脑后部可逆性脑病综合征MRI及DWI表现及临床意义

目的分析脑后部可逆性脑病MRI及DWI的影像学特点。方法 15例经临床诊治及MRI检查的脑后可逆性脑病综合征(Poster revers Tble encephalopathy.syndrome,PRES)患者的资料,均常规MRI及DWI扫描并计算出ADC图。结果 15例双侧大脑半球后部皮层受损,以枕叶、顶叶、颞叶好发,其中11例伴额叶受损,3例伴侧脑室深部白质、基底节受损,2例伴丘脑、小脑半球受损。13例发病时以血管源性水肿为主,2例为细胞毒性水肿。5例在首次检查后7~21d复查,3例病灶为可逆性完全消失,2例大部分病灶可逆性消失,局部有残留病灶。结论脑后部可逆性脑病综合征影像学具有特点,DWI、ADC容易区分血管源性水肿和细胞毒性水肿病灶,有助于临床鉴别及判断预后。     

并发颅内出血的可逆性后部脑病综合征5例临床分析并文献复习

目的探讨可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)并发颅内出血的临床及影像学特点。方法回顾性分析我院5例并发颅内出血的PRES患者的临床及影像学特点。结果 5例PRES患者均为年轻女性,4例继发于子痫前期,另1例继发于慢性肾衰竭。临床表现为头痛、癫痫发作、视物模糊、意识状态改变及局灶性神经功能缺损等。影像主要表现为双侧大脑后部为主的血管源性脑水肿,但也有额叶、基底节、脑干、小脑受累和细胞毒性脑水肿等不典型表现。5例患者均合并脑实质血肿,4例位于水肿周围,1例并发硬膜下血肿。5例患者均合并血小板减少及凝血功能异常,且均因病情危重而入住重症监护病房,经积极治疗后临床表现及影像学表现均明显好转。结论合并凝血功能异常的PRES较易出现颅内出血等并发症。     

后部可逆性脑病综合征2例病例报告

正后部可逆性脑病综合征(posterior reversible encephalopathy syndrome,PRES)是指患者在特定临床情况下出现皮质下可逆性血管源性水肿,出现急性或亚急性神经系统症状和体征,通常来说其临床及影像学改变具有可逆性~([1])。MRI技术的发展极大促进了对此病的认识,已证实此病并非完全可逆,且病灶并不局限于大脑后部脑白质,亦不局限于血管源性水肿改变。本文将报告2例PRES患者并对该病临床及影像学特点进行总结,以期加强临床医师对此病的认识并做出     

子痫前期或子痫致可逆性后部脑病综合征的临床及影像学分析

目的 探讨子痫前期或子痫致可逆性后部脑病综合征( posterior reversible encephalopathy syndrome,PRES)的临床及影像学特点.方法 选择子痫前期或子痫致PRES患者21例,采用回顾性分析方法对临床症状及脑磁共振成像(magnetic resonance imaging,MRI)资料进行分析.结果 主要临床症状:21例患者中癫痫发作18例,头痛16例,意识状态改变15例,视觉障碍12例;PRES病灶分布:顶、枕叶20例,额叶14例,颞叶11例,基底节区11例,胼胝体压部4例,小脑半球3例,脑干1例;PRES病灶分布模式:经典型7例,全脑型7例,额上沟型6例,部分或不对称型1例.结论 子痫前期或子痫致PRES临床症状典型,除顶、枕叶外,额叶、颞叶、基底节区等部位累及常见,多见3种主要病灶分布模式,准确识别其影像学表现对正确诊断具有重要意义.     

可复性后部脑病综合征的影像学诊断

目的探讨可复性后部脑病综合征（PRES）的影像学表现.方法回顾性分析了12例PRES病人的临床和影像学资料,其中9例为子痫/先兆子痫,2例为高血压脑病,1例为环孢菌素A（CSA）的神经毒性.12例均行MRI检查,其中7例同时行钆喷替酸葡甲胺（Gd-DTPA）增强扫描,4例行磁共振血管造影（3D-TOF MRA）检查,1例行弥散加权成像（DWI）.7例行CT平扫检查,2例行脑血管造影（DSA）检查.结果MRI显示病灶基本上呈双侧对称性分布,多数病灶位于顶、枕叶脑实质内,T1WI呈等或略低信号,T2WI呈高信号,FLAIR像显示皮层和皮层下白质明显高信号影,较T1WI、T2WI更加清楚.注射Gd-DTPA后多无明显异常对比增强.1例DWI显示双侧顶、枕叶及额叶皮层内弥散受限呈高信号,ADC图显示邻近的皮层下白质呈高信号.4例CT显示双侧顶、枕叶及额叶对称性斑片状低密度影,3例CT未见异常.经对症处理后复查示所有病灶几乎完全吸收消失.结论PRES的影像学表现具有特征性.MRI应作为诊断本病的首选手段.     

子癇患者的脑部磁共振改变

目的：探讨子癇患者的脑部MRI改变。方法：回顾性分析16例子患者的脑部MRI资料,总结其特点。结果：16例患者均表现为大脑半球皮质、皮质下白质多发病灶,T1WI低信号、T2WI、Flair高信号,DWI等或高信号、表观弥散系数（ADC）图高信号,大部分呈对称分布。其中2例ADC图显示在高信号范围内夹杂局限性低信号改变;2例患者在病灶中央区合并局灶性T1WI稍低信号,T2WI、Flair低信号改变。受累部位以双侧枕、顶叶最常见,其次为基底节、额叶、颞叶,少数累及小脑半球、脑干。部分患者短期内复查MRI完全恢复正常。结论：血管源性脑水肿是子癇患者主要的影像学改变;少数患者可合并细胞毒性脑水肿或脑出血;病变最常见累及后循环,多呈可逆性。     

脑肿瘤瘤周水肿的研究进展

脑水肿是指脑实质内水分的异常增多.按照Klatzo[1]分类方法,分为细胞毒性脑水肿和血管源性脑水肿.脑肿瘤瘤周水肿(peritumoral brain edema,PTBE)是典型的血管源性脑水肿,尤其多见于胶质瘤、转移瘤和脑膜瘤,导致颅内压增高,产生一系列并发症,甚至危及患者生命[2].PTBE发生机制复杂.本文就国内外对PTBE发生机制、影像学表现及其治疗方面的最新进展做一综述.     

可逆性后部白质脑病综合征临床及影像学特点15例分析

目的探讨可逆性后部白质脑病综合征的临床和影像学特征。方法分析15例可逆性后部白质脑病综合征患者的临床和影像学资料。结果 15例可逆性后部白质脑病综合征患者继发于高血压脑病、系统性红斑狼疮、尿毒症、子痫、甲状旁腺腺瘤伴发高钙血症、非霍奇金淋巴瘤、肾移植术后、急性淋巴细胞白血病和神经白塞病。其中血压升高者10例,临床主要表现为头痛、癫痫发作、视物模糊和意识障碍。头颅CT或MRI检查主要表现为对称的枕叶白质脑水肿,部分伴有顶额颞叶等病变。经治疗后患者症状消失,头颅CT或MRI复查病灶完全或大部分消失。结论可逆性后部白质脑病综合征可由多种病因产生,影像学主要表现为大脑后部白质血管源性脑水肿改变,及时治疗后症状和影像学特征迅速改善。     

吉兰巴雷综合征合并可逆性后部白质脑病综合征1例报道及文献复习

目的 探讨吉兰巴雷综合征(GBS)合并可逆性后部脑病综合征(Posterior reversible encephalopathy syndrome, PRES)的临床特点、影像学改变。方法 分析本科收治的1例GBS合并PRES的患者临床及影像学资料,并进行相关文献复习。结果 本例患者先有四肢乏力等表现,在发病的第7 d出现血压大幅波动(58～204/38～152 mmHg)、头痛、躁动不安、幻视等表现而转入本院,入院时患者四肢对称性下运动神经元性瘫痪、头颅MRI示两侧枕叶、顶叶对称性长T₁、长T₂异常信号影,ADC高信号、DWI等信号病灶,发病第2周脑脊液检查示蛋白细胞分离现象,肌电图检查显示右侧正中神经、双侧胫后神经F-波潜伏期延长,经过及时降血压及对症治疗,1个月后四肢肌力逐渐恢复、复查头颅MRI提示原有病灶基本消失。复习相关文献发现国外已经有17例类似患者报道,国内有1例儿童患者的报道,这些患者均有典型的吉兰巴雷综合征表现,在起病的早期多数患者还有不同程度的血压升高、头痛、视觉异常、意识障碍、癫痫等表现,所有患者头颅MRI均出现可逆性两侧枕叶、顶叶对称性长T₂及ADC高信号病灶,经积极治疗后多数患者预后良好。结论 GBS合并PRES临床特点包括除肢体迟缓性肌无力等GBS的表现外,多数患者会有不同程度的血压升高、头痛、视觉异常、意识障碍、癫痫等表现,头颅MRI出现可逆性两侧枕叶、顶叶对称性长T₂及ADC高信号病灶,多数患者预后良好。     

影像学分型与急性脑梗死患者认知功能关系的研究

目的探讨影像学分型与急性脑梗死患者认知功能关系。方法对136例急性大脑梗死患者于发病后24～72h内行颅脑MRI检查确定梗死部位、测量病灶大小并作出影像学分型，于发病1周内，在患者床前采用简易精神状态检查法（mini—mentalstate examination，MMSE），检测患者的认知功能，并同步进行事件相关电位P300的检测，判断患者认知功能的情况，对比分析应用MRI进行的影像学分型与认知功能关系。结果额叶、颞叶脑梗死患者的MMSE和WAIS—RC评分明显低于顶枕叶和基底节区梗死患者，P300潜伏时明显长于顶枕叶和基底节区梗死的患者，但其P300波幅低于顶枕叶和基底节区梗死的惠者；中梗死和多发性梗死患者的MMSE和WAIS—RC评分明显低于顶枕叶和基底节区梗死患者，B300潜伏时明显长于顶枕叶和基底节区梗死的患者，但其P300波幅低于顶枕叶和基底节区梗死的患者。结论影像学分型与急性脑梗死患者认知功能有相关性。     

Relationships between edema degree and clinical and biochemical parameters in posterior reversible encephalopathy syndrome: a preliminary study

The objective of the study was to investigate the associations between the degree of edema with the clinical and biochemical parameters such as serum lactate dehydrogenase (LDH), albumin (ALB) in posterior reversible encephalopathy syndrome (PRES) patients. Forty-nine patients with typical clinical symptoms and characteristic MR imaging findings of PRES were included in this study. Lactate dehydrogenase and ALB were analyzed with the immunoluminometric assays. Fluid-attenuated inversion recovery images were used to evaluate the distribution of the extent or severity of vasogenic edema by two observers. Correlation analysis between the scores of brain edema and the blood pressures, clinical conditions and biochemical parameters was performed. No significant difference of brain edema score was found between patients with eclampsia, chronic renal failure and other clinical condition (P?>?0.05). Both mean arterial pressures and LDH level were moderately correlated with the scores of brain edema distribution (Spearman's ρ test, r?=?0.405 and 0.497, respectively, P??0.05). Larger and more diffuse lesions may be predicted by higher LDH level and blood pressure. The overall severity of the systemic process might be predicted by the degree of edema expression in PRES.     

Reversible posterior encephalopathy syndrome: case report

The posterior reversible leukoencephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiologic entity.The most common causes of PRES are hypertensive encephalopathy, eclampsia, cyclosporin A neurotoxicity and the uremic encephalopathies.Most patients are markedly hypertensive at presentation, although some have only mildly elevated or even normal blood pressure. Symptoms may include headache, nausea, vomiting, altered mental status, seizures,stupor, and visual disturbances. On CT and MR studies, edema has been reported in a relatively symmetrical pattern, typically in the subcortical white matter and occasionally in the cortex of the occipital and parietal lobes. These often striking imaging findings usually are resolved on follow-up studies obtained after appropriate therapy. Diffusion-weighted images would not show hyperintense signal because of the presence of interstitial rather than cytotoxic edema. We report a case of PRES due to hypertensive encephalopathy studied by CT and MRI.     

Case of posterior reversible encephalopathy syndrome with cerebral vasoconstriction]

A 56-year-old woman attended our hospital because of acute severe (thunderclap) headache. Neurological examination was normal and no abnormality was found on head CT or by cerebrospinal fluid examination. A few days later, she experienced a recurrence and suffered a seizure in her left upper and lower extremities. On neurological examination, she had conjugate deviation of the eyes toward the right side and left lower limb paralysis with Chaddock sign. MRI showed multiple hyperintense lesions in the bilateral occipital and parietal lobes, predominantly in the subcortical white matter at the right side on T2-weighted and FLAIR images. We diagnosed posterior reversible encephalopathy syndrome (PRES) because the ADC map showed a vasogenic edema pattern (increased ADC values in the hypodense lesions on diffusion-weighted image). Her blood pressure was normal and there were no underling diseases. As MRA showed vasoconstriction especially in bilateral posterior cerebral arteries, we initiated a therapy with a Ca-channel blocker. On follow-up MRI, the hyperintense lesions on T2-weighted and FLAIR images had almost disappeared, and vasoconstriction was also improved on MRA. This case suggested that cerebral vasoconstriction could underlie both thunderclap headache and PRES.     

脑卒中后认知损害与影像学分型的相关研究

目的探讨不同部位缺血性脑卒中急性期患者认知功能损害的特点。方法收集230例脑梗死急性期（1～14 d）患者,包括额叶31例,颞叶27例,顶叶26例,枕叶21例,基底节47例,丘脑35例,小脑23例,脑干20例;采用中文版蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）对受试者进行认知功能测评。结果 （1）各病变部位认知障碍的发生率不同;额叶组、颞叶组及丘脑组MoCA总分低于其他各组（P〈0.05）,顶叶组、枕叶组MoCA总分与基底节组、小脑组和脑干组比较有显著性差别（P〈0.05）;（2）额叶组在视空间及执行功能、注意认知域及MoCA总分值低于其他各组（P〈0.05）;颞叶组在命名、延迟回忆认知域分值低于其他各组,MoCA总分与顶叶组、枕叶组、基底节组、小脑组、脑干组有显著性差异（P〈0.05）;顶叶组及枕叶组MoCA总分低于基底节、小脑、脑干组（P〈0.05）;丘脑组在视空间及执行功能、注意认知域及MoCA总分低于顶叶、枕叶、基底节、小脑和脑干组,语言及定向认知域分值低于其他各组（P〈0.05）。结论不同部位脑梗死患者认知障碍的发生率及认知损害的特点不同。     

热射病导致的脑梗死或脑出血的诊治分析

目的 探讨热射病导致的脑梗死或脑出血的影像学表现、治疗方法及其效果。方法 回顾性分析2012～2022年收治的20例热射病导致的脑出血或脑梗死的临床资料。结果 2例出现微出血病灶,部位为右额叶及左顶叶;18例出现缺血样改变,包括放射冠、基底节、额叶、颞叶、顶叶、枕叶、皮层下白质、胼胝体、海马,其中2例伴有明显脑水肿。出院时,11例恢复正常,未遗留明显肢体活动障碍、言语障碍及逻辑思维能力障碍;2例出现认知功能减退,主要存在语言表达能力障碍、遵嘱动作较差、小脑共济失调（轮替试验阳性、Romberg阳性）;3例深度昏迷,GCS评分3～4分;4例死亡。结论 热射病导致的脑梗死或脑出血,临床少见,多数病人保守治疗预后良好。建议早期进行康复治疗,以减少神经功能障碍。     

脑小血管病总负荷与记忆力下降老年患者认知功能、脑萎缩及脑灌注的相关性

目的 探索脑小血管病（cerebral small vessel disease,CSVD）总负荷与记忆力下降老年患者认知功能、 脑萎缩及脑灌注的关系。 方法 回顾性纳入2015年12月-2017年12月同济医院神经内科门诊及记忆减退专病门诊主诉记忆力 下降患者,收集一般资料及影像学信息,进行认知评估、CSVD总负荷评分、全脑及各脑叶脑萎缩评分, 计算脑血流（cerebral blood flow,CBF）值。采用Spearman相关分析CSVD总负荷评分与认知功能、脑萎 缩及CBF的关系。 结果 共纳入200例,平均年龄69.16±9.44岁,男性99例（49.5%）。CSVD总负荷与MoCA评分呈负相 关（r =-0.202,P =0.004）;与全脑（r =-0.234,P =0.001）、额叶（r =-0.252,P <0.001）、顶叶（r =- 0.253,P <0.001）、枕叶（r =-0.224,P =0.001）CBF呈负相关;CSVD负荷与全脑（r =0.313,P <0.001）、 额叶（r =0.393,P＜0.001）及顶叶（r =0.237,P =0.001）的脑萎缩评分呈正相关。 结论 CSVD总负荷越高,认知功能越差、脑灌注越低、脑萎缩越严重。     

Quantitative MRI study of progressive cerebral atrophy in multiple system atrophy]

We investigated cerebral atrophy in multiple system atrophy (MSA) by quantitative analysis of MRI. The subjects were 28 patients with MSA (14 striato-nigral degeneration; SND, 14 olivo-ponto-cerebellar atrophy; OPCA. 106 MRI examinations were performed totally) and 85 normal persons for control. The ratios of the ventral pons to the infratentorial space in the sagittal section, the putamen, cerebrum, frontal lobe and parietal & occipital lobes to the intracranial space in the horizontal section, and the temporal lobe to the intracranial space in the coronal section were measured. In the early stage of the disease, OPCA showed significant atrophy of the ventral pons compared with SND, and conversely, SND demonstrated significantly smaller putamen than that in OPCA. According to the progression of the disease, the atrophy of these neural tissues progressed, which resulted in no significant differences between SND and OPCA. The cerebral atrophy was observed in 17 MSA patients. The atrophy of the frontal lobe was much frequent and prominent to that in the temporal lobe and parietal & occipital lobes. SND showed higher incidence of the cerebral atrophy than OPCA in the early stage of the disease. In long period follow-up cases, one case showed cerebral atrophy in earlier stage, and another case in late stage. We indicated the involvement of the cerebral hemispheres in MSA, especially the frontal lobe.     

Posterior reversible encephalopathy syndrome: a case of unusual diffusion-weighted MR images

Posterior reversible encephalopathy (PRES) represents an uncommon entity related to multiple pathologies, the most common of which is hypertensive crisis. PRES is classically characterized as symmetrical parieto-occipital edema, but may affect other areas of the brain. Diffusion-weighted magnetic resonance imaging (DWI) is important for differentiating between vasogenic and cytotoxic edema. We present here the case of a 43-year-old woman, known to suffer from arterial hypertension and severe renal failure, who developed PRES with restricted apparent diffusion coefficients (ADC) in various cerebral areas, suggesting irreversible tissue damage. Nevertheless, follow-up cranial MRI revealed complete remission, indicating that restricted diffusion does not always lead to cell death in this pathology. The underlying pathophysiological mechanism is not well understood. Such reversibility of diffusion anomalies has already been reported with transient ischemia, vasospasm after subarachnoid hemorrhage and epilepsy but, to our knowledge, never before in PRES.