左旋咪唑所致脑病患者的临床与磁共振成像

A clinical and MRI study of levamisole induced demyelinating encephalopathy

目的 研究左旋咪唑致脱髓鞘脑病患者的临床与磁共振成像（ＭＲＩ） 特点。方法 分析１９ 例左旋咪唑致脱髓鞘脑病的临床和ＭＲＩ资料。结果 左旋咪唑致脱髓鞘脑病的主要临床表现为急性或亚急性起病的弥漫性脑损害，尤以早期的精神症状（７３．７％ ） 和运动障碍（８４．２ ％） 突出。１ 例脑活检显示脱髓鞘病灶。皮质激素治疗效果好。１９ 例ＭＲＩ均有异常，表现为双侧脑室周围及额、顶、枕、颞叶白质区有多发、散在的长Ｔ１ 长Ｔ２ 异常信号灶，部分病灶呈环形强化并周边水肿，仅１ 例有占位效应。Ｔ２ 加权像显示更敏感。结论 本病的诊断依靠其临床特点和影像学检查，ＭＲＩ对本病的诊断具有重要价值。

Objective To study the clinical and MRI features of levamisole induced demyelinating encephalopathy (LIDE). Methods The clinical and MRI data were analysed in 19 patients with LIDE. Results The main clinical manifestations of the disease were acute or subacute diffuse cerebral lesions, especially for early mental symptoms (73.7%) and motor weakness (84.2%). Brain biopsy revealed demyelinating lesions in one patient. The patients had good therapeutic effect of corticosteroids. The MRI of 19 cases showed multiple white matter lesions scattered in the frontal, parietal, occipital, temporal, and periventricular areas.The lesions were long T 1 and T 2 weighted signals.The MRI revealed peripheral ring type enhancement about the focus after Gd DTPA administration and edema around some lesions. Mass effect was shown in only one case. T 2 weighted images were highly sensitive to the lesions. Conclusions The diagnosis of LIDE depended on their clinical features and neuroradiological appearance. MRI was very valuable for the diagnosis of LIDE.