肥厚性硬脑膜炎12例临床表现和影像特征  

Clinical presentations and magnetic resonance imaging features in twelve patients with hypertrophic cranial pachymeningitis

作　　者：曹代荣[1] 慕容慎行[2] 倪希和[1] 李银官[1] 林钊[1] 方哲明[1] 郑贤应[1] 

机构地区：[1]福建医科大学附属第一医院影像科,福州350005 [2]福建医科大学附属第一医院神经内科,福州350005

出　　处：《中华神经科杂志》2005年第3期171-174,共4页Chinese Journal of Neurology

摘　　要：目的研究肥厚性硬脑膜炎(hypertrophic cranial pachymeningitis, HCP)的临床表现和磁共振成像(MRI)特征.方法对12例肥厚性硬脑膜炎患者的临床和MRI资料进行回顾性分析.结果多呈慢性起病,临床上以头痛(11例)和脑神经麻痹(9例)为主要表现,其中外展神经受损者7例,三叉神经4例,视神经、动眼神经、滑车神经、面神经各2例.MRI示受累硬脑膜最多见于鞍旁海绵窦区(7例),小脑幕(6例)次之,中颅窝底、大脑凸面各4例,累及大脑镰3例.同一病例可累及多个部位(弥漫型),本组弥漫型7例,局限型5例.增厚的硬脑膜厚度为0.5～2.0 cm,形状多呈条带状或斑块状; T1WI呈与脑灰质相等或略低信号,T2WI呈低信号,4例靠近脑实质面的硬膜呈明显高信号;增强后增厚的硬脑膜明显强化.5例伴邻近脑实质长T1长T2异常信号灶.复查时,病情改善者硬脑膜变薄,累及范围缩小,强化减轻,伴发的脑内异常信号影缩小或消失.结论肥厚性硬脑膜炎的MRI表现较具特征性,结合临床资料可以做出较明确诊断.Objective To study clinical findings and magnetic resonance imaging(MRI) features of hypertrophic cranial pachymeningitis (HCP).Methods The clinical presentations and MR imaging appearances for twelve patients with HCP were analyzed retrospectively.Results The onset of the disease was mostly chronic. The main clinical manifestations of the 12 cases of HCP were headache (11 cases) and cranial nerve palsy (9 cases). Cranial nerve palsy involved Ⅵ(7 cases),Ⅴ(4 cases),Ⅱ,Ⅲ,Ⅳ,Ⅶ(each 2 cases). The MRI detected thickened dura mater in various locations (7 cases in parasellar, 6 cases in tentorium, 4 cases in middle fossa , 4 cases in convexity of cerebral hemisphere and 3 cases in falx). There were multi-location involved in single case (called diffuse type). 7 cases were of diffuse type and 5 cases of focal type. The thickened dura mater measured 0.5 to 2.0 cm in thickness exhibiting a strip and plaque form. The signal intensity was changed with similar gray matter and less in T_1-weighted imaging and hypointensity signal in T_2-weighted imaging. Part of lesion near brain hemisphere presented long T_2 signal intensity in 4 cases. The thickened dura mater was markedly enhanced after contrast media. The lesion near brain hemisphere presented long T_1 and T_2 abnormal signal intensity in 5 cases. Follow-up examinations: MRI finding for patients with clinical improvement, demonstrated like improvement on MRI. The abnormal signal intensity of brain tissue also decreased significantly.Conclusions The MRI of HCP has characteristic features. The definite diagnosis will be required by consulted clinical information.

关 键 词：肥厚性硬脑膜炎 MRI 脑实质 弥漫型 临床表现 诊断 影像特征 膜厚度 大脑 消失 

分 类 号：R742.9[医药卫生—神经病学与精神病学]