不同临床分期海洛因海绵状白质脑病患者的头颅MRI特征

MRI features of patients with heroin spongiform leukoencephalopathy of different clinical stages

目的探讨不同临床分期的海洛因海绵状白质脑病(HSLE)患者的头颅影像特征和演变规律。方法回顾性分析本院收治的行 MRI 检查的32例 HSLE 患者资料,其中Ⅰ期(小脑受累期)6例,Ⅱ期(合并锥体束受累)21例,Ⅲ期(存在意识障碍)5例。按照临床分期对其吸毒史、临床表现、头颅 MRI 表现进行总结分析。结果全部患者均有烫吸海洛因病史;亚急性起病多见,小脑体征为早期主要表现;头颅 MR 检查显示均有双侧对称性的小脑半球损害,按照疾病的严重程度,逐步累及胼胝体压部、内囊后肢和枕顶叶深部白质,部分病例累及脑干及额颞叶深部白质;所有病例头颅MRI 均未见明显增强病灶。结论烫吸海洛因病史是诊断 HSLE 的必要条件。头颅 MRI 提供了HSLE 特征性结构性损害的病灶演变特征,对明确诊断具有重要意义,根据受累部位还有助于判断疾病的临床分期。

Objective To investigate radiological features of patients with heroin spongiform leukoencephalopathy （HSLE） of different clinical stages and discuss the evolutional characteristics of the disease. Methods Thirty two patients with HSLE underwent precontrast MRI and postcontrast MRI. The history of addiction, clinical presentations, and brain MRI were analyzed and summarized according to the patient＇s clinical staging. There are 6 cases in I stage,21 cases in II stage,5 cases in III stage. Results All patients had history of heroin vapor inhalation. Most of the cases developed subacute cerebellar impairment in earlier period. Brain MRI revealed symmetrical lesion within bilateral cerebellum in all patients. Splenium of the corpus callosum, posterior limb of the internal capsule, deep white matter of the occipital and parietal lobes, were gradually involved with progressive deterioration of HSLE. The brain stem and deep white matter of the frontal and temporal lobes were involved in some cases. Conclusions The history of heated heroin vapor inhalation was the prerequisite for the diagnosis of HSLE. Brain MRI presented the characteristic lesion and its evolution of HSLE. Brain MRI was very important for accurate diagnosis and helpful to judge the clinical stages according to the involved brain region.