1,2-二氯乙烷中毒性脑病6例临床分析

目的探讨1,2二氯乙烷中毒性脑病的临床表现及影像学分析。方法对6例1,2二氯乙烷中毒性脑病患者的临床、头部MRI、治疗预后进行观察分析。结果该组6例为亚急性或迟发性起病,病情进行性加重,均有明确的1,2二氯乙烷接触史。亚急性起病以颅高压及全脑症状为主,迟发性以精神状态改变及锥体外系症状为主。头部MRI表现为对称、弥漫、累及灰白质的病变,主要累及大脑半球、小脑齿状核、基底节、丘脑等。经治疗后,6例中2例因脑疝死亡,3例临床症状改善不明显,1例临床治愈。结论认识1,2二氯乙烷中毒性脑病各阶段的临床表现及影像学特点,使本病患者得到及时有效诊治。有1,2二氯乙烷接触史患者需定期复查MRI,尽早发现病变,降低遗留神经系统损害的几率及程度。     

海洛因中毒引起神经系统损害的临床研究

目的：研究海洛因急慢性中毒引起神经系统的损害。方法：对33例使用海洛因引起急慢性中毒致神经系统损害的部位、临床表现、影象学及后果进行研究。结果：损害部位多样，表现复杂，死亡5例，占15.15%；恶性及致残7例占21.2%；好转及治愈21例。结论：长期使用涨洛因可引起神经系统多部位损害，死亡率及致残率高。     

海洛因中毒引起神经系统损害的临床研究

目的：研讨海洛因急慢性中毒引起神经系统的损害。方法：对３３例使用海洛因引起急慢性中毒致神经系统损害的部位、临床表现、影象学及后果进行研究。结果：损害部位多样,表现复杂,死亡５例,占１５．１５％;恶化及致残７例占２１．２％;好转及治愈２１例。结论：长期使用海洛因可引起神经系统多部位损害,死亡率及致残率高。     

海洛因中毒性脑病的临床与影像学观察

目的：研究海洛因中毒性脑病的临床特点及影像学（CT和MRI）特征，方法：对13例海洛因中毒性脑病患者的临床和影像学资料进行观察和分析。结果：13例为男性，均以烫吸海洛因为吸毒方式，9例是在毒品戒断过程中发病，主要临床表现为亚急性起病的弥漫性脑扣害，尤为精神症状和小脑性共济失计为突出表现。13例CT表现为脑内多发，广泛且明显对称性的低密度灶，累及双额，顶、颞、枕叶白质区及小脑半球齿状核和脑干，一般无占位征象，6例周期MRI检查显示病灶的部位，范围与CT所见大致相同。结论：本病的诊断依靠明确烫吸海洛因史及具有特征性的临床表现和影像学征象。CT与MRI一样，对本病的诊断具有重要价值。激素对本病治疗效果差。     

海洛因中毒神经系统损害的影像研究

目的探讨海洛因中毒引起中毒性脑病脑部影像学特点。方法对37例海洛因中毒患者进行头颅CT/MRI检查分析。结果海洛因中毒脑病的脑部影像改变呈多样性,可表现为正常、轻度脑萎缩,对称性大脑半球的脑白质、内囊后肢、小脑齿状核病变。结论海洛因中毒性脑病可因不同机制而脑部影像表现而不同。     

海洛因中毒性脊髓病一例

近年来海洛因滥用已成为国际问题,海洛因滥用造成的神经系统损害也引起了越来越多人的关注,但主要见于海洛因中毒性脑病,海洛因中毒性脊髓病少见.现将我院2007年9月收治的1例海洛因中毒性脊髓病报道如下.     

海洛因中毒神经系统损害的影像研究

目的 探讨海洛因中毒引起中毒性脑病脑部影像学特点.方法 对37例海洛因中毒患者进行头颅CT/MRI检查分析.结果 海洛因中毒脑病的脑部影像改变呈多样性,可表现为正常、轻度脑萎缩、对称性大脑半球的脑白质、内囊后肢、小脑齿状核病变.结论 海洛因中毒性脑病可因不同机理而出现脑部影像表现也不同.     

海洛因中毒性脑病5例报告

目的探讨海洛因中毒性脑病的诊断及出现中枢神经系统(CNS)损害的特点和机制.方法分析本院收治的5例海洛因中毒性脑病患者的临床及影像学特点、治疗经过及预后.结果5例均出现言语含糊、吐字不清,甚至重复语言;4例出现反应迟钝,智能减退,甚至痴呆;4例出现行走不稳,步态异常.头颅MR均表现为双侧基底节区的尾状核、内囊、脑干腹侧及背侧核团、小脑齿状核以及双侧顶叶枕叶广泛性、对称性分布的T1低信号、T2高信号的病灶.结论海洛因中毒性脑病可出现CNS广泛性、对称性白质脱髓鞘样改变及神经元的变性,其发病机制未明,可能与中毒、缺氧、免疫等综合因素有关.对此类病人应采取综合治疗措施.     

艾滋病神经系统损害的脑部及脊髓影像学改变探讨

目的探讨艾滋病神经系统损害的脑部及脊髓影像学改变。方法对25例艾滋病伴神经系统损害患者包括脑部和脊髓损害进行影像学(CT或MRI)检查,分析其影像学特点。结果 25例有神经系统损害的艾滋病中表现脑部损害较为多见,影像学表现为3例颅内多发占位性病变;4例表现为进行性多灶白质脑病;11例隐球菌性脑病中4例表现为基底节多发小点片状低密度灶,2例有脑膜强化表现;其他无异常表现;4例表现为脑梗死;3例脊髓损害患者,其中1例表现为脊髓炎症改变,2例为后索损害表现为脊髓变细萎缩。结论艾滋病可引起神经系统不同部位及不同性质损害,在影像学上显示不同的非特征性改变。     

酷似中毒性脑病的可逆性后部白质脑病综合征:6例临床分析

目的探讨可逆性后部白质脑病综合征(RPLS)的临床及影像学特点,为与中毒性脑病进行鉴别提供依据。方法回顾性分析6例RPLS患者的临床特点、影像学资料及治疗经过。结果 6例患者分别有大量饮酒史、海洛因吸食史、煤气中毒史、长期接触油漆涂料史、一氧化碳吸入史和有机溶剂接触史。临床主要表现为头痛、恶心、呕吐、癫痫发作以及血压升高。头部MRI主要表现为双侧颞叶、顶叶、额叶、侧脑室旁白质、小脑、脑干病灶,呈长T1、长T2信号,无强化。6例患者对症及去除病因治疗后临床表现及影像学表现均明显好转。结论 RPLS患者可以出现与中毒性脑病相似的临床及影像学特点,特别是当患者有毒物吸入史时,应根据该病相对特征性的临床、影像学及疗效尽早排除。     

安钠咖相关脑损害三例临床与磁共振成像特点

目的 探讨安钠咖相关脑损害的临床表现及磁共振成像(MRI)特征.方法 对3例安钠咖相关脑损害患者进行临床及MRI观察.结果 3例均为男性,均有明确的烫吸安钠咖史(烫吸时间3～7年),除具有反应迟钝、智力障碍等常见的中毒性脑病特征外,尚有特殊的语言及肌张力障碍;头颅MRI显示双侧对称性大脑半球、内囊后肢、胼胝体、双侧大脑脚、脑桥的广泛脱髓鞘改变.3例经皮质激素、神经营养等治疗,在病后40 d病情均明显好转,仅例1残留轻度情感控制障碍.结论 安钠咖相关脑损害有特殊的语言及肌张力障碍,MRI存在广泛脱髓鞘,了解这些特点可为预防和治疗安钠咖引起的并发症提供帮助.     

急性氟乙酰胺中毒性脑病6例临床及影像学分析

目的探讨氟乙酰胺中毒性脑病的神经系统临床表现及影像学特点,以提高对本病认识。方法回顾性分析2006年3月~2012年10月在中国医科大学附属盛京医院急诊科诊断氟乙酰胺中毒性脑病患者6例的临床表现及颅脑磁共振(MRI)特点。结果男4例、女2例口服氟乙酰胺后出现头痛、抽搐及其他神经系统表现。颅脑磁共振表现为皮层及皮层下白质弥漫性对称分布的细胞毒性水肿性病变。经过治疗6例患者临床症状部分或全部缓解。6例患者在6~10 d后复查头颅CT(2例)或MRI(4例)显示病灶完全消失。结论本病诊断主要依靠病史及典型临床表现,影像学缺乏特异性,但头颅MRI表现能对早期诊断提供参考。早期诊断及治疗患者预后良好。     

Diffusion Weighted Imaging in Heroin-associated Spongiform Leukoencephalopathy

Background  Heroin-associated spongiform leukoencephalopathy (HASL) is a rare complication of heroin abuse. We report a case that highlights the increased sensitivity of diffusion weighted imaging (DWI) compared with T2-weighted imaging in the acute setting of HASL. Methods  Single case report. Results  A 36-year-old male with a history of heroin abuse (snorting) presented with a 3-day history of lethargy. MRI brain revealed restricted diffusion involving the globus pallidum and cerebral cortex bilaterally that was not seen on fluid-attenuated inversion recovery (FLAIR) images. The patient was diagnosed with acute HASL. Repeated MRI FLAIR at 3 months confirmed the development of atrophy and T2 hyperintensity in the subcortical white matter, consistent with leukoencephalopathy. Neurological exam at 3-month follow-up was nonfocal. Conclusions  Restricted diffusion, which likely corresponds to electron microscopic findings of fluid entrapment between the myelin lamellae, may be detectable earlier than changes on FLAIR. Clinicians should be aware of the neuroimaging findings of HASL and the increased sensitivity of MRI DWI over T2-weighted images in detecting HASL acutely.     

海洛因脑病的临床表现与影像学特征

目的:探讨海洛因脑病患者临床表现和影像学特点。方法:回顾性分析经临床和实验室确诊的7例海洛因脑病患者的相关资料。结果:所有患者有吸食海洛因病史,在突然戒断期间中发病,临床以言语障碍,共济失调、锥体束征阳性为特征,MRI表现为对称性大脑、小脑白质、内囊以及脑干的长T1、长T2信号,Gd～DTPA增强后无强化,脑脊液检查一般未见异常。结论:海洛因脑病多见于青年男性,有吸食海洛因史,临床表现多变,影像学有较典型的特点。     

Neurosarcoidosis without systemic sarcoidosis

Summary Neurosarcoidosis is a well-recognised complication of systemic sarcoidosis but diagnosis may be difficult if there is no clear evidence of an extracerebral manifestation of the disease. We present the case of a 42-year-old woman with clinical features characteristic of cerebral sarcoidosis including tetraparesis, diabetes insipidus, diencephalic hyperphagia, personality changes, and memory loss. Diagnosis was supported by cerebrospinal fluid (CSF) findings and magnetic resonance imaging (MRI): CSF showed mild lymphocytic pleocytosis, intrathecal production of IgG without oligoclonal bands, and a raised level of lysozyme. MRI revealed multiple contrast-enhanced granulomas at the base of the brain with partial involvement of diencephalic and mesencephalic structures and parts of the spinal cord. There was no evidence of systemic manifestation of sarcoidosis. Administration of corticosteroids led to improvement of the symptoms.     

A case of late adult-onset dentatorubral-pallidoluysian atrophy mimicking central pontine myelinolysis

We report the case of a 52-year-old man with late-onset dentatorubral-pallidoluysian atrophy (DRPLA). MRI findings of late-onset DRPLA usually showed the involvement of cerebral white matter lesions with high intensity on T2-weighted images (WI), in addition to brainstem, globus pallidus, and thalamus. But our patient did not present with abnormal manifestation of white matter lesions of the cerebrum. In addition, the appearance of pontine base was remarkably similar to central pontine myelinolysis (CPM). There is no reported case of DRPLA mimicking CPM in the literature, while there is one previous report of CPM with cerebellar ataxia without pyramidal tract involvement, and CPM may exhibit cerebellar ataxia. Although there is differentiation between CPM and DRPLA by the presence of the atrophy of brainstem and cerebellum, the characteristic MRI findings of pontine base may make it difficult to differentiate CPM with cerebellar ataxia from DRPLA with inconspicuous leukoencephalopathy. In such a situation, we should return to the clinical history and background of a patient, and, if necessary, DNA analysis should be performed for a definite diagnosis.     

Novel Neuroimaging Findings in a Patient with Cerebral Whipple''s Disease: A Magnetic Resonance Imaging and Positron Emission Tomography Study

The authors report a 43-year-old patient with histopathologically proven cerebral Whipple's disease. Magnetic resonance imaging (MRI) revealed a multilayered left frontal lesion without mass effect, no perifocal brain edema, no contrast enhancement, and a thin shell of fluid signal that presented as an incomplete, open ring. An [11C]methionine positron emission tomography (PET) study showed low uptake below the threshold that is characteristic for brain tumors. In precise co-registration to the MR images, the PET data showed that increased uptake was mainly located in the direct adjacent part of the MRI lesion. The fluid signal on MRI corresponded to the extensive outflow of fluid from the lesion, which was observed during neurosurgical resection, and also to the neuropathological findings. The authors conclude that this cerebral manifestation of Whipple's disease made a unique and hitherto undescribed appearance on MRI; uptake pattern of PET amino acid tracer may help in the preoperative distinction of inflammatory from neoplastic lesions.     

以失用为主要表现的胼胝体梗死

目的探讨胼胝体梗死的临床表现、病因及鉴别诊断特点。方法对2005年7月收治的1例53岁男性胼胝体梗死患者的临床表现、影像学特点、病因机制及其治疗过程进行回顾分析。结果临床主要表现为发作性黑蒙、言语不利,既往有高血压、糖尿病、脑梗死、吸烟、饮酒史,体格检查以失用为主要表现。头部MRI检查可见左侧脑室旁、胼胝体梗死,右侧基底节、脑桥陈旧性腔隙性梗死;脑血管造影检查显示为多发性血管狭窄,其中以左侧大脑中动脉、右侧颈内动脉及基底动脉最为严重。经颈内动脉内膜剥离术及颈内动脉支架植入术治疗,临床症状缓解。结论失用可以是胼胝体梗死的主要表现,其病因是在脑动脉粥样硬化基础上的血流动力学改变,患者预后良好。     

水痘-带状疱疹病毒性脑血管炎的临床表现以及影像学、病理学改变

目的 分析水痘-带状疱疹病毒（VZV）引起的脑动脉炎的临床特征、影像学和病理改变。方法 对2例VZV脑动脉炎患者的临床表现、辅助检查、影像学和病理特征进行了总结。结果 患者为急性起病，表现为脑卒中样发作。从病毒感染到脑梗死的发生间隔时间分别为5d和6个月，头颅MRI表现为半卵圆、双侧基底节区的多发性长T1、长T2信号，注射钆喷酸葡胺（Gd-DTPA）后无增强效应。数字减影血管造影术（DSA）检查发现在大脑中动脉、前动脉存在多处狭窄段。病理学检查发现，在脑组织血管周围有炎性细胞浸润，呈血管鞘样，脑内血管存在多处明显的纤维素样坏死。该病预后良好。结论 VZV引起的脑动脉炎存在病毒前驱感染病史，具有较为特征的临床和影像学表现。