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目的分析梅毒脑病MRI表现,探讨其征象特点、演变规律以及在预后评估中的价值,以提高对梅毒脑病早期诊断及治疗水平。方法回顾性分析18例经临床确诊的梅毒脑病患者的MRI平扫、增强,MRA以及复查头颅MRI图像特点。结果 (1)脑萎缩13例,脑梗死8例,脑炎8例,脑膜炎改变8例,头颅MRI正常2例。(2)13例均表现为多种形式病变并存,脑萎缩为主要改变。(3)神经梅毒脑MRI病变的演变:3例行有效治疗后脑炎异常信号基本或完全吸收,后遗改变主要是脑萎缩出现或加重,2例未行正规有效治疗,脑炎病灶出现或扩大。(4)神经梅毒脑血管病变:6例MRA检查中2例局部动脉血管重度狭窄。结论 (1)梅毒脑病的基本MRI征象有脑萎缩、脑梗死、脑炎以及脑膜炎等改变;(2)不对称性脑萎缩,同时伴有脑炎和/或脑膜炎改变,具有提示梅毒脑病的意义。(3)MRI随诊能够显示梅毒脑病脑内病变的演变,特别是脑炎向脑萎缩的转变。(4)MRA可以发现梅毒所致脑内主要动脉狭窄或闭塞。
Objective To analyze the manifestations of syphilitic encephalopathy (MRI) and to explore its characteristics, evolvement rules and prognostic value in order to improve the early diagnosis and treatment of syphilitic encephalopathy. Methods Retrospective analysis of 18 cases of clinically diagnosed syphilitic encephalopathy patients with MRI plain, enhanced, MRA and rechecked head MRI features. Results (1) 13 cases of brain atrophy, cerebral infarction in 8 cases, 8 cases of encephalitis, meningitis in 8 cases, 2 cases of normal cranial MRI. (2) Thirteen cases showed the coexistence of various forms of lesions, brain atrophy as the main change. (3) The evolution of neurosyphilis brain MRI lesions: 3 cases of effective treatment of encephalitis after the basic or complete absorption of abnormal signals, the main change is the emergence or aggravation of brain atrophy, 2 patients without formal effective treatment, encephalitis lesions appear or expand. (4) Neurosyphilis Cerebrovascular disease: 2 cases of severe local arterial stenosis in MRA in 6 cases. Conclusions (1) The basic MRI signs of syphilitic encephalopathy include cerebral atrophy, cerebral infarction, encephalitis and meningitis; (2) Asymetric atrophy with concomitant changes of encephalitis and / or meningitis, Meaning. (3) MRI follow-up can show the evolution of the brain lesions of syphilitic encephalopathy, especially the change of encephalitis to brain atrophy. (4) MRA can be found in syphilis main cerebral artery stenosis or occlusion.