以双下肢无力为主要表现的中枢神经系统表面含铁血黄素沉着症MRI检查漏诊分析

Analysis of Missed Diagnosis of Superficial Siderosis of the Central Nervous System on MRI Manifested as Inability of the Lower Extremity

目的加强临床医生对中枢神经系统表面含铁血黄素沉着症(superficial siderosis of central nervous system,SSCNS)的认识,熟知其主要MRI表现,减少临床误漏诊。方法回顾分析MRI检查曾漏诊的SSCNS 1例的临床资料。结果女,52岁。因进行性双下肢无力5年,加重不能行走1年就诊。多年来多次就诊外院,行头颅及颈椎MRI等检查,均未能明确诊断。入我院后行头颅MRI检查T1WI序列示双侧小脑半球、桥臂、小脑蚓部表面、纵裂池内多发高信号影,大脑纵裂池内2个类椭圆形高低混杂信号影(考虑海绵状血管瘤);T2WI序列示桥脑、小脑及大脑表面条带状低信号影。结合进行性双下肢无力、双耳听力下降及其他神经系统损害症状,诊断为SSCNS和海绵状血管瘤。给予相关保守治疗后病情相对平稳出院。随访1年,恢复可。结论 SSCNS是一种罕见的综合征,MRI磁敏感加权成像对其诊断有极高的敏感性。加深对该病临床及影像学表现认识,及早行MRI相关序列检查,有助于SSCNS早期诊断并指导临床治疗。

Objective To enhance the clinicians＇ understanding of superficial siderosis of the central nervous system（ SSCNS）,to familiarize MRI manifestations,and to reduce the clinical misdiagnosis. Methods Clinical data of one patient with SSCNS that had been missed by MRI was analyzed retrospectively. Results A 52-year-old female presented to our department because of progressive weakness of the lower limbs for 5 years and inability to walk after aggravation for 1 year. After years of many visits to other hospitals,definitive diagnosis was yet not made by various examinations including head and cervical MRI. After admission to our hospital,head MRI revealed hyperintense on T1 WI sequence in bilateral cerebellar vermis,brachium pontis,surface of cerebellar vermis and interhemispheric fissure; two oval mixed hypo and hyperintense on T1 WI in cisterna longitudinal fissurae cerebri（ suspected cavernous hemangioma）; band-like hypointense on T2 WI sequence in the bridge brain,cerebellum and the surface of the cerebrum. She was diagnosed as having SSCNS and cavernous hemangioma based on various symptoms,such as progressive weakness of double lower limbs,hearing loss of both ears and other neurological damage. After conservative treatment,the patient was discharged in stable condition and followed up for 1 year,reporting excellent recovery.Conclusion SSCNS is a rare syndrome,therefore,MRI magnetic sensitivity weighted imaging is highly sensitive to the diagnosis of the disease. Enhanced understanding of the clinical and imaging manifestations of this disease,as well as early detection of MRI sequences may contribute to early diagnosis and guidance of clinical treatment.