亚急性联合变性的电生理、磁共振表现及随访

The natural history of electrophysiological and magnetic resonance changes of subacute combined degeneration

目的 观察亚急性联合变性 (SCD)患者的电生理和磁共振 (MRI)表现及治疗前后的变化 ,评价其对诊断的价值。方法 对 10例患者进行治疗前后的神经功能评定 ,并进行 3～ 36个月随访 ,检查血清维生素 (Vit)B12 、叶酸浓度、脊髓MRI、周围神经传导速度、体感诱发电位 (SEP)、视觉诱发电位 (VEP) ,并观察治疗前后脊髓MRI、SEP的变化。结果 患者经VitB12 治疗后 ,症状均有明显改善 ,但仍遗留不同程度的深感觉异常 ,SEP治疗前后的变化与临床症状相符 ,脊髓MRI检查绝大多数能直观地显示病灶 ,主要表现为 :脊髓后、侧索的长条状等T1长T2异常信号 ,胸段多见 ,加强后病灶不强化 ,病灶随病情好转而缩小或消失。结论 脊髓MRI、神经电生理检查能客观地提示病变部位及治疗前后的变化 ,对诊断具有重要价值 ,对患者进行随访 ,也是明确诊断。

Objective To observe the presentations and in the patients with subacute combined degeneration (SCD)changes of electrophysiology (EP) and magnetic resonance image (MRI) before and after treatment and to analyze their values in diagnosis. Methods 10 patients received a series of examinations, including clinical neurological functions, serum vitamin B12 and folic acid concentrations, spinal cord MRI, peripheral nerve conduction velocity, sensory evoked potential (SEP) and visual evoked potential(VEP). They were followed up for 3 to 36 months. The changes of spinal cord MRI and SEP before and after the treatment were studied. Results After Vitamin B12 therapy, all the patients improved,but there were still some abnormalities of SEP left. The lesions could be shown sensitively by EP. The changes of SEP and clinical symptoms correlated with each other. The spinal cord MRIs of most patients showed the lesions objectively, demonstrating primarily long tape abnormal signals in posterior and lateral columns, iso intense on T1 and hyper intense on T2 without contrast. Most lessions were seen at the thoracic cord. The lesions constricted or disappeared when the clinical conditions improved. Conclusion Spinal cord MRI and EP could objectively show the lesions of SCD and the change before and after the treatment.These examinations and the follow up of disease could be helpful in the diagnosis of SCD.