低血糖颅脑损伤.pptVIP

01几乎不累及丘脑，小脑及脑干低血糖脑损害具有一定的区域选择性，细胞愈进化，对缺糖愈敏感尾状核、豆状核、大脑皮质、海马和黑质是低血糖的敏感区域，最易受损也有研究提示敏感区域还包括胼胝体和皮质下白质。020304有研究发现，严重低血糖患者病损一旦侵犯到皮质和基底节区，病变多不易恢复01临床症状和DWI异常可在短时间内逆转者，病变多在胼胝体压部，皮质下白质和内囊后肢02提示DWI序列在一定程度上有助于判断预后，胼胝体压部受损者预后相对较好03低血糖性脑病与缺血性脑血管病神经影像学两个显著差别:1一是缺血性脑血管病可见到小的出血点灶，而低血糖性脑病时没有二是缺血性脑血管病可见到对称性丘脑损害，而低血糖性脑病没有2大脑皮质双侧损害Fig1.Case1,a65-year-oldmaninadiabeticcomawithseizures.A,Fastspin-echomilliseconds/110fluidattenuatedinversionrecovery(9000millisecondseffective/2200milliseconds[TR/TE/TI])MRimageshowsbilateralhyperintensityofthecortexoverthetemporalandoccipitallobes.BandC,Diffusion-weighted(10000/105,bvalue1000seconds/mm2)MRimagesshowingcorrespondinghyperintensityinthecortex.DandE,ADCmapsatthesamelevelsasBandCshowdecreasedADCintheselesions(618103mm2/s)comparedwithnormalwhitematter(819103mm2/s).大脑皮质偏侧损害Imagesin26-year-oldman(patient6)foundunconscious,withaGlasgowComaScalescoreof7,andnotmovingleftside.(a)DWMRimageshowsconfluenthyperintenselesionsintherightinferiorfrontal,insular,andposteriortemporallobecortices.(b)MRangiogramshowsincreasedvascularityoftherightmiddlecerebralarterybranches(arrow)comparedwiththenormalleftside,suggestingaugmentedcollateralflow.(c)Relativecerebralbloodvolumemapshowsnonoticeabledecreaseintheabnormalrightcerebralhemisphere;bloodvolumewasinfactincreasedby20%–25%,afindingthatisalsosuggestiveofmaximalvasodilatation(seetext).(d)Graphofsingle-oxelMRspectroscopicdatainaffectedrightcerebralcortexshowsdecreasedN-acetylaspartate(NAA)level,preservedcholine(Cho)andcreatine(Cr)levels,andnoevidenceofabnormallactatelevel(arrow1.3ppm).大脑皮质损害，丘脑未累及Diffusion-weightedmagneticresonance(MR)imaging(A)andT2-weightedMRimaging(B)showedadiffusecorticalhighsignal.Thebrainstem,cerebellum,andthalamusweresparedas