后部皮质萎缩临床及影像学特征分析

Clinical features and imaging biomarkers of posterior cortical atrophy

目的总结后部皮质萎缩的临床及影像学特征。方法与结果纳入2021年4-6月四川大学华西医院收治的5例后部皮质萎缩患者,均表现为空间感知觉障碍、同时性失认、失算、失写、结构性失用、环境失认,以及各有3例存在穿衣失用、左右失认,有1例存在面孔失认、视觉性共济失调、物体感知觉障碍;脑脊液生物学标志物测定,3例β-淀粉样蛋白42(Aβ42)降低,2例Aβ42/β-淀粉样蛋白40(Aβ40)比值显著降低,5例总t-tau蛋白水平均升高,3例磷酸化tau蛋白181水平升高;神经心理学测验,5例均存在不同程度认知功能障碍和日常生活活动能力障碍,以及视空间能力、视觉记忆、注意力减退,3例伴焦虑或抑郁情绪,3例语言功能和执行功能下降,2例言语记忆减退;头部MRI检查,5例均存在不同程度顶枕颞皮质萎缩,1例18F-FDG PET显示颞顶皮质葡萄糖代谢明显降低。5例双眼视力下降,1例全视野缺损、2例部分视野缺损。除1例失访外,余4例平均随访21个月,2例患者认知功能、视空间能力减退,其中1例生活大部分无法自理;1例认知功能、视空间能力改善;1例认知功能、视空间能力未见明显变化。结论对于发病年龄较早,以失认、视野缺损、视空间能力障碍等为核心症状的患者,可以完善视觉相关神经心理学测验、头部MRI和18F-FDG PET检查、脑脊液生物学标志物测定等,以辅助诊断后部皮质萎缩。

Objective To sudm Rmeasruizlets the clinical and imaging features of patients with posterior cortical atrophy(PCA).Methods anFive patients with PCA admitted in West China Hospital,Sichuan University from April to June 2021 were included.All of them showed spatial perception disorder,simultaneous agnosia,miscalculation,agraphia,structural apraxia,environmental agnosia.Apraxia of dressing and agnosia of left and right were found in 3 cases.One case had facial agnosia,visual ataxia and object perception disorder.Cerebrospinal fluid(CSF)biomarker determination:amyloidβ-protein 42(Aβes,the ratio of Aβ42)decreased in 3 cas)in42/amyloidβ-protein 40(Aβcreased in all 5 cases,pho40)decreased significantly in 2 cases,the content of total tau protein(t-tausphorylated tau 181 protein(p-tau181)increased in 3 cases.Neuropsychological tests showed that:1)Five patients all had different degrees of cognitive dysfunction and impairment of activities of daily living,as well as impairment of visuospatial ability,visual memory and attention.2)Three cases had anxiety and depression,language and executive function were impaired in 3 cases,and verbal memory was impaired in 2 cases.Head MRI examination all indicated different degrees of parieto-occipital-temporal cortical atrophy.Hypometabolism in posterior regions involving parietal and temporal cortex was observed in one case with18F-FDG PET.Three cases completed the visual field examination,including 5 cases of binocular vision loss,one case of complete visual field defect,2 cases of partial visual field defect.Except one case lost to follow-up,other 4 cases were followed up for 20-22 months.Two cases of cognitive function,visuospatical ability decline,of which one case could not take care of themselves most of the life.Cognitive function and visuospatial ability improveCd in one case.There was no significant change in cognitive function and visuospatial ability in one case.onclusions PCA should be considered in patients with relatively early-onset of agnosia,visual field defect 1and visuospatial impairment.Comprehensive neuropsychological tests related to visual function,brain MRI,8F-FDG PET and CSF biomarkers would be helpful for accurate diagnosis.