中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2004年
28期
6199-6201
,共3页
白质软化病,脑室周围%体层摄影术,X线计算机,磁共振成像%脑动脉硬化,脑梗塞
白質軟化病,腦室週圍%體層攝影術,X線計算機,磁共振成像%腦動脈硬化,腦梗塞
백질연화병,뇌실주위%체층섭영술,X선계산궤,자공진성상%뇌동맥경화,뇌경새
背景:脑白质疏松症( Leukoaraiosis, LA)是由多种不同病因引起的一组影像学所描述的临床综合征,对其确切发病机制及临床表现和早期评估普遍重视不足. 目的:探讨单纯脑白质疏松症患者的危险因素、认知功能、步态变化与 CT及 MRI特征以及与 Binswanger病( Binswanger disease, BD)、脑梗死的关系. 设计:以诊断为依据的回顾性病例对照研究. 地点和对象: 1995-08/2000-03到山东大学齐鲁医院门诊或住院的脑血管病患者,包括 114例 LA患者, 41例 BD患者, 113例脑梗死合并 LA患者. 干预:对参加者详细询问病史、神经科查体,行头颅 CT或 MRI检查,采用简易精神状态量表进行神经心理学测试. 主要观察指标:①既往发生高血压、冠心病、糖尿病、高脂血症、吸烟及脑卒中等危险因素情况.②各组患者主要临床特征及头颅 CT或 MRI表现. 结果:单纯 LA组危险因素多样化,以轻度记忆力减退、步态欠平稳为主要临床特点; CT显示脑白质异常以 1型为主( 70.2%), MRI显示脑白质异常以 1型为主( 71.6%),单纯 LA组均无脑室扩大. BD组危险因素以高血压为主( 95.1%)、均有神经局灶体征、均有较明显的认知功能障碍、脑卒中样发作为主要临床特征; CT显示脑白质异常以 3型为主( 73.2%), MRI显示脑白质异常以 3型( 54.3%)、 4型( 45.7%)为主, BD组均有双侧脑室对称性扩大. CI合并 LA组危险因素以冠心病( 50%)、高血压( 43.4%)、高脂血症( 31.0%)为主,除伴有程度不同的偏瘫等神经局灶体征外,较单纯 LA组有较明显的认知功能障碍; CT显示脑白质异常以 2型为主( 66.4%), MRI显示脑白质异常以 2型为主( 68.1%).可伴有脑室扩大( 39.8%). 结论:单纯 LA危险因素多样化,无明显神经局灶体征,诊断主要以影像学描述 1型脑白质异常为依据. BD的临床诊断标准以高血压、较明显的认知功能障碍、常见脑卒中样发作为主要特征, CT显示脑白质异常 3型, MRI显示脑白质异常 3型或 4型为影像学诊断依据. CI合并 LA的危险因素以冠心病、高血压、高脂血症为主,较单纯 LA有较明显的认知功能障碍.
揹景:腦白質疏鬆癥( Leukoaraiosis, LA)是由多種不同病因引起的一組影像學所描述的臨床綜閤徵,對其確切髮病機製及臨床錶現和早期評估普遍重視不足. 目的:探討單純腦白質疏鬆癥患者的危險因素、認知功能、步態變化與 CT及 MRI特徵以及與 Binswanger病( Binswanger disease, BD)、腦梗死的關繫. 設計:以診斷為依據的迴顧性病例對照研究. 地點和對象: 1995-08/2000-03到山東大學齊魯醫院門診或住院的腦血管病患者,包括 114例 LA患者, 41例 BD患者, 113例腦梗死閤併 LA患者. 榦預:對參加者詳細詢問病史、神經科查體,行頭顱 CT或 MRI檢查,採用簡易精神狀態量錶進行神經心理學測試. 主要觀察指標:①既往髮生高血壓、冠心病、糖尿病、高脂血癥、吸煙及腦卒中等危險因素情況.②各組患者主要臨床特徵及頭顱 CT或 MRI錶現. 結果:單純 LA組危險因素多樣化,以輕度記憶力減退、步態欠平穩為主要臨床特點; CT顯示腦白質異常以 1型為主( 70.2%), MRI顯示腦白質異常以 1型為主( 71.6%),單純 LA組均無腦室擴大. BD組危險因素以高血壓為主( 95.1%)、均有神經跼竈體徵、均有較明顯的認知功能障礙、腦卒中樣髮作為主要臨床特徵; CT顯示腦白質異常以 3型為主( 73.2%), MRI顯示腦白質異常以 3型( 54.3%)、 4型( 45.7%)為主, BD組均有雙側腦室對稱性擴大. CI閤併 LA組危險因素以冠心病( 50%)、高血壓( 43.4%)、高脂血癥( 31.0%)為主,除伴有程度不同的偏癱等神經跼竈體徵外,較單純 LA組有較明顯的認知功能障礙; CT顯示腦白質異常以 2型為主( 66.4%), MRI顯示腦白質異常以 2型為主( 68.1%).可伴有腦室擴大( 39.8%). 結論:單純 LA危險因素多樣化,無明顯神經跼竈體徵,診斷主要以影像學描述 1型腦白質異常為依據. BD的臨床診斷標準以高血壓、較明顯的認知功能障礙、常見腦卒中樣髮作為主要特徵, CT顯示腦白質異常 3型, MRI顯示腦白質異常 3型或 4型為影像學診斷依據. CI閤併 LA的危險因素以冠心病、高血壓、高脂血癥為主,較單純 LA有較明顯的認知功能障礙.
배경:뇌백질소송증( Leukoaraiosis, LA)시유다충불동병인인기적일조영상학소묘술적림상종합정,대기학절발병궤제급림상표현화조기평고보편중시불족. 목적:탐토단순뇌백질소송증환자적위험인소、인지공능、보태변화여 CT급 MRI특정이급여 Binswanger병( Binswanger disease, BD)、뇌경사적관계. 설계:이진단위의거적회고성병례대조연구. 지점화대상: 1995-08/2000-03도산동대학제로의원문진혹주원적뇌혈관병환자,포괄 114례 LA환자, 41례 BD환자, 113례뇌경사합병 LA환자. 간예:대삼가자상세순문병사、신경과사체,행두로 CT혹 MRI검사,채용간역정신상태량표진행신경심이학측시. 주요관찰지표:①기왕발생고혈압、관심병、당뇨병、고지혈증、흡연급뇌졸중등위험인소정황.②각조환자주요림상특정급두로 CT혹 MRI표현. 결과:단순 LA조위험인소다양화,이경도기억력감퇴、보태흠평은위주요림상특점; CT현시뇌백질이상이 1형위주( 70.2%), MRI현시뇌백질이상이 1형위주( 71.6%),단순 LA조균무뇌실확대. BD조위험인소이고혈압위주( 95.1%)、균유신경국조체정、균유교명현적인지공능장애、뇌졸중양발작위주요림상특정; CT현시뇌백질이상이 3형위주( 73.2%), MRI현시뇌백질이상이 3형( 54.3%)、 4형( 45.7%)위주, BD조균유쌍측뇌실대칭성확대. CI합병 LA조위험인소이관심병( 50%)、고혈압( 43.4%)、고지혈증( 31.0%)위주,제반유정도불동적편탄등신경국조체정외,교단순 LA조유교명현적인지공능장애; CT현시뇌백질이상이 2형위주( 66.4%), MRI현시뇌백질이상이 2형위주( 68.1%).가반유뇌실확대( 39.8%). 결론:단순 LA위험인소다양화,무명현신경국조체정,진단주요이영상학묘술 1형뇌백질이상위의거. BD적림상진단표준이고혈압、교명현적인지공능장애、상견뇌졸중양발작위주요특정, CT현시뇌백질이상 3형, MRI현시뇌백질이상 3형혹 4형위영상학진단의거. CI합병 LA적위험인소이관심병、고혈압、고지혈증위주,교단순 LA유교명현적인지공능장애.
BACKGROUND:Leukoaraiosis(LA) is a clinical syndrome manifested by a group of images,which is caused by various factors. However,it has not been attached much importance to its mechanism,clinical manifestations as well as early assessment. OBJECTIVE:To explore the risk factors,cognition,gait,CT and MRI characteristics of simply leukoaraiosis(LA) as well as its relationship with Binswanger's disease(BD) and cerebral infarction (CI). DESIGN:Retrospective case control study on the basis of diagnosis. SETTING and PARTICIPANTS:The patients were diagnosed with cerebrovascular diseases in Qilu Hospital of Shandong University during August 1995 to March 2000.There were 114 patients with LA,41 patients with BD and 113 patients with CI combining LA. INTERVENTIONS:The participants were asked detailed medical histories,taken neural examinations,head CT or MRI and MMES scale to measure neuropsychological states. MAIN OUTCOME MEASURES:①Previous history of hypertension,coronary heart disease,diabetes,hyperlipemia,smoking and cerebral infarction;②Clinical features of patients in each group,head CT or MRI images. RESULTS: There were diversified risk factors of simply LA which were characterized by mild hypomnesia,instable gait.Both CT and MRI showed that type 1 anomaly of white matter was commonly seen(70.2% ,71.6% )respectively.There was no dilated ventricle found in simply LA group. Hypertension was the primary risk factor of BD group(95.1% ). Patients in this group all had local neurological signs,obvious cognitive dysfunction and symptoms like cerebral apoplexy.CT showed that the type 3 anomaly of white matter accounts for 73.2% .MRI showed that type 3,type 4 anomaly were common seen which was 54.3% and 45.7% respectively. There were bilateral ventricle dilations in this group.In CI combining LA group,coronary heart disease(50% ),hypertension(43.4% ) and hyperlipemia(31.0% ) were major risk factors.Patients in this group had obvious cognitive dysfunction than patient in simply LA group besides suffering different level of neural focal sign such as hemiplegia and so on.Type 2 anomaly of white matter was commonly seen from both CT(66.4% ) and MRI(68.1% ) with dilated ventricle(39.8% ). CONCLUSION:Simply LA has various risk factors. It has no obvious neural focal sign and the diagnosis of it is mainly based on the imaging showing of type 1 white matter anomaly.The diagnostic standard of BD includes hypertension,obvious cognitive dysfunction and episode of CI.The imaging diagnosis is based on the type 3 anomaly of white matter in CT and type 3 or 4 in MRI.The risk factors of CI combining LA are coronary heart dishease,ypertension and hyperlipemia.It has more obvious cognitive dysfunction that simply LA.
