摘要
目的报道1例脑内多发囊性巨大血管周围间隙(PVS)及其诊治体会。方法回顾性分析1例脑内多发囊性巨大PVS患者的病例资料,通过检索PubMed和Medline数据库,综合文献结果,总结多发囊性巨大PVS的解剖、病生理、临床表现、影像学改变及治疗原则。结果本例为19岁男性士兵,因枕部间断性胀痛2周入院。头颅MRI显示右侧大脑半球多发性囊性病变,无强化。头颈动脉CT血管成像未发现异常。诊断为脑内多发囊性巨大PVS。口服复方对乙酰氨基酚片3 d后,头痛缓解。定期随访3.5年,患者没有发生任何疾病相关症状。截至2020年10月13日,PubMed和Medline收录脑内多发囊性巨大PVS英文报道41篇,共含46例多发囊性巨大PVS病例。临床表现取决于PVS周围的神经组织是否受压以及受压程度。头痛占32.6%,脑积水占43.5%。PVS的MRI表现为圆形、椭圆形或管状结构,边缘清晰光滑,信号强度与脑脊液相同,无强化。当PVS直径大于15 mm时称为巨大PVS,可能造成周围神经组织受压或脑积水,神经外科手术有助于改善病情。结论巨大PVS的MRI特征是所有序列均为脑脊液样信号的囊性病变,无强化。临床应重视鉴别诊断和随访。如果发生占位效应或脑积水,可行神经外科干预,否则无需特殊处理。
Objective To improve doctors’ understanding of giant perivascular space (PVS) in the brain.Methods A case of giant intracranial polycystic PVS was analyzed retrospectively by searching the databases of PubMed and Medline,combining with literature reports,the anatomy,pathophysiology,clinical manifestations,imaging changes,and treatment principles of giant PVS were summarized.Results A 19-year-old male solder was admitted due to intermittent occipital distension pain for 2 weeks.The brain MRI showed multiple cystic lesions in the right cerebral hemisphere without enhancement.The head-carotid artery CT angiography found no abnormality.The diagnosis was polycystic giant PVS in the brain.His headache was relieved after 3 days of oral compound paracetamol tablets.During a regular follow-up period for 3.5 years,he complained no discomfort.Until October 13,2020,there were only 41 English articles about brain polycystic giant PVS collected in PubMed,including total of 46 cases.The clinical manifestations were not specific,depending on whether the nerve tissue around PVS was compressed or not.Headache accounted for 32.6%,and hydrocephalus for 43.5%.The MRI of PVS was characterized by its round,oval or tubular structure with a clear,smooth and homogeneous edge,its signal intensity was equal to that of cerebrospinal fluid (CSF) without enhancement.It is called giant or huge PVS when its diameter is more than 15 mm.There was no special treatment unless the giant PVS causes surrounding tissue oppression or hydrocephalus,if so,neurosurgical operation could be help to improve patient’s status.Conclusions Characteristics of giant PVS appeared on all sequences of MIR is a CSF-like intensity cystic lesion without enhancement.Clinical attention should be paid to differential diagnosis and follow-up and.If space-occupying effect or hydrocephalus development,it can be intervened by neurosurgery,otherwise no special treatment.
作者
王海霞
黄勇华
张楠
夏翠俏
李昀
王国强
Wang Hai-Xia;Huang Yong-Hua;Zhang Nan;Xia Cui-Qiao;Li Yun;Wang Guo-Qiang(Department of Neurology,the Seventh Medical Center of Chinese PLA General Hospital,Beijing 100700,China;Department of Neurology,Weifang People's Hospital,Weifang,Shandong 261000,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2021年第1期57-63,共7页
Medical Journal of Chinese People's Liberation Army
关键词
脑
血管周围间隙
扩张
巨大
多囊
磁共振成像
cerebral
perivascular space
dilate
giant
polycystic
magnetic resonance imaging
