视神经易受累，电生理，免疫学及影像学检查有助诊断，糖皮质激素治疗有效。结论 根据临床特点，综合神经电生理，脑脊液免疫学及影像检查能大大提高临床确诊率，其中磁共振成像意义较大。     

31例多发性硬化患者的脑磁共振表现

目的:回顾分析31例多发性硬化患者的脑MRI常规扫描序列及磁敏感加权成像(susceptibility weighted imaging,SWI)的特征,以提高脑多发性硬化诊断的准确率。方法 :选取2012年8月至2014年6月我院确诊的多发性硬化患者31例,分析所有患者的MRI及SWI检查结果。结果:多发性硬化患者脑脱髓鞘斑块在常规MRI图像上可表现为树冠征、犄角征、煎鸡蛋征和倒逗号征,而在SWI图像上可见有小静脉穿行或绕行病灶。结论:常规MRI及SWI图像上的特异性征象对提高脑多发性硬化的诊断准确率有很高的应用价值。     

弥散加权成像表观弥散系数值在儿童海马硬化术前评定中的应用

目的评价弥散加权成像(DWI)表观弥散系数(ADC)值的测量在儿童海马硬化术前评定中的价值.方法 7例经手术及病理证实为海马硬化的儿童患者为研究对象.术前应用3.0T超导型磁共振扫描系统,对患儿进行DWI检查 (b=2000 s/mm2),并定量测量双侧海马结构的ADC值.结果弥散加权图像双侧对比可以观察到5例患者一侧海马结构信号降低(与手术侧别相一致).患者双侧海马结构ADC值的测量结果显示患侧的ADC值均高于对侧,在统计学上有非常显著的差异(P<0.01).结论表观弥散系数值的测量能够早于常规MRI发现海马结构的异常,而且弥散加权成像扫描时间短,成像速度快,适应儿童磁共振检查的需要,ADC值增高能成为儿童海马硬化术前定侧的非常有用的辅助工具.     

MRI对儿童癫痫患者海马硬化的应用价值分析

目的探讨磁共振成像(MRI)对儿童癫痫患者海马硬化的应用价值分析。方法选取2013年11月至2014年11月经手术治疗确诊的癫痫海马硬化患者23例。通过对23例儿童癫痫海马硬化患者进行磁共振成像常规MRI扫描、液体衰减反转恢复序列(FLAIR)薄层扫描、辅助T2W-FLAIR序列、横断位GM-only、三维T1加权成像(3DT1W)与海马单体素磁共振波谱成像(1H-MRS),分析MRI检查对癫痫患者海马硬化的应用价值。结果 MRI检查显示海马结构特征清晰,23例患者在FSET1WI序列图像中海马面积均有萎缩性改变;20例患者出现单侧海马体积缩小(左侧11例,右侧9例);3例患者出现海马体积双侧缩小;FLAIR序列中23例患者海马病变处信号均增高,FSET2WI序列19例患者病变侧海马信号增高,4例无明显变化;海马病变侧头部浅沟明显消失20个,病变侧白质萎缩3个,病变侧颞角增大1个,病变侧颞叶萎缩2个;海马硬化在MRI图像中以表面硬化、颞角增大、T2WI序列中海马信号异常升高、海马体积缩小、病变侧NAA峰下降等为主要特征。结论 MRI各序列的扫描图像对海马硬化区域显示直观,可定量分析脑组织内生化代谢的异常变化,可为深入地了解癫痫灶的病理生理改变及临床手术定位提供丰富的影像学资料。     

Magnetic resonance imaging in multiple sclerosis

Brain and spinal magnetic resonance imaging (MRI) play an important role in the diagnosis of multiple sclerosis (MS). McDonald criteria allow MRI evidence for dissemination in space and dissemination in time to be used to diagnose MS in patients who present with clinically isolated syndromes. Long spinal cord lesion on spinal MRI is a diagnostic finding of opticospinal MS with autoantibodies to the aquaporin-4 water channel. Magnetic resonance spectroscopy, diffusion tensor imaging and magnetization transfer ratio map may reveal chemical pathology and tract change in normal appearing white matter of MS.     

复发型视神经脊髓炎与复发型多发性硬化患者视神经改变的磁共振对照研究

目的：探讨复发型视神经脊髓炎（relapsing neuromyelitis optica,R—NM0）与复发型多发性硬化（relapsing－remitting multiple sclerosis,RRMS）患者视神经的MRI影像表现。方法：对临床满足R—NMO最新Wingerchuk等制定的诊断标准及满足最新McDonald诊断标准的RRMS患者,进行脑部、脊髓及视神经的扫描,并将两组复发型患者视神经MRI表现特点,与32位健康自愿者进行对照研究。同时回顾性分析患者的VEP检查结果。结果：41例R—NMO患者MRI检查显示患者均有单侧或双侧视神经鞘膜腔信号明显增高,呈“轨道样”改变,22例患者（53．7％）伴有视神经增粗,或（和）扭曲,17例（41．5％）可看视神经内点状高信号表现。随着病程的延长,15例（36．6％）MRI上可见单侧或双侧视神经萎缩、变细,甚至扭曲。最终35例（80．5％）视神经内见到点状高信号表现。121例RRMS患者中,共81名（66．9％）患者在MRI上见到了视神经的异常表现,主要表现为单侧或双侧视神经鞘膜腔部分节段或全段呈“轨道样”高信号改变,其中23例（28．4％）表现为视神经球球后起始段局限性信号增高,视神经15例（12．4％）伴有视神经的肿胀,但视神经萎缩不及R—NMO患者明显。随着时间延长,12例（9．9％）可见视神经内点状高信号脱髓鞘改变。两组患者P100峰值延迟时间差异具有统计学意义（P〈0．05）。结论：MRI可以成为视神经炎的首选影像学检查方法。两组患者MRI与VEP检查结果存在一定的差异性,可以成为鉴别诊断的依据。     

Atypical CT pattern in multiple sclerosis

We have reported a case of multiple sclerosis in which CT showed a large enhancing lesion with mass effect that was later found to be an acute demyelinating plaque. Magnetic resonance imaging showed other lesions in the centrum semiovale and periventricular areas bilaterally. The advent of magnetic resonance imaging permits diagnosis of atypical demyelinating processes in a less invasive and more direct manner.     

脑型多发性硬化的磁共振影像学分析

目的:探讨脑型多发性硬化(MS)的临床特点,分析核磁共振检查(MRI)对脑型多发性硬化的诊断价值。方法:搜集脑型多发性硬化患者的MRI结果进行回顾性分析。结果:23例患者入组,脑MRI检查均有阳性发现,以脑室周围及胼胝体最常受累,皮质受累4例(17.4%)。MRI增强见强化病灶者13例(56.5%)。结论:常规MRI对多发性硬化的诊断具有一定的价值,必要时定期复查。     

Hereditary coproporphyria: an imitator of multiple sclerosis.

Hereditary coproporphyria can cause both peripheral neuropathy and central nervous system abnormalities. There are several similarities between multiple sclerosis and hereditary coproporphyria that are probably due to the central nervous system dysfunction present in both. This report describes a 62-year-old man with a five-year history of progressive paraparesis initially diagnosed as multiple sclerosis. Supporting evidence for the diagnosis of a demyelinating disease included three oligoclonal bands in the patient's cerebral spinal fluid, a prolonged visual evoked response bilaterally, abnormal sensory evoked potentials, and an area of increased signal in the posterior cervical cord suggestive of demyelination that was demonstrated on magnetic resonance imaging (MRI). Features atypical for multiple sclerosis were hypoactive deep-tendon reflexes, electromyographic evidence of peripheral neuropathy, and severe constipation. Elevated urine porphyrins and decreased levels of coproporphyrinogen oxidase confirmed the correct diagnosis of hereditary coproporphyria. The patient improved after being placed on a high-carbohydrate diet. Although central demyelination is known to occur in patients with porphyria, delayed evoked potentials and MRI abnormalities have not been previously reported.     

Multiple sclerosis: update in diagnosis and review of prognostic factors

The cornerstone of the diagnosis of multiple sclerosis is the neurologic history and examination. Support for the diagnosis as well as aid in the exclusion of other disorders can be obtained from other investigations. Analysis of cerebrospinal fluid can provide evidence of a central nervous system inflammatory process; evoked potential studies can provide evidence of subclinical multifocal involvement of the central nervous system. Magnetic resonance imaging can reveal dissemination of white matter lesions and help in the exclusion of other neurologic disorders. These tests have been incorporated into the modern diagnostic criteria for multiple sclerosis. The natural history of multiple sclerosis is variable; accordingly, early in the clinical course of the disorder, predicting the prognosis for a specific patient is usually difficult. Nevertheless, some features have limited predictive value.     

Minor head trauma and isolated unilateral internuclear ophthalmoplegia

Internuclear ophthalmoplegia is a syndrome that develops due to a lesion of the medial longitudinal fasciculus. This lesion is mostly caused by multiple sclerosis (usually bilaterally), and only rarely by head injury. A case is presented of unilateral internuclear ophthalmoplegia as an isolated sequel of minor head trauma, which eventually resolved. A 40-year-old woman with isolated internuclear ophthalmoplegia secondary to closed head trauma with anatomical lesions of the mesencephalon in the region of medial longitudinal fasciculus is described. A minor contusion was detected by magnetic resonance imaging. Diplopia resolved in 5 months. In conclusion, internuclear ophthalmoplegia should be considered in the differential diagnosis in patients with recent head injuries showing adduction impairment. The connection between the clinical picture and anatomical lesions is visualized by magnetic resonance imaging.     

结节性硬化综合征的腹部超声表现

目的探讨腹部超声对结节性硬化综合征的诊断和随访价值。方法回顾性分析1999年-2005年11月我院确诊的结节性硬化11例（采用全美TS协会1998年修订的诊断标准）患者的腹部超声表现,对病变的特点进行总结。结果11例结节性硬化患者,肾错构瘤9例,单发2例,多发7例,多囊肾2例,其中1例合并肾错构瘤,单发肾囊肿1例,肝内血管平滑肌脂肪瘤5例,均为多发。结论超声有助于该病的确诊,是结节性硬化综合征腹部病变的重要的影像学随访方法。     

加强多发性硬化的磁共振成像诊断及研究

本述评对多发性硬化(multiple sclerosis,MS)的临床分型、临床诊断标准、MRI诊断标准以及主要的鉴别诊断进行了概述,强调了MRI在MS诊断中的作用,阐述了MRI在开展MS相关研究中的重要性.     

Diagnosis and differential diagnosis of trigeminal neuralgia.

Trigeminal neuralgia is a chronic facial pain classified as a neuropathic pain. There is widespread agreement regarding the International Association for the Study of Pain definition of classical idiopathic trigeminal neuralgia as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve." However, there are variations in presentation that are less easy to diagnose and an erroneous diagnosis of trigeminal neuralgia is occasionally made. In patients with tumors or multiple sclerosis, trigeminal neuralgia is termed secondary. Currently, clinical manifestations are the mainstay for diagnosis because there are no objective tests to validate the diagnosis. The sensitivity and specificity of these clinical manifestations is reviewed. Magnetic resonance imaging (MRI) and three-dimensional fast-in-flow with steady-state precession MRI are performed to determine the presence of tumors or plaques of multiple sclerosis and to assess possible compressions and deformations of the trigeminal nerve. Their specificity and sensitivity regarding compressions found at the time of surgery is reviewed. Other differential diagnoses for chronic unilateral orofacial pain are discussed.