Konagaya M, Sakai M, Kuru S, Kato T, Yasuma F, Matsuoka Y
Department of Neurology, Suzuka National Hospital, Mie, Japan.
No To Shinkei. 1999 Jul;51(7):621-6.
We evaluated cranial CT findings of 160 patients with various type of progressive muscular dystrophy (PMD). Significant brain atrophy was observed in 21 out of 63 cases of Duchenne muscular dystrophy (DMD), 7 out of 15 Becker muscular dystrophy (BMD), no case of 2 female dystrophinopathy (F-dyst), 11 out of 21 limb-girdle muscular dystrophy (LG), all cases of 10 Fukuyama type congenital muscular dystrophy (FCMD), 2 out of 5 fascioscapulohumeral muscular dystrophy (FSH), and 32 out of 44 myotonic dystrophy (MyD). Genetical degenerative process and vascular insufficiency seemed to cause brain atrophy in these disease. The intracranial calcification was observed in one DMD, one LG and seven MyD. One LG patient showed focal atrophy in left temporal lobe, and one MyD demonstrated right temporal meningioma. The trace of cerebral vascular accident was disclosed in eleven patients with PMD (1 DMD, 2 BMD, 1 F-dyst, 2 LG, 5 MyD). In these cases, 2 patients had dilated cardiomyopathy, 6 patients with decreased left ventricular ejection fraction, 3 with atrial fibrillation, 1 with cardiac arrest followed by pacemaker instillation, 1 with Adam-Stokes attack, and 3 with 1 degree AV-block. Diffuse low density in the white matter was seen in a patient with F-dyst, a FCMD patient, and 8 MyD patients. Cardiac emobolism, severe arrythmia, cardiogenic shock and hemodynamic disorder were seemed to cause cerebral vascular disease in PMD.
我们评估了160例不同类型进行性肌营养不良(PMD)患者的头颅CT检查结果。在63例杜氏肌营养不良(DMD)患者中,21例出现明显脑萎缩;15例贝克肌营养不良(BMD)患者中,7例出现脑萎缩;2例女性肌营养不良蛋白病(F-dyst)患者中,无一例出现脑萎缩;21例肢带型肌营养不良(LG)患者中,11例出现脑萎缩;10例福山型先天性肌营养不良(FCMD)患者全部出现脑萎缩;5例面肩肱型肌营养不良(FSH)患者中,2例出现脑萎缩;44例强直性肌营养不良(MyD)患者中,32例出现脑萎缩。在这些疾病中,遗传退行性变过程和血管功能不全似乎导致了脑萎缩。在1例DMD、1例LG和7例MyD患者中观察到颅内钙化。1例LG患者左侧颞叶出现局灶性萎缩,1例MyD患者出现右侧颞叶脑膜瘤。在11例PMD患者(1例DMD、2例BMD、1例F-dyst、2例LG、5例MyD)中发现脑血管意外痕迹。在这些病例中,2例患者患有扩张型心肌病,6例患者左心室射血分数降低,3例患者患有心房颤动,1例患者心脏骤停后植入起搏器,1例患者出现阿-斯发作,3例患者患有一度房室传导阻滞。1例F-dyst患者、1例FCMD患者和8例MyD患者出现白质弥漫性低密度影。心脏栓塞、严重心律失常、心源性休克和血流动力学紊乱似乎导致了PMD患者的脑血管疾病。