海洛因海绵状白质脑病的CT和MR表现

目的：总结海洛因海绵状白质脑病的CT及MRI特征。方法：分析5例海洛因海绵状白质脑病的临床特点，影像表现及1例病理所见，总结其CT和MRI的诊断要点。结果：海劣因海绵状白质脑病的CT和MRI特征为：（1）病变广泛累及小脑，大脑白质及脑博干，内囊后肢，多以小脑损害为重，其中以小脑中线两侧对称性边界清楚的类圆形蝴蝶样病灶为特征。（2）病灶双侧对称，边界清楚；（3）CT示病灶为低密度。MRI示病灶为T1WI低信号以及T2WI高信号影；（4）增强病灶无强化。主要的病理改变为脑白质的空泡样变性。结论：海洛因海绵状白质脑病的CT和MR表现为特征性改变，有海洛因烫吸史者，一旦出现小脑受损的表现，应及早行头部影像学检查明确诊断。     

中毒性脑病的CT与MRI表现

目的:分析各种中毒性脑病的CT与MRI表现.材料和方法:分析23例中毒性脑病患者的CT和MRI表现,其中7例海洛因烫吸中毒,8例CO中毒,2例工业有机溶剂中毒,6例代谢性中毒,总结其CT和MRI的诊断要点.结果:CT表现为脑白质及神经核团的对称性低密度,MRI表现为相应的长T1、长T2信号.其中基底节区发生改变的有19例,小脑齿状核的有5例,脑干有3例,丘脑有6例,发生广泛白质改变的有10例.小脑齿状核发生改变的仅限于海洛因烫吸中毒患者.结论:CT和MRI能发现脑白质及神经核团的变性和坏死改变,但各种中毒性脑病的这些改变大都不具有特异性,只是小脑齿状核的改变仅见于海洛因烫吸中毒患者.正确的诊断需认真分析影像表现,密切结合临床病史.     

海洛因中毒性海绵状脑白质变性的CT和MRI表现

目的探讨海洛因中毒性海绵状脑白质变性的CT和MRI的表现。方法结合文献回顾性分析6例海洛因中毒性海绵状脑白质变性者的CT和MRI资料。结果全部病灶都位于脑白质内,呈多形性、对称性分布。CT为低密度,MRI为长T1、T2信号,边界清楚或模糊,增强无强化。MRI诊断本病明显比CT优越,共显示大脑病灶55个,中脑病灶4个,小脑病灶8个。结论海洛因中毒性海绵状脑白质变性的CT和MRI表现颇具特点,结合吸毒史和中枢神经症状,不难与其他脱髓鞘疾病鉴别诊断。     

不同临床分期海洛因海绵状白质脑病患者的头颅MRI特征

目的探讨不同临床分期的海洛因海绵状白质脑病（HSLE）患者的头颅影像特征和演变规律。方法回顾性分析本院收治的行MRI检查的32例HSLE患者资料，其中I期（小脑受累期）6例，Ⅱ期（合并锥体束受累）21例，Ⅲ期（存在意识障碍）5例。按照临床分期对其吸毒史、临床表现、头颅MRI表现进行总结分析。结果全部患者均有烫吸海洛因病史；亚急性起病多见，小脑体征为早期主要表现；头颅MR检查显示均有双侧对称性的小脑半球损害，按照疾病的严重程度，逐步累及胼胝体压部、内囊后肢和枕顶叶深部白质，部分病例累及脑干及额颞叶深部白质；所有病例头颅MRI均未见明显增强病灶。结论烫吸海洛因病史是诊断HSLE的必要条件。头颅MRI提供了HSLE特征性结构性损害的病灶演变特征，对明确诊断具有重要意义，根据受累部位还有助于判断疾病的临床分期。     

海洛因海绵状白质脑病的PET影像表现

目的　本研究旨在阐述海洛因所致的海绵状白质脑病的PET影像表现及其诊断价值。方法　海洛因海绵状白质脑病患者 6例 ,均为男性 ,年龄 2 6～ 3 7岁 ,平均 3 0 .4岁。临床表现为不同程度的小脑共济失调 ,构音障碍 ,反应迟钝 ,并且进行性加重。既往均曾吸食海洛因史 1～ 3年 ,有 2例就诊时已戒毒 1.5～ 3个月。吸毒方式均为通过铝箔加热经鼻吸入海洛因蒸汽。以上 6例患者经CT及MRI检查均有特征性表现 ,其中 2例经活检病理证实为脑白质海绵状变性。6例患者均进行常规 18F -FDGPET脑3D显像 ,其中有 1例于 18F -FDGPET检查完第 2天进行 13 N -NH3 PET脑血流灌注显像。结果　18F -FDGPET代谢显像 6例患者均有不同程度的大脑双侧内囊后肢及双侧小脑白质对称性放射性稀疏或缺损 ,大脑双侧枕叶及双侧小脑皮质见对称性放射性减低影。其中 1例 13 N -NH3 PET脑血流灌注显像白质改变与 18F -FDGPET显像所见基本一致 ,还可见双侧枕叶、双侧额叶、双侧颞叶部分皮质放射性明显减低影 ,其中双侧枕叶呈对称性改变。结论　海洛因白质脑病PET影像表现有一定特点 ,结合吸毒史有助于海洛因白质脑病的诊断     

海洛因所致海绵状白质脑病的MRI诊断

目的 阐述海洛因所致海绵状白质脑病的MRI表现及其诊断价值。材料与方法 搜集11例具有吸食海洛因史者的MRI资料,全部患者均进行MRI检查,检查序列包括T1WI、T2WI、FLAIR序列。结果 全部患者幕上半球脑白质、小脑半球、内囊后肢及膝部、胼胝体压部及膝部 见双侧,对称性异常改变,2例患者桥脑中央见椭圆形病变。MRI均表现为T1WI呈低信号,T2WI及FLAIR序列为不均匀或均匀高信号。以小脑半球白质受累最为严重,但其灰质核团未见受累,结论 海洛因所致海绵状白质脑病具有典型的MRI表现,结合病史,MRI诊断具有特异性。     

海洛因海绵状脑病的临床和影像表现及疗效观察

目的：总结海洛因海绵状脑病临床表现及CT、MRI、ECT的影像特点。方法：分析4例海洛因海绵状脑病的临床表现、影像特点，并将不同影像方法显示的病灶与临床定位对照。结果：①CT、MRI显示的病灶范围广泛，超过临床神经系统检查定位。②CT、MRI显示4例患者脑内病灶均成对称性分布，病灶范围及MRI信号强度基本一致。呈均匀长T1、长T2信号，CT呈均匀低密度。病灶从下到上分别累及小脑齿状核、中脑导水管周围皮质、中脑锥体束、内囊后肢、胼胝体压部．3例患者累及两侧半卵圆中心(后部为主)．病灶边界清楚，脑室系统及蛛网膜下腔未见变形，余未见明显异常。③2例患者是以小脑、脑干受损为主要临床表现。2例以锥体系及锥体外系受损为主要临床表现。但4例CT、MRI表现基本相同。④3例病灶ECT能反映治疗前后脑灌注的变化，与临床表现相符。常规MRI和CT不能反映临床转归。结论：海洛因海绵状脑病CT、MRI表现有特征性，结合病史诊断不难。但要了解活动性病灶的范围及评估疗效．应采用磁共振灌注、弥散、波谱等功能成像法。     

海洛因海绵状白质脑病的MR表现1例报告

男,48岁。4年吸食“海洛因”史,每天吸食“海洛因”约4 g左右。MR I显示两侧小脑半球对称性长T1、长T2信号(图1,2),在FLAIR序列病灶呈等信号(图3),两侧内囊后肢以及脑干内被盖中央束、内侧丘系显示相同的T2高信号(图4,5)。讨论:吸食海洛因导致海绵状白质脑病由W olters于1982年首先报道[1],随后世界各国不断有病例报道[2]。海洛因海绵状白质脑病有其特征性的影像学表现,病变局限在脑白质,两侧对称,广泛存在,以小脑受侵犯最早。早期表现为小脑半球白质内两侧对称性长T1、长T2信号(MR I)或低密度(CT)病时影像检查也是判断预后的根据,…     

吸毒引起中毒性脑病的MRI表现

目的探讨吸食毒品引起中毒性脑病的MRI表现.材料与方法4例男性,年龄28～40岁.均吸毒品海洛因.吸毒史2～4年.结果(1)临床表现4例均出现程度不同的锥体外系症状、精神症状和智力障碍.(2)MRI表现①脑白质受累型表现为半卵圆中心、内囊、胼胝体和小脑齿状核周围白质和中脑导水管周围白质对称性长T1和长T2改变,②神经核团受累型两侧小脑半球齿状核和两侧丘脑外侧核对称性长T1和长T2改变.结论长期大量吸食毒品对中枢神经系统产生明显的毒性作用.大脑、小脑半球白质和胼胝体、丘脑外侧核和小脑齿状核是主要的累及部位.     

海洛因海绵状白质脑病的临床研究(附16例临床分析)

目的:探讨海洛因海绵状白质脑病的病理特点,临床表现,影像学特点及诊治环节要点.方法:国内外文献回顾结合16例病例临床分析.结果:16例患者多于戒毒后4 d至2周内起病,临床表现以淡漠、构音障碍、反应迟钝、走路不稳为主,并出现肌力、肌张力、腱反射改变.头颅MRI病灶均累及小脑半球(100%),累及脑叶白质者14例(87.5%),内外囊者7例(43.7%),脑干部4例(25%),胼胝体部3例(18.8%),齿状核等灰质核团被累及者6例(37.5%).病灶不被强化.CSF化验无明显异常.给予脱水及对症治疗之后,14例好转出院,1例无变化,1例自动出院后死亡..结论:海洛因海绵状白质脑病多于戒毒后亚急性起病,以共济失调及锥体束受损症状要临床表现,病灶主要累及小脑半球,大脑皮层,胼胝体等部位白质,灰质核团可以受累,病变在MRI上显示为长T1、长T2信号.临床注意与大面积脑梗塞、多发性硬化、脑白质营养不良及皮质-纹状体-脊髓变性等疾病鉴别,治疗方法无特殊,预后一般尚佳.     

Neuroimaging features of heroin inhalation toxicity: "chasing the dragon"

OBJECTIVE: Our objective was to illustrate the dramatic neuroimaging findings of toxic leukoencephalopathy caused by heroin vapor inhalation. CONCLUSION: Symmetric abnormality involving the cerebellar white matter and posterior limb of the internal capsule is characteristic of heroin vapor inhalation toxicity, although involvement may be more extensive, depending on the severity of the condition. MR imaging and CT appear to be essential for making this diagnosis because clinical history is often unreliable and findings at physical examination are nonspecific.     

海洛因烟雾吸入致海绵状白质脑病的CT、MRI表现

目的 探讨海洛因烟雾吸入所致的海绵状脑病的CT、MRI征象,提高对该病的认识和诊断水平。方法 对4例加热吸食海洛因烟雾的患者进行颅脑CT或MR平扫和增强,MRI常规行SE序列平扫、增强,以及液体衰减反转恢复序列（FLAIR）、磁共振波谱（MRS）检查。结果 2例CT扫描的病例表现为双侧小脑半球、脑干、内囊后肢、大脑脚 、胼胝体压部、大脑后部脑白质对称性低密度灶,无强化。2例MRI检查的病例也表现为相应区域长T1、长T2信号,无强化。FLAIR像呈高信号,小脑病变较大脑明显,顶枕叶病变较额叶显著,MRS显示脑白质变性,乳酸升高。结论 该病的CT及MRI表现较具特征性,结合病史,可作出诊断。     

"Chasing the dragon"--imaging of heroin inhalation leukoencephalopathy.

"Chasing the dragon" refers to the inhalation of heroin pyrolysate vapors produced when the freebase form of heroin is heated. Inhalation of these vapors can result in a rare toxic spongiform leukoencephalopathy. The patients may progress through 3 defined clinical stages, with one-quarter reaching the terminal stage, which invariably leads to death. Imaging and, in particular, magnetic resonance imaging (MRI) demonstrates white matter findings that are felt to be specific for this entity and essential in its early diagnosis. We present the typical imaging findings in a pictorial essay format, using images taken from 9 patients who presented within an 18-month period at UBC-affiliated hospitals. These findings include low computed tomography (CT) attenuation and high T2 MRI signal most commonly in the posterior cerebral and cerebellar white matter, cerebellar peduncles, splenium of the corpus callosum, and posterior limb of the internal capsules. In addition, there is often selective, symmetric involvement of the corticospinal tract, the medial lemniscus, and the tractus solitarius. We also present the variable diffusion-weighted imaging and apparent diffusion coefficient findings from 4 of our patients, which to our knowledge, have not been described in the literature.     

Cree leukoencephalopathy: neuroimaging findings.

PURPOSE: To describe the computed tomographic (CT) and magnetic resonance (MR) imaging findings in Cree leukoencephalopathy. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records and neuroimaging studies in 12 infants with Cree leukoencephalopathy (CT in 12 infants, MR in six). The diagnosis was established clinically in six patients and at autopsy in the other six. RESULTS: At CT, extensive, diffuse, and symmetric hypoattenuation was seen in the cerebral and cerebellar white matter in all 12 patients. Hypoattenuation was also seen in the corpus callosum in 11 (92%), internal capsule in 10 (83%), globus pallidus in nine (75%), brainstem in nine (75%), and thalamus in four (33%). The caudate nucleus and putamen were spared. On T2-weighted MR images in six patients, the cerebral and cerebellar white matter, including the subcortical arcuate fibers, was hyperintense as were the internal capsule, corpus callosum, corticospinal tracts, and globus pallidus. The thalamus was affected in four (67%) patients, pons in five (83%), and medulla in four (33%). The caudate nucleus and putamen were not affected. CONCLUSION: Cree leukoencephalopathy causes striking symmetric and diffuse involvement of the cerebral and cerebellar white matter and brainstem with sparing of the caudate nucleus and putamen.     

Chasing "chasing the dragon" with MRI: leukoencephalopathy in drug abuse

Spongiform leukoencephalopathy is a rare complication from inhalation of heated heroin vapour, a practice called "chasing the dragon". The MRI findings are considered pathognomonic, making MRI important for diagnosis. This is especially true in busy urban emergency departments where a variety of patients may present obtunded, unable or unwilling to provide a useful history. Even though the MR pattern of "chasing" toxicity is considered pathognomonic, there are mimickers. We compare the MRI findings of two classic cases of chasing leukoencephalopathy with one case of mimickery from cocaine exposure only. All three cases had diffuse symmetrical white matter changes. MR spectroscopy (MRS) in chasing patients showed increased lactic acid and myo-inositol, decreased N-acetyl aspartate and creatine, normal to slightly decreased choline, and normal lipid peak. MRS in the cocaine exposure patient showed marked increase in lactic acid and lipids. MR perfusion in one chasing patient was normal. In conclusion: (1) All three cases have MR findings suggestive of spongiform leukoencephalopathy. MRS may help differentiate toxicity due to inhaled heroin from other non-heroin related toxicities. (2) Discordance between perfusion and spectroscopy in one chasing patient adds evidence that the disease is due to impaired energy metabolism at the cellular level. (3) MR findings of spongiform leukoencephalopathy secondary to chasing heroin can progress despite apparent abstinence of the drug and during clinical improvement, suggesting the MR changes may represent an evolving injury.     

海洛因依赖的影像学表现分析

目的：分析海洛因依赖者的影像学表现,并提高对本病的认识。方法：本组海洛因依赖者39例中,无神经系统症状组26例和产生神经系统症状组13例分别行MRI和／或CT扫描。结果：无神经系统症状组中MRI表现正常,产生神经系统症状组则出现明显的特征性MRI和CT改变,即对称性大脑半球脑白质、内囊后支、小脑、胼胝体、脑干改变。结果：当海洛因依赖病人出现神经系统症状时,头频MRI和CT的表现具有特征性。     

Reversible delayed posthypoxic leukoencephalopathy

Hypoxic ischemic encephalopathy may cause early deep white matter abnormalities on MR imaging that usually progress to include gray matter and basal ganglia change. Toxic leukoencephalopathy due to heroin inhalation predominantly causes cerebellar and posterior cerebral radiologic change. Both conditions rarely present clinically and radiologically in a delayed manner with subsequent recovery. We report a case of reversible delayed posthypoxic/toxic leukoencephalopathy with no clinical or radiologic evidence of gray matter insult.