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MRI示脑干急性脑梗病变，真的只是脑梗塞吗？

2018-10-15 赵桂宪 赵桂宪大夫

MRI脑干急性脑梗病变
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患者，男性，53岁，既往2型糖尿病20余年，高血压病多年，还有冠心病。

9月份病房遇到的病例

患者，男性，53岁，既往2型糖尿病20余年，高血压病多年，还有冠心病。

因突发左侧肢体无力，伴言语不利，外院行头部MRI示脑干急性脑梗病变，按“脑梗死”治疗2月余，患者仍不能发出声音，肢体活动不能抬离床面。

因机缘巧合收到我的床位上，尽管患者危险因素都有了，脑梗塞诊断解释合情合理，但我看磁共振可疑，不够支持单纯脑梗塞，加之血免疫指标轻度异常，综合考虑患者基底动脉血管炎可能大。

冒着糖尿病的风险给患者使用了激素治疗，皇天不负有心人，患者用药后第二天就发出了声音，无力的肢体可以抬离床面了。随着治疗及家属的积极配合，患者的病情一天天在好转，1个月的时间，患者可以讲话，尽管声音比较轻，并可以在家人搀扶下行走。

这个病人的诊断中，我用了一个很有意义的检查：高分辨率血管壁磁共振检查结果支持我的判断，使得我放心地坚持治疗。

月份1个月长门诊遇到了好几例大脑中动脉或基底动脉狭窄致脑梗塞的患者，我特别关注了高分辨率血管壁MR成像技术在临床的应用。

年初有篇文章（Intracranial Vessel Wall MRI: Principles and Expert ConsensusRecommendations of the American Society of Neuroradiology）详细讲解了这项技术在脑血管病（缺血性卒中和脑出血）中的应用，深圳宝安医院放射科的宋建勋主任和赵双全主任翻译了本文，经同意，将翻译后的内容发在公众号中做个科普，再此，向两位主任表示感谢！

■ 以下将分享文章中的内容：












































































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    2018-10-17 huangshifeng

    #脑梗塞#

    0

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    2018-10-17 karmond

    #脑梗#

    0

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    2018-10-16 test1797

    锦绣香江休息休息奖学金小鸡鸡都惦记解答解答解答惊喜惊喜惊喜惊喜惊喜惊喜

    0

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    2018-10-16 test1797

    婚纱

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    2018-10-16 test1797

    呵呵哈哈哈

    0

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