成年人卒中后华勒变性的临床和影像学特征:4例病例系列研究

Clinical and imaging features of Wallerian degeneration after stroke in adults: a study of 4 cases

目的探讨成年人卒中后华勒变性的临床及影像学特点。方法回顾性纳入2018年10月至2019年9月期间中国医科大学附属盛京医院收治的成年人卒中华勒变性患者,结合相关文献探讨卒中后华勒变性的临床及影像学特征。结果共纳入4例卒中后华勒变性患者,男性3例,女性1例,年龄56~63岁。主要临床症状为构音障碍(n=3)、肢体活动不灵(n=3)、吞咽困难(n=1)和头晕(n=1),美国国立卫生研究院卒中量表评分1~6分。发病后初次MRI及CT表现符合卒中诊断,在发病后3~7个月随访过程中MRI发现华勒变性,表现为T2及液体衰减反转恢复序列沿神经纤维走行的高信号,几乎所有病例的弥散加权成像也发现沿神经纤维走行的高信号。结论颈内动脉供血区急性卒中(包括缺血性及出血性卒中)后可出现同侧锥体束损害,影响患者长期运动功能;单侧脑桥卒中后可出现双侧脑桥臂损害,影响患者共济和平衡功能。卒中后华勒变性是一种特殊的神经变性过程,其影像学表现与新发脑梗死相近,正确认识这一现象可避免误诊。

Objective To investigate the clinical and imaging features of Wallerian degeneration in adults with stroke.Methods Adult stroke patients with Wallerian degeneration admitted to Shengjing Hospital of China Medical University from October 2018 to September 2019 were enrolled retrospectively.Combined with the related literature,the clinical and imaging features of Wallerian degeneration after stroke were investigated.Results A total of 4 patients with Wallerian degeneration after stroke were enrolled,including 3 males and 1 female,aged 56-63 years.The main clinical symptoms were dysarthria(n=3),poor physical activity(n=3),dysphagia(n=1),and dizziness(n=1).The National Institutes of Health Stroke Scale score was 1-6.The initial MRI and CT findings after stroke were consistent with the diagnosis of acute cerebral infarction.During the follow-up of 3 to 7 months after the onset,MRI revealed Wallerian degeneration,which showed hyperintensities along nerve fibers on T2 and Fluid-Attenuation Inversion Recovery(FLAIR)sequence images.Diffusion-Weighted Imaging(DWI)in almost all cases also found hyperintensities along nerve fibers.Conclusions After acute stroke(including ischemic and hemorrhagic stroke)in the territory of the internal carotid artery,ipsilateral pyramidal tract damage may occur,affecting the long-term motor function of patients.After unilateral pontine stroke,bilateral pontine arm damage may occur,affecting ataxia and balance function of the patients.Wallerian degeneration after stroke is a special neurodegenerative process.Its imaging manifestations are similar to those of new cerebral infarction.Correct understanding of this phenomenon can avoid misdiagnosis.