Diffusion-weighted imaging as a problem-solving tool in the evaluation of patients with acute strokelike syndromes.
Diffusion-weighted imaging as a problem-solving tool in the evaluation of patients with acute strokelike syndromes.
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DOI：
10.1097/00002142-200010000-00006
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发表时间：
2000-10-01
期刊：
影响因子：
--
通讯作者：
Schaefer, P W
中科院分区：
文献类型：
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作者：
Schaefer, P W
这篇文章讨论了临床和/或放射学上类似急性中风的综合征。这些综合征一般分为四类。(1)急性神经功能缺损伴非缺血性病变且弥散加权成像无急性异常的患者。这些患者可能有周围性眩晕、偏头痛、癫痫、痴呆、功能障碍、淀粉样血管病或代谢紊乱。当这些患者出现时，我们可以自信地预测他们没有发生梗死。(2)具有可逆性临床缺陷的缺血性病变患者。近50%的短暂性脑缺血发作患者的病变扩散受限。短暂性完全遗忘症患者可能在内侧海马、海马旁回和胼胝体出现弥散受限的点状病变。(3)临床上和常规影像学上可能与急性梗死相似的血管源性水肿综合征。这些包括子痫/高血压脑病、其他后部白质脑病、人类免疫缺陷病毒脑病、颈动脉内膜切除术后的过度灌注综合征、静脉窦血栓形成、急性脱髓鞘和肿瘤。这些综合征表现为弥散增加，而不是急性缺血性卒中相关的弥散受限。(4)扩散受限的实体可能类似于急性梗死。这些包括化脓性感染、疱疹病毒性脑炎、克雅氏病、弥漫性轴索损伤、细胞密集的肿瘤和罕见的急性脱髓鞘病变。
This article addresses syndromes that clinically and/or radiologically resemble acute stroke. These syndromes generally fall into four categories. (1) Patients with acute neurological deficits with nonischemic lesions and no acute abnormality on diffusion-weighted images. These patients may have peripheral vertigo, migraines, seizures, dementia, functional disorders, amyloid angiopathy, or metabolic disorders. When these patients present, we can confidently predict that they are not undergoing infarction. (2) Patients with ischemic lesions with reversible clinical deficits. Nearly 50% of patients with transient ischemic attacks have lesions with restricted diffusion. Patients with transient global amnesia may have punctate lesions with restricted diffusion in the medial hippocampus, parahippocampal gyms, and corpus callosum. (3) Vasogenic edema syndromes that may mimic acute infarction clinically and on conventional imaging. These include eclampsia/hypertensive encephalopathy, other posterior leukoencephalopathies, human immunodeficiency virus encephalopathy, hyperperfusion syndrome following carotid endarterectomy, venous sinus thrombosis, acute demyelination, and neoplasm. These syndromes demonstrate elevated diffusion rather than the restricted diffusion associated with acute ischemic stroke. (4) Entities in which restricted diffusion may resemble acute infarction. These include pyogenic infections, herpes virus encephalitis, Creutzfeldt-Jakob disease, diffuse axonal injury, tumors with dense cell packing, and rare acute demyelinative lesions.