双侧丘脑病变的临床表现及影像学分析

发布时间：2018-06-01 23:01

本文选题：双侧丘脑病变 + 影像学　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:分析双侧丘脑病变的病因、临床症状、影像学表现、诊断及预后等,提高对双侧丘脑病变的认识,从而为临床诊治提供帮助。方法:对2011年9月～2017年2月吉林大学第一医院神经内科收治的50例双侧丘脑病变患者,根据病因不同进行分组,收集患者的一般临床资料,分析其临床表现、影像学特征、诊断及预后情况,总结不同病因所致双侧丘脑病变的特点。结果:(1)一般情况本研究共纳入50例患者,男22例,女28例,发病年龄13～77岁,平均年龄48.08±18.30岁。(2)原因血管性疾病29例(58%):其中动脉性梗死17例,静脉性梗死9例,丘脑出血2例,中央变异型可逆性后部白质脑病1例;代谢性疾病6例(12%),为Wernicke脑病;遗传性疾病5例(10%):其中肝豆状核变性4例,肾上腺脑白质营养不良1例;感染性疾病4例(8%):其中巨细胞病毒所致脑膜脑炎1例,可能的流行性乙型脑炎3例;脱髓鞘疾病2例(4%):其中急性播散性脑脊髓炎1例,多发性硬化1例;免疫相关性疾病3例(6%):脑干脑炎1例,自身免疫性脑炎1例,神经精神狼疮1例;很可能的淋巴瘤1例(2%)。(3)临床表现本研究中意识障碍39例,言语障碍22例,运功障碍20例,认知障碍19例,精神症状13例,眼动障碍14例,瞳孔异常13例,头痛10例,锥体外系症状9例,癫痫发作5例,共济失调3例,感觉障碍1例。(4)特征性影像学表现所有病例头MRI均表现为双侧丘脑T1WI低信号及T2WI高信号。Percheron动脉闭塞所致双侧丘脑梗死15例,8例累及中脑,其中4例呈中脑“V”字征,3例累及丘脑前部,DWI高信号;静脉性梗死可见双侧丘脑对称性DWI高信号,血管源性水肿比较明显,3例MRI可见大脑大静脉、直窦异常信号,均行MRV检查提示大脑深静脉血栓形成;丘脑出血行CT检查表现为不对称高密度影,1例CTA检查提示moya-moya病;中央变异型可逆性后部白质脑病除了累及丘脑外,伴有双侧基底节、脑干、小脑受累。Wernicke脑病患者除累及丘脑内侧,还伴有中脑导水管、乳头体、四叠体、第三、四脑室旁、海马、基底节受累。肝豆状核变性除了累及丘脑外,伴有尾状核、苍白球、壳核、脑干受累,T2WI表现为稍高不均匀信号,FLAIR混杂信号;肾上腺脑白质营养不良除了累及丘脑外,典型表现为侧脑室三角区对称分布的蝶翼状大片白质病变,脑干、小脑、海马亦受累。感染性病因患者中均为病毒性感染,除了丘脑对称性病变外还伴有基底节、海马、胼胝体受累。急性播散性脑脊髓炎患者丘脑肿胀明显,伴脑干受累。(5)预后死亡患者3例:其中急性播散性脑脊髓炎1例,神经精神狼疮1例,很可能的淋巴瘤1例。存活患者中往往遗留不同程度的意识障碍、眼动障碍、认知障碍、精神症状、锥体外系症状等,预后不佳。结论:双侧丘脑病变病因较多,几乎包括了中枢神经系统疾病所有常见的病因,如血管性、感染性、代谢性、遗传性、脱髓鞘性、免疫相关性疾病等,本研究中双侧丘脑病变以血管性疾病最常见,血管性疾病中以动脉性梗死最多见。不同原因导致双侧丘脑病变的影像学各有特点,掌握常见病因的影像学表现对诊断双侧丘脑病变有重要的意义。
[Abstract]:Objective: to analyze the etiology, clinical symptoms, imaging manifestations, diagnosis and prognosis of bilateral thalamus, to improve the understanding of bilateral thalamic lesions, and to provide help for clinical diagnosis and treatment. Methods: 50 cases of bilateral thalamus treated in No.1 Hospital of Jilin University from September 2011 to February 2017 were divided into different pathogeny. Group, collect the general clinical data of the patients, analyze their clinical manifestations, imaging features, diagnosis and prognosis, summarize the characteristics of bilateral thalamus caused by different causes. Results: (1) the general situation of this study included 50 cases, 22 men and 28 women, the age of 13~77 years, and the average age of 48.08 + 18.30 years. (2) the cause of vascular disease 29. Cases (58%): 17 cases of arterial infarction, 9 cases of venous infarction, 2 cases of thalamic hemorrhage, 1 cases of central variant reversible posterior white encephalopathy, 6 cases of metabolic disease (12%), Wernicke encephalopathy, 5 cases of hereditary disease (10%), 4 cases of hepatolenticular degeneration, 1 cases of suprarenal glandular brain white matter dystrophy and 4 cases of infectious disease (8%): Cytomegalovirus 1 cases of meningoencephalitis, 3 cases of epidemic encephalitis B, 2 cases of demyelinating disease (4%), 1 cases of acute disseminated encephalomyelitis, 1 cases of multiple sclerosis, 3 cases of immune related diseases (6%), 1 cases of brainstem encephalitis, 1 autoimmune encephalitis, 1 lupus, 1 cases of lymphoma (2%). 39 cases of disorder, 22 cases of speech disorder, 20 cases of dysfunction of cognition, 19 cases of cognitive impairment, 13 cases of mental symptoms, 14 cases of eye movement disorder, 13 cases of pupil abnormalities, 10 cases of headache, 9 cases of extrapyramidal symptoms, 5 cases of epileptic seizures, 3 cases of ataxia and 1 cases of sensory disorders. (4) all cases head MRI of all cases showed bilateral hypothalamic hypothalamic low signal and T2WI high There were 15 cases of bilateral thalamic infarction caused by signal.Percheron artery occlusion and 8 cases involving the mesencephalon, of which 4 had the "V" sign in the middle brain, 3 cases involved the anterior thalamus and the high signal of DWI, and the bilateral thalamus symmetrical DWI high signal was seen in the venous infarction, and the angiogenic edema was obvious in the 3 case of MRI, and the abnormal signal of the cerebral great vein and the straight sinus were observed. All of them were prompted MRV examination. Deep venous thrombosis of the brain; CT examination of thalamic hemorrhage showed asymmetric high density, and 1 cases of CTA examination suggested Moya-Moya disease; central variant reversible posterior white encephalopathy was associated with bilateral basal ganglia, brain stem, and cerebellar.Wernicke encephalopathy in addition to the medial thalamus, as well as the mesencephalic aqueduct, and the nipple body. The third, fourth ventricle, the hippocampus, and the basal ganglia were involved. The hepatolenticular degeneration was associated with the thalamus, with the caudate nucleus, the globus pallidus, the putamen, and the brain stem, and the T2WI showed a slightly high uneven signal and FLAIR mixed signal; the adrenale-malnutrition, except for the thalamus, was typical of the sphenoid wing of the lateral ventricle. A large area of white matter, brain stem, cerebellum and hippocampus are also involved. All the infected patients are viral infection, except for thalamic symmetry lesions, including basal ganglia, hippocampus, corpus callosum. Acute disseminated encephalomyelitis patients with thalamus swelling and brain stem involvement. (5) 3 cases of prognosis death patients: acute disseminated encephalomyelitis 1 There are 1 cases of neuromental lupus, 1 cases of very likely lymphoma. The survival patients often leave different degrees of consciousness disorder, eye movement disorder, cognitive impairment, mental symptoms, extrapyramidal symptoms and so on, and the prognosis is poor. Conclusion: bilateral thalamus disease is cause of many causes, almost all common causes of central nervous system disease, such as vascular, sense Dyeability, metabolic, hereditary, demyelinating, immune related diseases and so on. Bilateral thalamus is the most common vascular disease in this study, and arterial infarction is the most common in vascular diseases. The imaging features of bilateral thalamus are characterized by different causes. The imaging findings of the common cause of the thalamus are important for the diagnosis of bilateral thalamus lesions. The meaning of it.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742

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