视神经脊髓炎脑部病灶的影像学特征及临床表现

Magnetic resonance imaging characteristics and clinical manifestations of brain abnormalities in neuromyelitis optica

目的探讨视神经脊髓炎（NMO）脑部病灶的影像学特征及主要临床表现。方法回顾性分析南京医科大学附属脑科医院神经内科自2002年1月至2008年5月收治的19例NMO患者脑部MRI检查结果及相关病史资料。结果本组19例患者中15例行头颅MRI检查，7例发现脑部病灶；病变累及大脑半球3例，丘脑2例，下丘脑1例，第三脑室和中脑导水管周边1例，中脑1例，桥脑1例，延髓2例；MRI上病灶为点状、斑片状或线样，呈T1低信号、T2和FLAIR高信号改变。临床表现恶心、呕吐、呃逆、复视、眼震、面部麻木、认知功能障碍及嗜睡等。结论NMO可出现不同部位脑部病灶，以脑室管膜周边和下丘脑处病灶具有疾病特征性。部分NMO患者出现脑部受累表现，少数患者以脑部症状为首发临床事件。

Objective To summarize the magnetic resonance imaging （MRI） characteristics and clinical manifestations of brain abnormalities in patients with neuromyelitis optica （NMO）. Methods The clinical and brain MRI data of 19 patients with NMO treated in our hospital from January, 2002 to May, 2008 were retrospectively analyzed. Results Of the 19 patients with NMO, 15 underwent brain MRI, and brain abnormalities were identified in 7 patients. The lesions involved the cerebral hemisphere in 3 cases, the thalamus in 2 cases, the hypothalamus in 1 case, the surrounding areas of the third ventricle and the midbrain aqueduct in 1 case, the midbrain in 1 case, the pons in 1 case, and the medulla in 2 cases. On brain MRI, the lesions appeared as spots, patches or linear changes in the brain with low signals on Tl-weighted imaging and high signals on T2-weighted and FLAIR imaging. The main clinical manifestations included nausea, vomiting, hiccup, diplopia, nystagmus, facial numbness, cognition impairment, and lethargy. Conclusion NMO may cause lesions in different brain regions, typically in the surrounding areas of the ependyma and hypothalamus. Clinical manifestations may occur in some patients with brain lesions, and in a few cases, these manifestations can be the initial clinical event of NMO onset.