Specific changes in human brain after hypoglycemic injury
Specific changes in human brain after hypoglycemic injury
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DOI：
10.1161/01.str.28.3.584
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发表时间：
1997-03-01
期刊：
影响因子：
8.3
通讯作者：
Ishii, Y
中科院分区：
文献类型：
--
作者：
Fujioka, M;Okuchi, K;Ishii, Y
背景与目的关于严重低血糖损伤后人类大脑的一系列变化的报道很少。本研究的目的是研究低血糖昏迷患者与先前用相同方法研究的心脏骤停患者的大脑序列神经放射学变化。方法对4例糖尿病合并重度低血糖的植物人患者在1.5 T时的CT和MR图像进行反复研究。结果所有患者在发病后7 ~ 14天，连续CT扫描均显示对称性、持续性低密度病变，尾状核和透镜状核短暂增强，大脑皮层短暂增强。从发病后8天到12个月，连续MR图像一致显示，在T1和t2加权图像上，尾状核和透镜状核、大脑皮层、黑质和/或海马分别出现持续的高、低强度对称病变。结论重复磁共振成像显示双侧基底节区、大脑皮层、黑质和海马的特异性病变，提示这些区域在人类大脑中特别容易发生低血糖。我们推测，局部病变代表组织变性，包括选择性神经元死亡、星形胶质细胞增殖、顺磁性物质沉积和/或脂质积累的某种组合。低血糖性脑病的MR图像上没有局部出血，与缺血性脑病的局部轻微出血形成鲜明对比。
Background and Purpose Very few reports are available on serial changes in the human brain after severe hypoglycemic injury. The aim of this study was to investigate sequential neuroradiological changes in brains of patients after hypoglycemic coma compared with those after cardiac arrest previously studied with the same methods.Methods We repeatedly studied CT scans and MR images obtained at 1.5 T in four vegetative patients after profound hypoglycemia associated with diabetes mellitus.Results In all patients, consecutive CT scans showed symmetrical, persistent low-density lesions with transient enhancement in the caudate and lenticular nuclei and transient enhancement in the cerebral cortex 7 to 14 days after onset. Serial MR images consistently revealed symmetrical lesions of persistent hyperintensity and hypointensity on T1- and T2-weighted images, respectively, in the caudate and lenticular nuclei, cerebral cortex, substantia nigra, and/or hippocampus from 8 days to 12 months after onset.Conclusions Repeated MR images revealed specific lesions in the bilateral basal ganglia, cerebral cortex, substantia nigra, and hippocampus, which suggests the particular vulnerability of these areas to hypoglycemia in the human brain. We speculate that the localized lesions represent tissue degeneration, including some combination of selective neuronal death, proliferation of astrocytic glial cells, paramagnetic substance deposition, and/or lipid accumulation. The absence of localized hemorrhages on MR images in hypoglycemic encephalopathy is in marked contrast to the presence of regional minor hemorrhages in postischemic-anoxic encephalopathy.