原发性中枢神经系统血管炎10例临床分析及高分辨核磁应用价值  

A clinical analysis of 10 cases of primary central nervous system vasculitis and value of high-resolution magnetic resonance imaging

作　　者：乔清[1] 邢永红[1] 曹宸 俞宁[1] 周官恩[1] 李志涛[3] QIAO Qing;XING Yonghong;CAO Chen(Fifth Department of Neurology,Tianjin Huanhu Hospital Affiliated to Nankai University,Tianjin 300350,China)

机构地区：[1]天津市环湖医院(南开大学附属环湖医院)神经内科五病区,天津300350 [2]天津市环湖医院(南开大学附属环湖医院)医学影像科,天津300350 [3]天津市环湖医院(南开大学附属环湖医院)神经外科九病区,天津300350

出　　处：《中风与神经疾病杂志》2023年第7期641-646,共6页Journal of Apoplexy and Nervous Diseases

基　　金：天津市卫生健康科技人才培育项目(KJ20065)。

摘　　要：目的总结原发性中枢神经系统血管炎病例的临床特点,分析高分辨核磁在诊断中的价值。方法从天津市环湖医院住院患者及病案室归档住院病历中,共收集到10个原发中枢神经系统血管炎病例,结合文献总结分析临床表现、实验室检查、影像学、治疗、预后等特点。结果10例患者的主要临床表现包括言语障碍、肢体无力、头痛、头晕、视物成双、呃逆等;系统性血管炎免疫相关检查大致正常,脑脊液检查蛋白轻度升高。实质影像学检查显示病灶前后循环供血区均可分布,血管影像学检查显示动脉狭窄、闭塞、微动脉瘤等病变。部分病例应用糖皮质激素(简称激素)治疗。经3个月、1年随访大部分患者预后良好,2例复发后缓解,1例复发后死亡。结论高分辨核磁发现责任血管管壁均匀向心性增厚伴强化,有助于原发中枢神经系统血管炎明确诊断。Objective To summarize the clinical characteristics of primary central nervous system vasculitis and analyze the value of high-resolution magnetic resonance imaging(MRI)in its diagnosis.Methods We collected 10 cases of primary central nervous system vasculitis from inpatient medical records of our hospital.We also reviewed literature to analyze the clinical manifestations,laboratory examination,imaging,treatment,and prognosis of this disease.Results The main clinical manifestations of the 10 patients included speech and language impairment,limb weakness,headache,dizziness,diplopia,and hiccup.Immune test results for systemic vasculitis were generally normal.The protein level in cerebrospinal fluid was mildly elevated.Parenchymal imaging examination showed that the lesions could be distributed in the anterior and/or posterior circulation areas.Vascular imaging examination showed the presence of artery stenosis,artery occlusion,and microaneurysms.Some cases were treated with glucocorticoids.At 3-month and 1-year follow-ups,most patients had good outcomes,2 cases had remission after relapse,and one case died after relapse.Conclusion The offending vessel wall shows uniform concentric thickening with enhancement on high-resolution MRI,which is helpful to diagnose primary central nervous system vasculitis.

关 键 词：原发性中枢神经系统血管炎 血管炎 高分辨核磁 血管造影 

分 类 号：R743.9[医药卫生—神经病学与精神病学]