磁共振成像表现为双侧桥臂异常信号的不同疾病的临床分析  

Clinical analysis of different cases with abnormal signals of bilateral pontine brachium on magnetic resonance imaging

作　　者：姜季委 孙丽红[1] 张元超[1] 左效衢 商秀丽[1] 

机构地区：[1]中国医科大学附属第一医院神经内科,沈阳110001 [2]辽宁省人民医院神经内科

出　　处：《中华神经科杂志》2018年第1期49-54,共6页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目（81100243,81502181）;沈阳市科技计划项目（17-230-9-17）

摘　　要：目的探讨磁共振成像表现为双侧桥臂异常信号患者的临床表现与疾病诊断，以提高对双侧桥臂病变的认识。方法回顾性分析2015年6月至2017年5月就诊于我院的5例双侧桥臂病变患者的资料，结合辅助检查结果比较其临床表现的差异，分析双侧桥臂病变的特点。结果5例患者磁共振成像极其相似，均表现为双侧桥臂对称性长T1、长T2、FLAIR高信号，增强后无明显强化。但临床表现和诊断各不相同：例1患者表现为头晕、视物旋转、言语不清以及右侧肢体活动不灵，诊断为急性脑梗死；例2患者仅有头晕表现，结合既往脑梗死病史，诊断为急性梗死后华勒变性；例3患者表现为左眼失明、右眼视物不清、四肢麻木，诊断为视神经脊髓炎；例4患者表现为口齿不清、行走不稳、胡言乱语、抽搐，吸食海洛因数十次，诊断为海洛因脑病；例5患者表现为走路不稳、言语不清、面部表情少、饮水呛咳及吞咽困难、尿潴留，诊断为橄榄脑桥小脑萎缩。结论双侧桥臂病变的病因和临床表现复杂多样，脑血管病、脱髓鞘病、感染中毒性疾病、神经系统变性疾病等均可涉及。Objective To investigate the clinical manifestations and diagnosis of patients with abnormal signal of bilateral pontine brachium on magnetic resonance imaging （MRI） , in order to improve the understanding of diseases involving bilateral middle cerebellar peduncles. Methods Combined with auxiliary examination, we compared the clinical manifestations of five patients and analyzed the characteristics of diseases involving bilateral middle cercbellar peduncles. Results MRI was similar in all five patients. Symmetrical T2-weighted, FLAIR-weighted images of bilateral middle cerebellar peduncles were seen on MRI, with corresponding hypointensity on T1 Vii of all five patients. No obvious enhancement has been showed. But there were different clinical manifestations and diagnosis of them. The first patient manifested as dizziness, visual rotation, slurred speech and inactivity of fight limb. She was diagnosed with acute cerebral infarction. The second patient only manifested as dizziness. Combined with the history of cerebral infarction, he was diagnosed as Wallerian degeneration. The third patient manifested as blindness in the left eye, vision blurred in right eye and numbness of limbs. She was diagnosed with neuromyelitis optica. The forth patient manifested as lisp, walking instability, talk rubbish and hyperspaamia. She took heroin for dozens of times, and was diagnosed with heroin encephalopathy finally. The final patient manifested as ataxia, slurred speech, choking, dysphagia, less facial expression and urinary retention. He was diagnosed with olivopontocerebellar atrophy. Conclusions The etiology of bilateral pontine brachium lesion is complex. Cerebrovascular diseases, demyelinating diseases, infectious and toxic diseases, and neurodegenerative diseases can be involved. The mechanism of bilateral pontine brachium lesions is not very clear and needs to be further explored.

关 键 词：卒中 视神经脊髓炎 海洛因 多系统萎缩 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]