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Neurology：病例:成人急性坏死性脑病的影像学演变

2018-08-18 zyx整理 神经科病例撷英拾粹

急性坏死性脑病发热脑脊液对称性脑损伤
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37岁女性，既往体健，在寒战，发烧和肌痛3天后出现谵妄，入院时为昏迷状态。神经影像学提示双侧丘脑和脑桥受累（图1-2），静脉窦正常。实验室检查发现血清转氨酶升高，脑脊液蛋白增加，无特异性病毒（表1-3）。患者4天内逐渐恢复意识，左侧瘫痪（肌力1/5），言语不清，28天后出院（NIHSS评分2分）。

37岁女性，既往体健，在寒战，发烧和肌痛3天后出现谵妄，入院时为昏迷状态。神经影像学提示双侧丘脑和脑桥受累（图1-2），静脉窦正常。实验室检查发现血清转氨酶升高，脑脊液蛋白增加，无特异性病毒（表1-3）。患者4天内逐渐恢复意识，左侧瘫痪（肌力1/5），言语不清，28天后出院（NIHSS评分2分）。

急性坏死性脑病（ANE）罕见于成人。由先前感染引起的多灶性，对称性脑损伤是ANE最显着的特征（表4）。


（图1：A：入院时MRI提示脑桥[A.a-A.b]T1WI和T2WI低信号，以及双侧丘脑[A.c-A.d]T1WI低信号和T2WI高信号，证实为出血性坏死；B-C：复查MRI可见脑桥[B.a和C.a：T1WI；B.b和C.b：T2WI）和丘脑病变[B.c和C.c：T1WI；B.d和C.d：T2WI]逐渐好转）


（图2：A：入院时，ADC和DWI可见双侧丘脑靶样病灶和水肿；B：第9天，ADC和DWI可见病灶较前消退）

表1  腰穿脑脊液结果



表2  血乳酸和血氨



表3  血清转氨酶结果



表4  成人ANE的鉴别诊断



原始出处：Liang W1, Shao Y1, Cui Y1, et al. Teaching NeuroImages: Radiographic evolution in an adult case of acute necrotizing encephalopathy. Neurology. 2018 Jul 31;91(5):e490-e491.

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    2019-07-26 showtest

    #脑病#

    0

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    2019-06-02 yinhl1978

    #Neurol#

    0

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    2018-10-27 oliver181

    #演变#

    0

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    2018-08-20 millore

    #坏死#

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