多发性硬化42例临床表现和MRI结果分析
Analysis of clinical manifestation and MRI of 42 patients with multiple sclerosis
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摘要: 目的:总结多发性硬化(multiple sclerosis,MS)的临床和MRI特点,提高MS的临床诊断水平。方法:回顾性分析42例MS的临床表现和MRI资料及治疗情况。结果:MS多见于中青年女性,急性或亚急性发病。26例病前有诱因,主要与感染有关,首发症状以肢体无力和视力减退为多见,复发-缓解型32例,病变部位中脊髓29例,视神经28例,大脑半球14例,脑干8例,小脑4例,发作性症状14例。MRI检查脑部病灶多位于侧脑室周围和胼胝体,病灶多呈卵圆形,大部分病灶与侧脑室壁切线垂直或相连;脊髓病灶位于颈髓和胸髓,与脊髓长轴一致的长条状或多发非连贯性条索状,位于脊髓后外侧,激素治疗后大部分病灶可缩小或消失。急性期及亚急性期组均有明显疗效,慢性起病者也有改善。结论:结合MS的临床表现和脑部及脊髓MRI结果,可以提高对MS诊断的准确性。Abstract: Objective: To summarize the clinical and MRI characteristics of multiple sclerosis(MS) and to improve the diagnosis of the disease.Methods: The clinical manifestation and MRI appearance of 42 cases of MS were analyzed retrospectively.Results: MS was commonly seen in young and middle aged females and the onsets were acute or subacute.Twenty-six of the cases had evoking factors before onset,which were mainly relevant to infections.Weakness and visual deterioration were the most common initial symptoms.Thirty-two of the cases had relapses.The lesion was observed in the spinal cord in 29 cases,in the optic nerve in 28 cases,in the cerebral hemisphere in 14 cases,in the brain stem in 8 cases and in the cerebellum in 4 cases.Fourteen cases had paroxysmal symptoms.As shown by MRI,the intra-brain focus was mainly located around the lateral ventricles and corpus callosum.Oval lesion was the most common form.Most of the lesions were closely adjacent to the lateral ventricle or their long-axis was perpendicular with the tangent line of the lateral ventricle.Intra-spinal foci were in the cervical and thoracic cord,which were long-strip or multiple noncontinuous fusiform,and located posteriolaterally in the spinal cord.After treatment with corticosteroids,most of the focal lesions were reduced or disappeared.Conclusions: Diagnosis of MS could be improved by combining the clinical manifestation with the MRI of brain and spinal cord.