新生儿低血糖脑损伤的MRI表现及鉴别

The MRI findings and differential diagnosis of brain injury caused by neonatal hypoglycemia

目的探讨新生儿低血糖脑损伤的MRI表现及其与新生儿缺血缺氧性脑病的鉴别与联系。方法回顾性分析明确诊断为低血糖脑损伤的19例患儿的MRI表现及临床资料。结果 19例行DWI扫描均发现斑片状、条状及脑回样高信号,其中受累部位双侧顶枕叶皮层及皮层下白质18例,胼胝体受累9例,侧脑室旁脑白质受累5例,基底核受累2例,尾状核头部受累1例。常规MRI中6例内囊后肢T1加权高信号消失,5例因脑室周围及胼胝体压部出血表现为小片状短T1、短T2信号或短T1、长T2信号,3例表现为双侧顶枕叶皮层脑回样短T1及皮层下稍长T1信号,1例因双侧顶枕叶皮层及皮层下脑水肿表现为稍长T1、稍长T2信号。尚有3例同时伴有硬膜下血肿。3个月后2例复查MRI,均发现双侧顶枕叶多发软化灶。结论低血糖脑损伤多发生于大脑半球后部顶枕叶皮层及皮层下白质区,具有一定特征性,在临床中应引起重视,要结合临床病史及好发部位,以防误诊漏诊,造成严重后果。

Objective To report the MRI findings of brain damage observed in neonatal patients who suffered from hypoglycemia and to explore the differential diagnosis with hypoxic-ischemic encephalopathy.Methods Analyze the magnetic resonance imaging and diffusion-weighted imaging （DWI） of 19 neonates with hypoglycemia brain injury.Results All of the DWI imaging showed abnormalities; The parietal and occipital cortex and subcortical white matter abnormalities occurred in 94.7% （18 cases） of infants with hypoglycemia brain injury,corpus callosum abnormalities occurred in 47.3% （9 cases） of infants with hypoglycemia brain injury; 31.6% （6 cases） had an abnormal posterior limb of the internal capsule;the periventricular white matter injury occurred in 26.3% （5 cases） of infants with hypoglycemia brain injury;10.5% （2 cases） of infants with hypoglycemia had basal ganglia abnormalities,and 1 case（5.3%）had head of caudate nucleus abmormality. 6 cases of infants had posterior limb of internal capsule high signal intensity had disappeared; 5 cases had a high signal intensity on T1-weighted MRI scans and a high/low signal intensity on T2-weighted MRI scans ,because of the periventricular white matter and splenium of corpus callosum hemorrhage; 1 case had a low signal intensity on T1-weighted MRI scans and a high signal intensity on T2-weighted MRI scans because of the parietal and occipital cortex and subcortical white matter edema; The followed-up MRI of 2 cases after three months showed that regional encephalomalacia in the affected occipital and parieta lobes.Conclusion Patterns of injury associated with symptomatic neonatal hypoglycemia were more varied than described previously.,but the most common diagnostic area is the parietal and occipital cortex and subcortical white matter. In Clinic we should respect and combine the clinical medical history,and try to avoid misdiagnosis and the serious consequences.