首诊于精神科的脑淀粉样血管病1例

doi:10.3969/j.issn.1004-583X.2024.01.011

摘要/Abstract

摘要：

目的探讨脑淀粉样血管病的临床症状及影像学表现。方法回顾性分析1例首诊于精神科的脑淀粉样血管病的临床资料。结果患者女性,56岁,临床主要表现为情感平淡、言语减少、记忆力减退。患者脑脊液蛋白0.51 g/L,氯118.9 mmol/L,潘氏试验弱阳性,脑电图α波不规则,慢波较多,磁敏感加权成像显示颅内弥漫性微出血,蒙特利尔认知评估11分,韦氏智力测试55分。给予甲强龙500 mg/d和罂粟碱90 mg/d治疗,出院2个月后复查,症状部分改善。结论磁敏感加权成像对诊断脑淀粉样血管病具有较高的临床应用价值。

关键词: 脑淀粉样血管病, 精神科, 脑电描记术, 脑脊液, 磁敏感加权成像

Abstract:

Objective To investigate the clinical symptoms and imaging manifestations of cerebral amyloid angiopathy(CAA). Methods The clinical data of a case who was first diagnosed with CAA in psychiatric department was retrospectively analyzed. Results The 58-year-old female patient had main clinical manifestations of plain emotion, reduced speech, and memory loss, with 0.51 g/L of cerebrospinal fluid protein, 118.9 mmol/L of chlorine, weak positive in Pan's test, irregular electroencephalogram alpha wave, more slow wave, displaying diffuse intracranial microbleeding by susceptibility weighted imaging(SWI), 11 points of Montreal cognitive assessment score(MCAS), 55 points of Wechsler Intelligence Scale(WIS). The patient was managed by methylprednisolone (500 mg/d) and papaverine (90 mg/d), and the symptoms were partially improved after two months of discharge. Conclusion SWI has high clinical value in the diagnosis of CAA.

Key words: cerebral amyloid angiopath, psychiatry department, electroencephalography, cerebrospinal fluid, susceptibility weighted imaging

中图分类号:

R597.2

马秀云, 朱菊红, 杨斌. 首诊于精神科的脑淀粉样血管病1例[J]. 临床荟萃, 2024, 39(1): 61-64.

Ma Xiuyun, Zhu Juhong, Yang Bin. A case of cerebral amyloid angiopathy firstly visiting mental health department[J]. Clinical Focus, 2024, 39(1): 61-64.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.01.011

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I1/61

图/表 1

图1 脑淀粉样血管病头颅影像图 a.T2加权序列示双侧额叶、右侧顶枕叶及双侧侧脑室前后角周围见斑片样稍高信号影,部分呈高信号;b.SWI见双侧大脑半球弥漫性、散在微出血灶;c.MR增强轴位图,脑实质未见明显异常强化

Fig.1 Cephalic image of cerebral amyloid angiopathosisa a. T2-weighted sequence showed that slightly patchy high signal shadows were in the bilateral frontal lobe, right parieto-occipital lobe, and the anterior and posterior corners of bilateral lateral ventricles, but some prsented high signal shadows; b.SWI showed diffuse and scattered microbleeding in both cerebral hemispheres; c. MR Enhancement axis map, no significant abnormal enhancement was observed in brain parenchyma

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