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华西医学  2011 

癫痫持续状态引起的脑部异常MRI表现

, PP. 900-903

Keywords: 癫痫持续状态,MRI

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Abstract:

【】 目的 探讨癫痫持续状态引起的脑部异常MRI表现的特点。 方法 回顾分析2004年―2007年5例患者由癫痫持续状态引起的脑部异常MRI表现,患者均在发作后72h内行头颅MRI检查,常规进行了T2WI、T1WI、液体衰减反转恢复序列、弥散加权成像(diffusion-weightedimaging,DWI),同时进行了磁共振血管造影(magneticresonanceangiography,MRA)及增强扫描。 结果 5例患者均由部分性发作泛发为全面性强直-阵挛发作,均在发作后行MRI时出现明显单侧大脑半球异常表现,且与部分性发作侧相对应,在T2WI上均表现为局部皮层肿胀,呈高信号,其中3例DWI上出现皮层高信号,病灶不按脑血管分布。4例在MRA上出现病灶同侧大脑中动脉血管较对侧明显增多。5例行增强扫描后均见病灶侧脑膜明显强化。5例患者临床发作后均遗留有与MRI异常病灶相应的临床神经功能缺失。其中3例病情稳定后复查MRI,发现异常病灶及MRA完全恢复正常。 结论 癫痫持续状态引起脑部异常MRI表现特点①常局限于大脑皮层的T2WI、DWI高信号,且病灶不按血管分布区分布;②MRA提示单侧脑血管增多;③增强扫描见单侧脑膜强化。大部分病灶可逆。这些特点可用来区别是癫痫引起的异常病灶还是脑部的致痫灶。【Abstract】 Objective TosummarizethecharacteristicsofabnormalMRIfindingsofbraincausedbystatusepilepticus. Methods WeretrospectivelyanalyzedtheabnormalMRIfindingsofbraininfivepatientswithstatusepilepticusfrom2004to2007.AllofthemreceivedMRIexaminationwithin72hoursafterseizures,includingtheroutineexaminationofT2WI,T1WI,FLAIRanddiffusion-weightedimaging(DWI).Meanwhile,MRAandenhancementscanningwerecarriedout.ThreeofthemwerereexaminedwithMRIafterthediseasecameintoastablecondition. Results Allthefivepatientstransferredfrompartialseizuresinitiallytogeneralizedtonicclonicseizures,andobviousabnormalMRIfindingsweredetectedattheunilateralcerebralhemisphere,correspondingtothesideofpartialseizures.TheyappearedregionalswellingofcortexwithhighsignalinT2WI,andthreecaseswerefoundwithcortexhighsignalsinDWI,whichwerenotdistributedaccordingtocerebralvessels.Infourcases,wefoundthatthebranchesofthemiddlecerebralarteryincreasedmarkedlythanthecontralateralbranchesontheipsilaterallesionsinMRA.Enhancementscanningalsoshowedthatthemeningesatthesideofthelesionwasstrengthenedsignificantlyinfivecases.ThelossofneurologicalfunctionscorrespondingtoabnormallesionsinMRremainedafterseizuresinfivecasesamongwhomthreepatientsrecoveredcompletelyintermsoftheirabnormalfocusesandMRAfindingsaftertheirdiseasescameintoastablecondition. Conclusions ThefeaturesofabnormalbrainMRIfindingscausedbystatusepilepticusare①HighsignalsinT2WIandDWIareconfinedtothecortex,andthefocusesarenotdistributedaccordingtocerebralvessels;②MRAshowsthatunilateralcerebralvesselsincreasesinnumber;③Strengthenedunilateralmeningescanbeobservedinenhancedscanningandmostoflesionsarereversible.Accordingthecharacteristics,wecandistinguishtheabnormallesionscausedbyepilepsyfromfocusesinthebraincausingepilepsy.

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