原发性脑损害继发锥体束Wallerian变性磁共振影像分析及临床表现

Magnetic Resonance Imaging and Clinical Manifestation Analysis of Pyramidal Tract Wallerian Degeneration Secondary to Primary Brain Injury

目的:探讨原发性脑损害后继发性锥体束Wallerian变性患者的磁共振影像分析及临床表现。材料与方法:回顾性分析了32例原发性脑损害后继发性锥体束Wallerian变性患者的磁共振征象及临床表现。结果:所有原发病灶均位于幕上,单侧发病多见,主要表现为病变同侧的锥体束信号异常,呈长T1/稍长T1、长T2及FLAIR的混杂信号影,该异常信号影经放射冠区穿过内囊膝部或后肢的前半部,大脑脚外侧及脑桥基底部到达延髓锥体,引起同侧大脑脚及桥脑体积萎缩(程度与原发病灶的大小和时间的长短而不同)。临床表现继发性对侧肢体无力,肢体远端症状较近段明显。结论:MRI可以明确显示原发灶脑损害后继发锥体束Wallerian变性系列改变。有助于临床医师对患者运用功能康复的评估并与脑梗死后所致肢体无力等鉴别。

Purpose： To study magnetic resonance imaging（MRI） and clinical manifestation characteristics of pyramidal tract Wallerian degeneration secondary to primary brain injury. Materials and Methods： Retrospective study MRI and clinical manifestation characteristics of 32 cases with pyramidal tract WaUerian degeneration secondary to primary brain injury. Results： All primary lesions located in supratentorial with priority to unilateral onset, and MRI characteristics of that was abnormal signal of ipsilateral pyramidal tract, suggesting mixed signals of a long or slightly long T1, long T2 and FLAIR. Through radial area the abnormal signal covered first half of internal capsule knee or hind legs, lateral cerebral peduncle, pons base and medulla oblongata, causing volume contraction of the ipsilateral cerebral peduncle and bridge brain （contraction degree varied by the size and persistent time of the primary lesion）. Clinical expression was contralateral limb weakness, with distal limb symptoms priority to closer obviously. Conclusion： MRI can clearly demonstrate the series of change of pyramidal tract Wallerian degeneration secondary to primary brain injury and assist clinicians to assess movement function recovery of patients and identify the symptoms from physical weakness caused by cerebral infarction, such as identification.