低血糖脑病MRI表现与临床分析

MRI findings and clinical analysis of hypoglycemic encephalopathy

目的探讨低血糖脑病的MRI表现及临床鉴别。方法回顾分析我院2009年～2012年临床确诊的9例低血糖脑病的临床及MRI资料。结果本组最终确诊9例中5例有明确糖尿病病史,病程3～16年,1例脑挫裂伤术后半年,1例有节食瘦身行为,1例长期大量饮酒,1例原因不明;突发偏瘫、失语5例,局灶性抽搐4例,躁动、情绪激越1例,表情淡漠、反应迟钝、视物模糊1例,昏迷1例;本组9例患者颅脑MRI检查均发现异常信号,8例表现为额、顶、枕叶皮层异常信号,1例胼胝体压部片状异常信号;T1WI呈稍低信号,T2WI呈稍高信号,FLAIR序列呈高信号,DWI呈高信号,ADC图呈低信号;经治疗2周后4例复查MRI,病灶有明显吸收好转;8例患者经治疗后痊愈出院,1例死亡。结论临床上有脑卒中样表现的患者,需注意低血糖性脑病的可能,常规检测血糖及影像学检查对早期正确干预具有重要意义;低血糖脑病发病部位及颅脑MRI信号表现具有一定特征性,DWI序列对病变更敏感,呈高信号。

Objective Explore the MRI manifestations and clinical identification of hypoglycemic encephalopathy.Methods In our hospital from 2009 to 2012,retrospective analysis of clinical diagnosis of 9cases of clinical and MRI data of hypoglycemic encephalopathy.Results Group finally confirmed in 9cases,5cases with clear history of diabetes,course of 3 ～ 16 years,1case of cerebral contusion of postoperative half year,1case with dieting behavior thin body,1case of long-term heavy drinking,1case of unknown cause;Sudden hemiplegia and aphasia in 5cases,focal convulsions in 4cases,restlessness,emotional agitation in 1case,expression of indifference,1case was slow to respond,blurred vision,coma in 1case;This group of cerebral MRI of 9cases were found abnormal signal,8cases of frontal,top,occipital cortex abnormal signal,1case of corpus callosum shape abnormal signal;T1WI was slightly low signal,T2 WI was slightly high signal,FLAIR sequences show high signal,DWI has high signal,can the ADC figure has low signal;After 2weeks treatment 4cases reviewed MRI,absorbed lesions significantly improve;Eight patients recovered after treatment the treatment,1case died.Conclusion A kind of cerebral apoplexy patients,clinical need to pay attention to the possibility of hypoglycemic encephalopathy,routine blood glucose and imaging examination is of great significance for early intervention right;Hypoglycemic encephalopathy incidence area and cerebral MRI signal performance has a certain characteristic,DWI sequence is more sensitive to the lesion,can show high signal.