本文選題：雙側(cè)丘腦病變 + 影像學�。� 參考：《吉林大學》2017年碩士論文

【摘要】：目的:分析雙側(cè)丘腦病變的病因、臨床癥狀、影像學表現(xiàn)、診斷及預(yù)后等,提高對雙側(cè)丘腦病變的認識,從而為臨床診治提供幫助。方法:對2011年9月～2017年2月吉林大學第一醫(yī)院神經(jīng)內(nèi)科收治的50例雙側(cè)丘腦病變患者,根據(jù)病因不同進行分組,收集患者的一般臨床資料,分析其臨床表現(xiàn)、影像學特征、診斷及預(yù)后情況,總結(jié)不同病因所致雙側(cè)丘腦病變的特點。結(jié)果:(1)一般情況本研究共納入50例患者,男22例,女28例,發(fā)病年齡13～77歲,平均年齡48.08±18.30歲。(2)原因血管性疾病29例(58%):其中動脈性梗死17例,靜脈性梗死9例,丘腦出血2例,中央變異型可逆性后部白質(zhì)腦病1例;代謝性疾病6例(12%),為Wernicke腦病;遺傳性疾病5例(10%):其中肝豆狀核變性4例,腎上腺腦白質(zhì)營養(yǎng)不良1例;感染性疾病4例(8%):其中巨細胞病毒所致腦膜腦炎1例,可能的流行性乙型腦炎3例;脫髓鞘疾病2例(4%):其中急性播散性腦脊髓炎1例,多發(fā)性硬化1例;免疫相關(guān)性疾病3例(6%):腦干腦炎1例,自身免疫性腦炎1例,神經(jīng)精神狼瘡1例;很可能的淋巴瘤1例(2%)。(3)臨床表現(xiàn)本研究中意識障礙39例,言語障礙22例,運功障礙20例,認知障礙19例,精神癥狀13例,眼動障礙14例,瞳孔異常13例,頭痛10例,錐體外系癥狀9例,癲癇發(fā)作5例,共濟失調(diào)3例,感覺障礙1例。(4)特征性影像學表現(xiàn)所有病例頭MRI均表現(xiàn)為雙側(cè)丘腦T1WI低信號及T2WI高信號。Percheron動脈閉塞所致雙側(cè)丘腦梗死15例,8例累及中腦,其中4例呈中腦“V”字征,3例累及丘腦前部,DWI高信號;靜脈性梗死可見雙側(cè)丘腦對稱性DWI高信號,血管源性水腫比較明顯,3例MRI可見大腦大靜脈、直竇異常信號,均行MRV檢查提示大腦深靜脈血栓形成;丘腦出血行CT檢查表現(xiàn)為不對稱高密度影,1例CTA檢查提示moya-moya病;中央變異型可逆性后部白質(zhì)腦病除了累及丘腦外,伴有雙側(cè)基底節(jié)、腦干、小腦受累。Wernicke腦病患者除累及丘腦內(nèi)側(cè),還伴有中腦導水管、乳頭體、四疊體、第三、四腦室旁、海馬、基底節(jié)受累。肝豆狀核變性除了累及丘腦外,伴有尾狀核、蒼白球、殼核、腦干受累,T2WI表現(xiàn)為稍高不均勻信號,FLAIR混雜信號;腎上腺腦白質(zhì)營養(yǎng)不良除了累及丘腦外,典型表現(xiàn)為側(cè)腦室三角區(qū)對稱分布的蝶翼狀大片白質(zhì)病變,腦干、小腦、海馬亦受累。感染性病因患者中均為病毒性感染,除了丘腦對稱性病變外還伴有基底節(jié)、海馬、胼胝體受累。急性播散性腦脊髓炎患者丘腦腫脹明顯,伴腦干受累。(5)預(yù)后死亡患者3例:其中急性播散性腦脊髓炎1例,神經(jīng)精神狼瘡1例,很可能的淋巴瘤1例。存活患者中往往遺留不同程度的意識障礙、眼動障礙、認知障礙、精神癥狀、錐體外系癥狀等,預(yù)后不佳。結(jié)論:雙側(cè)丘腦病變病因較多,幾乎包括了中樞神經(jīng)系統(tǒng)疾病所有常見的病因,如血管性、感染性、代謝性、遺傳性、脫髓鞘性、免疫相關(guān)性疾病等,本研究中雙側(cè)丘腦病變以血管性疾病最常見,血管性疾病中以動脈性梗死最多見。不同原因?qū)е码p側(cè)丘腦病變的影像學各有特點,掌握常見病因的影像學表現(xiàn)對診斷雙側(cè)丘腦病變有重要的意義。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742

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