3例高血糖相关性急性脑损伤患者的临床与影像分析

Clinical and imaging analysis of 3 patients with hyperglycemia-associated acute brain injury

目的探讨高血糖导致急性脑损伤的临床特征和影像学变化。方法分析2例糖尿病伴偏侧舞蹈症和1例糖尿病伴局灶性癫痫的患者,并对3例由高血糖引起的急性脑损伤患者的临床表现、NECT及MR的变化进行总结。结果3例患者均表现为高血糖及糖化血红蛋白(HbAlc)明显升高,2例表现为偏侧舞蹈症,1例表现为局灶性癫痫;例1为舞蹈症患者,头部CT表现为左侧基底节区高密度灶,头颅MR:T_(1)WI示左侧豆状核高信号灶,T_(2)WI示双侧豆状核低信号、左侧更明显,DWI及ADC序列未见明显弥散受限及高灌注表现,例2为舞蹈症合并脑梗死患者,头部CT表现为右侧尾状核片状低密度影,周围密度增高,头颅MR:T_(1)WI序列显示右侧基底节区有一片状低信号灶(为脑梗死),病灶周边有高信号灶(考虑高血糖急性脑损伤),T_(2)WI序列显示右侧基底节高信号,周围为低信号,DWI无弥散受限,例3为局灶性癫痫患者,头部CT未见明显异常病灶,头部MR:T_(1)WI序列示左侧枕叶等信号,T_(2)WI序列可见稍低信号影,而DWI、ADC稍低信号,SWI呈稍低信号。3例患者均经积极降糖及对症治疗后恢复正常。结论高血糖相关性急性脑损伤,患者可表现偏侧舞蹈症及癫痫等症状,其影像学表现为NECT为稍高密度灶或等密度灶,T_(2)或FLAIR序列均呈低信号,高血糖纠正及对症治疗后症状改善明显,预后良好。

Objective To explore the clinical features and radiographic changes of acute brain injury due to hyperglycemia.Methods Two cases of diabetes with hemichorea and one case of diabetes with focal epilepsy were analyzed,and the clinical manifestations,NECT and MR Changes in three cases of acute brain injury caused by hyperglycemia were summarized.Results All the 3 patients presented with high blood sugar and HbAlc increased significantly,2 patients presented with hemichorea,1 patient presented with focal epilepsy.Case 1 was a chorea patient with head CT showed a high density lesion in the left basal ganglia.Cranial MR:T_(1)WI showed high signal focus in the left lentulous nucleus,T_(2)WI showed low signal in the bilateral lentulous nucleus,more obvious in the left side,no obvious limited diffusion and high perfusion in DWI and ADC sequences.Case 2 was a chorea patient with cerebral infarction,head CT showed lamellar low-density shadow in the right caudate nucleus,with increased surrounding density.Skull MR:T_(1)WI sequence showed a lamellar low-signal lesion in the right basal ganglia(cerebral infarction),and high-signal lesion around the lesion(considering acute brain injury with hyperglycemia).T_(2)WI sequence showed high signal in the right basal ganglia,surrounding low-signal,and no limited diffusion on DWI.In 3 patients with focal epilepsy,no obvious abnormal lesions were found on head CT.T_(1)WI sequences showed isosignal in the left occipital lobe,T_(2)WI sequences showed slightly lower signal shadow,DWI and ADC showed slightly lower signal,and SWI showed slightly lower signal.All the 3 patients recovered to normal after active hypoglycemic and symptomatic treatment.Conclusion Hyperglycemic-related acute brain inju⁃ry may present hemichorea,epilepsy and other symptoms.The imaging findings show that NECT is slightly high-density focus or isodense focus,and T_(2)or FLAIR sequence is hyposignal.The symptoms improve significant⁃ly after hyperglycemia correction and symptomatic treatment,and the prognosis is good.