海洛因海绵状白质脑病的临床和病理特点

PET,MRI and pathologic characteristics of heroin spongiform leukoencephalopathy

目的 总结海洛因海绵状白质脑病 (HSLE)的PET、MRI和病理特征。方法 2 8例患者的临床、CT和MRI分析 ,2例脑局部解剖和 8例脑活检组织用苏木素 伊红染色 ,神经元纤维染色 ,苏木素髓鞘染色、刚果红染色并进行电镜观察。结果 HSLP的临床、影像和病理特点 :(1) 2 8例有烫吸海洛因病史 ;(2 ) 2 8例有戒毒史 ,戒毒后症状加重 ;(3) 2 3例急性起病 ,首发症状多为小脑受损 ;(4 ) 4例PET顶枕及小脑皮质变薄 ,大脑白质扩大 ,1例未治疗患者内囊后肢、枕叶示小脑白质无代谢 ,3例已治疗患者代谢明显低减 ;(5 )CT和MRI示大脑 (2 5例 )、小脑白质广泛对称性受累 (2 8例 )。 结论HSLE患者CT和MRI示大脑、小脑白质广泛对称性受累 ,主要病理改变为脑白质海绵状空泡变性。PET在判断病情进展程度及治疗效果方面较MRI有明显优势。

Objective To summarize PET?MRI and pathologic characteristics of heroin spongiform leukoencephalopathy(HSLE). Methods Clinically, 28 cases underwent CT and MRI analysis,in which 2 cases had brain autopsies and 8 cases had brain biopsies. HE, GFAP, Loyez and Congo Red staining were made and observation done through electronic microscope. 4 cases underwent PET analysis. Results The PET, MRI and pathologic characteristics of HSLE showed (1) Spongiform vacuoles degeneration of white matter was pathologically the main morphological change. (2) All the 28 cases had a history of inhalation of heated heroin vapor and abstained from durg. (3) Most cases were described with acute onset characterized by cerebellar signs. (4) PET shows the cortex of the parietal lobe, occipital lobe and cerebellum became thin in 4 cases, while the cerebral white matter had enlarged. (5) Brain CT and MRI revealed extensive symmetric white matter lesions in cerebra and cerebellum. Conclusions Brain CT and MRI revealed extensive symmetric white matter lesions in cerebra and cerebellum. PET has more advantage in judging progress of patient's condition and therapeutic effecacy than MRI. Spongiform vacuoles degeneration of white matter was the main pathological change.