临床常见脑病的临床及影像学特点分析
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摘要
目的探讨临床常见的脑病,包括代谢、中毒及放射性脑病等临床常见脑病的临床及影像学表现特点。方法收集作者医院收治的临床常见脑病患者43例,其中中毒性脑病17例(包括装修苯中毒1例、鼠药氟乙酰胺中毒1例、化疗药物中毒5例、有机磷农药中毒4例、一氧化碳中毒5例、海洛因中毒1例)、放射性脑病5例及代谢性脑病21例(包括Wernick脑病2例、低血糖脑病4例、肝性脑病4例、尿毒症性脑病5例、桥本脑病3例、甲基丙二酸尿症1例、卟啉病1例、伴有囊肿及钙化的白质脑病1例),总结分析临床常见脑病的临床及影像学特点。结果 (1)临床表现:不同病因脑病患者多表现为不同程度的认知功能障碍、精神行为异常、言语含糊及计算力减退等,部分患者表现为肢体力弱或无力,少数患者表现为语音障碍、眼球固定、发作性肢体抽搐及腹痛等。(1)表现为认知功能障碍:包括不同程度的反应迟钝伴记忆力减退(脑病中苯中毒1例、有机磷农药中毒2例、化疗药物中毒5例、一氧化碳中毒2例、放射性脑病5例、尿毒症性脑病5例、桥本脑病3例),以及不同程度的意识障碍(有机磷农药中毒2例、一氧化碳中毒3例、低血糖脑病2例、肝性脑病4例);(2)精神行为异常(桥本脑病3例、甲基丙二酸尿症1例);(3)表现为言语含糊伴计算力减退(海洛因脑病1例);(4)部分患者表现为肢体力弱或无力,少数患者表现为语音障碍、眼球固定、发作性肢体抽搐及腹痛等,其中包括放射性脑病3例、低血糖脑病2例、甲基丙二酸尿症1例、卟啉病1例、伴有囊肿及钙化的白质脑病1例表现为肢体力弱,Wernick脑病2例表现为进行性声音嘶哑伴双下肢力弱及眼球固定,苯中毒及鼠药氟乙酰胺中毒各1例表现为发作性肢体抽搐,卟啉病1例表现为发作性腹痛、肢体无力伴言语不清。(2)影像学表现:影像学表现病变主要累及白质、基底节核团,少数可累及脑室旁及导水管区域,仅1例表现为广泛性脑萎缩。病变表现以白质脑病为主者包括苯中毒、鼠药氟乙酰胺中毒、化疗药物中毒、有机磷农药中毒、一氧化碳中毒、海洛因中毒、尿毒症性脑病及桥本脑病患者;伴钙化与囊变的脑白质病患者表现为双侧大脑半球脑白质区多发大小不等囊状病灶;以基底节核团病变为主者包括低血糖性脑病、肝性脑病、卟啉病、有机磷农药中毒性脑病,一氧化碳中毒迟发性脑病及海洛因中毒性脑病;Wernick脑病患者病灶多位于三脑室旁、侧脑室旁及导水管周围;甲基丙二酸尿症1例表现为广泛脑萎缩。结论临床上常见类型的脑病病因多样,均有不同程度的认知功能障碍,影像学表现包括广泛的白质脱髓鞘、皮层萎缩及基底节区病变等,诊断应结合临床、影像学特点及相应的病史进行诊断。
Objective To research the clinical and imaging features of clinical common encephalopathies,including metabolic,toxic and radiation encephalopathies.Methods We gathered 43 cases of clinical common encephalopathy.17 cases of toxic encephalopathy including benzene(1 case),fluorine ethane(1 case),chemotherapeutic agents(5 case),organophosphorus(4 case),carbon monoxide(5 case),and heroinomania poisoning(1 case).21 cases of metabolic encephalopathy included Wernicke encephalopathy(2 case),hypoglycaemia(4 case),hepatic encephalopathy(4 case),uremia(5 case),Hashimoto encephalopathy(3 case),methyl malonic acid urine disease(1 case),porphyrin disease(1 case)and leukoencephalopathy brain calcifications and cysts(1 case).We researched clinical and imaging features of these clinical common encephalopathies.Results Decreased memory and response were present in benzene(1 case),organophosphorus(2 case),chemotherapeutic agents(5 case),and carbon monoxide(2 case)intoxication,as well as radiation encephalopathy(5 case),uremia(5 case),and Hashimoto encephalopathy(3 case).Seizure was present in benzene(1 case)and fluorine ethane(1 case)in toxication.Conscious distubance was present in organophosphorus(2 case),carbon monoxide(3 case),hypoglycaemia(2 case),hepatic encephalopathy(4 case).Limbs weakness was present in radiation encephalopathy(3 case),hypoglycaemia(2 case),methyl malonic acid urine disease(1 case),porphyrin disease(1 case)and leukoencephalopathy brain calcifications and cysts(1 case).Mental disorders were present in Hashimoto encephalopathy(3 case),methyl malonic acid urine disease(1 case).Blurred speech and decreased calculation were present in heroinomania poisoning(1 case).Hoarse voice,bilateral lower extremities weakness and eyeball fixed showed in Wernicke encephalopathy(2 case).Blurred speech,extremities weakness and paroxysmal abdominal pain showed in porphyrin disease(1 case).Lesions in white matter were present in benzene,fluorine ethane,chemotherapeutic agents,organophosphorus,and carbon monoxide intoxication,as well as uremia,Hashimoto encephalopathy and 1 case of hypoglycaemia.Lesions in basal ganglia were present in hypoglycaemia,hepatic encephalopathy,porphyrin disease,organophosphorus,carbon monoxide and heroinomania poisoning.Lesions in periphery third ventricle,lateral ventricles and aqueductus mesencephali existed in Wernicke encephalopathy.Widespread cerebral atrophy was present in methyl malonic acid urine disease.Multiple spina bifida cystic lesions in bilateral cerebral hemispheres were present in leukoencephalopathy brain calcifications and cysts.Conclusions There are various causes and clinical manifestations of metabolic,radiation and toxic encephalopathy.Cognitive dysfunction is the typical clinical manifestation.To identify diagnosis,we need to combine clinical features including headache,metal disorders,cognitive functions disorders and speech disorders,imaging features including extensive cerebral white matter demyelination,atrophy of cerebral cortex or lesion of basal ganglia and medical history.
Objective To research the clinical and imaging features of clinical common encephalopathies,including metabolic,toxic and radiation encephalopathies.Methods We gathered 43 cases of clinical common encephalopathy.17 cases of toxic encephalopathy including benzene(1 case),fluorine ethane(1 case),chemotherapeutic agents(5 case),organophosphorus(4 case),carbon monoxide(5 case),and heroinomania poisoning(1 case).21 cases of metabolic encephalopathy included Wernicke encephalopathy(2 case),hypoglycaemia(4 case),hepatic encephalopathy(4 case),uremia(5 case),Hashimoto encephalopathy(3 case),methyl malonic acid urine disease(1 case),porphyrin disease(1 case)and leukoencephalopathy brain calcifications and cysts(1 case).We researched clinical and imaging features of these clinical common encephalopathies.Results Decreased memory and response were present in benzene(1 case),organophosphorus(2 case),chemotherapeutic agents(5 case),and carbon monoxide(2 case)intoxication,as well as radiation encephalopathy(5 case),uremia(5 case),and Hashimoto encephalopathy(3 case).Seizure was present in benzene(1 case)and fluorine ethane(1 case)in toxication.Conscious distubance was present in organophosphorus(2 case),carbon monoxide(3 case),hypoglycaemia(2 case),hepatic encephalopathy(4 case).Limbs weakness was present in radiation encephalopathy(3 case),hypoglycaemia(2 case),methyl malonic acid urine disease(1 case),porphyrin disease(1 case)and leukoencephalopathy brain calcifications and cysts(1 case).Mental disorders were present in Hashimoto encephalopathy(3 case),methyl malonic acid urine disease(1 case).Blurred speech and decreased calculation were present in heroinomania poisoning(1 case).Hoarse voice,bilateral lower extremities weakness and eyeball fixed showed in Wernicke encephalopathy(2 case).Blurred speech,extremities weakness and paroxysmal abdominal pain showed in porphyrin disease(1 case).Lesions in white matter were present in benzene,fluorine ethane,chemotherapeutic agents,organophosphorus,and carbon monoxide intoxication,as well as uremia,Hashimoto encephalopathy and 1 case of hypoglycaemia.Lesions in basal ganglia were present in hypoglycaemia,hepatic encephalopathy,porphyrin disease,organophosphorus,carbon monoxide and heroinomania poisoning.Lesions in periphery third ventricle,lateral ventricles and aqueductus mesencephali existed in Wernicke encephalopathy.Widespread cerebral atrophy was present in methyl malonic acid urine disease.Multiple spina bifida cystic lesions in bilateral cerebral hemispheres were present in leukoencephalopathy brain calcifications and cysts.Conclusions There are various causes and clinical manifestations of metabolic,radiation and toxic encephalopathy.Cognitive dysfunction is the typical clinical manifestation.To identify diagnosis,we need to combine clinical features including headache,metal disorders,cognitive functions disorders and speech disorders,imaging features including extensive cerebral white matter demyelination,atrophy of cerebral cortex or lesion of basal ganglia and medical history.
引文
[1]Faigle R,Sutter R,Kaplan PW.Electroencephalography of encephalopathy in patients with endocrine and metabolic disorders[J].J Clin Neurophysiol,2013,30(5):505-516.
[2]邓淑敏,李蕾,刘芳,等.有机溶剂致中毒性脑病5例分析[J].中风与神经疾病杂志,2012,29(7):639-641.
[3]谢明辉,罗文安,赖宇林,等.儿童鼠药中毒性脑病的MRI诊断[J].放射学实践,2009,24(6):691.
[4]林飞飞,干芸根,张龚巍,等.儿童急性淋巴细胞性白血病化疗相关颅脑并发症的MRI表现[J].中国CT和MRI杂志,2014,12(5):24-27.
[5]韦艳萍,杨灿华,蒙喜斯.重度有机磷农药中毒致急性脱髓鞘脑病1例临床分析[J].内科,2013,8(4):383-391.
[6]谢安明,丁耀军.一氧化碳中毒性脑病的弥散加权成像表现与预后的关系[J].南昌大学学报(医学版),2014,54(9):46-49.
[7]周文明,张京,卢德奇,等.海洛因中毒性脑病的影像表现[J].罕少疾病杂志,2008,15(2):19-22.
[8]耿道颖,陈增爱.放射性脑病的临床病理和影像学[J].国外医学临床放射学分册,2001,24(3):161-165.
[9]卢禹.磁共振对Wernicke脑病的诊断价值[J].中风与神经疾病杂志,2015,32(2):177-178.
[10]谭红艳,张健,刘君凤,等.低血糖脑病胼胝体压部MR扩散加权成像高信号的可逆性[J].中国医学影像学杂志,2014,22(7):495-498.
[11]雷新军,邹建勋,李旭丹.MRI诊断获得性肝性脑部变性的价值[J].医学影像学杂志,2010,20(7):929-931.
[12]余美娟,崔凤,郝亮.尿毒症脑病MRI表现[J].浙江实用医学,2013,18(4):280-282.
[13]姚生,戚晓昆,俞英欣,等.桥本脑(脊髓)病的临床分析及治疗体会[J].中国神经免疫学和神经病学杂志,2013,20(3):164-171.
[14]陈娟,李玉华.甲基丙二酸尿症及丙酸尿症的颅脑MRI研究[J].放射学实践,2008,23(6):595-597.
[15]高海凤,鲁琳,李永秋.表现为可逆性后部白质脑病综合征的急性间歇性卟啉病(附1例报告)[J].临床神经病学杂志,2012,25(2):141-143.
[16]程岗,张剑宁.伴钙化与囊变的脑白质病研究进展[J].立体定向和功能性神经外科杂志,2013,26(2):121-124.
[2]邓淑敏,李蕾,刘芳,等.有机溶剂致中毒性脑病5例分析[J].中风与神经疾病杂志,2012,29(7):639-641.
[3]谢明辉,罗文安,赖宇林,等.儿童鼠药中毒性脑病的MRI诊断[J].放射学实践,2009,24(6):691.
[4]林飞飞,干芸根,张龚巍,等.儿童急性淋巴细胞性白血病化疗相关颅脑并发症的MRI表现[J].中国CT和MRI杂志,2014,12(5):24-27.
[5]韦艳萍,杨灿华,蒙喜斯.重度有机磷农药中毒致急性脱髓鞘脑病1例临床分析[J].内科,2013,8(4):383-391.
[6]谢安明,丁耀军.一氧化碳中毒性脑病的弥散加权成像表现与预后的关系[J].南昌大学学报(医学版),2014,54(9):46-49.
[7]周文明,张京,卢德奇,等.海洛因中毒性脑病的影像表现[J].罕少疾病杂志,2008,15(2):19-22.
[8]耿道颖,陈增爱.放射性脑病的临床病理和影像学[J].国外医学临床放射学分册,2001,24(3):161-165.
[9]卢禹.磁共振对Wernicke脑病的诊断价值[J].中风与神经疾病杂志,2015,32(2):177-178.
[10]谭红艳,张健,刘君凤,等.低血糖脑病胼胝体压部MR扩散加权成像高信号的可逆性[J].中国医学影像学杂志,2014,22(7):495-498.
[11]雷新军,邹建勋,李旭丹.MRI诊断获得性肝性脑部变性的价值[J].医学影像学杂志,2010,20(7):929-931.
[12]余美娟,崔凤,郝亮.尿毒症脑病MRI表现[J].浙江实用医学,2013,18(4):280-282.
[13]姚生,戚晓昆,俞英欣,等.桥本脑(脊髓)病的临床分析及治疗体会[J].中国神经免疫学和神经病学杂志,2013,20(3):164-171.
[14]陈娟,李玉华.甲基丙二酸尿症及丙酸尿症的颅脑MRI研究[J].放射学实践,2008,23(6):595-597.
[15]高海凤,鲁琳,李永秋.表现为可逆性后部白质脑病综合征的急性间歇性卟啉病(附1例报告)[J].临床神经病学杂志,2012,25(2):141-143.
[16]程岗,张剑宁.伴钙化与囊变的脑白质病研究进展[J].立体定向和功能性神经外科杂志,2013,26(2):121-124.