Novel Application of Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging for Diagnosis of External Hydrocephalus
Novel Application of Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging for Diagnosis of External Hydrocephalus
复制标题
时空标记反转脉冲磁共振成像在脑外积水诊断中的新应用
DOI：
10.1016/j.wneu.2017.09.175
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发表时间：
2018
影响因子：
2
通讯作者：
Hirose Yuichi
中科院分区：
文献类型：
--
作者：
Nakae Shunsuke;Murayama Kazuhiro;Adachi Kazuhide;Kumai Tadashi;Abe Masato;Hirose Yuichi
背景虽然经常观察到硬膜下积液，但鉴别由外部脑积水引起的硬膜下积液和由硬膜下积液引起的硬膜下积液的诊断方法尚未建立。在此，我们报告一例由格列德尔所致的嗜酸性脑膜炎引起的外部性脑积水，该病例仅有1例，可通过时间-空间标记反转脉冲磁共振成像(Time-Sliding Inversion Pulse MRI，Time-Slip MRI)诊断。肿瘤被手术切除，并在手术中被诊断为高级别胶质瘤；随后植入了格里亚德尔晶片。手术三周后，患者出现意识障碍，计算机断层扫描显示硬膜下积液。采用时间滑移MRI检测切除腔内脑脊液流出情况。脑脊液检测显示高白血球计数和高蛋白水平，超过90%的白血球计数由嗜酸性粒细胞组成。因此，我们怀疑硬膜下积液是由于格列德尔诱发的嗜酸性脑膜炎而引起的外部性脑积水。我们通过手术移除了Garia del晶片，随后进行了手术以插入脑室-腹膜分流术。组织学检查显示Garia del晶片周围有嗜酸性粒细胞聚集。结论在本病例中，时间滑移MRI是诊断由嗜酸性脑膜炎引起的外部性脑积水的一种有用且无创的方法。
BackgroundAlthough a subdural fluid collection frequently is observed, diagnostic methods that differentiate between the subdural collection caused by external hydrocephalus and that caused by subdural hygroma have not been established. Here, we report a case of external hydrocephalus caused by Gliadel-induced eosinophilic meningitis that has been previously reported in only 1 case and can be diagnosed by time-spatial labeling inversion pulse magnetic resonance imaging (time-SLIP MRI).Case DescriptionA tumor located in the left temporal was detected incidentally in an 81-year-old man by examination of a head injury. The tumor was surgically resected and diagnosed as a high-grade glioma during the surgery; Gliadel wafers subsequently were implanted. Three weeks after the resection, the patient showed disturbed consciousness, and computed tomography revealed a subdural fluid collection. The out-flow of cerebrospinal through the resection cavity was detected by time-SLIP MRI. Cerebrospinal tests indicated high white blood cell counts and high protein levels, with more than 90% of the white blood cell count comprising eosinophils. Therefore, we suspected that the subdural fluid collection was caused by external hydrocephalus because of Gliadel-induced eosinophilic meningitis. We surgically removed the Gliadel wafers and subsequently performed a surgery to insert a ventriculoperitoneal shunt. Histologic examination indicated eosinophilic accumulation around the Gliadel wafers. The patient's symptoms improved after the insertion of a ventriculoperitoneal shunt.ConclusionsIn the present case, time-SLIP MRI was a useful and noninvasive method for diagnosing external hydrocephalus which was caused by eosinophilic meningitis because of Gliadel-induced eosinophilic meningitis.