海马硬化患儿磁共振成像上的颞叶前部改变：癫痫发作对未成熟大脑的影响？
Anterior temporal changes on MR images of children with hippocampal sclerosis: an effect of seizures on the immature brain?
作者信息
Mitchell L Anne, Harvey A Simon, Coleman Lee T, Mandelstam Simone A, Jackson Graeme D
机构信息
Department of Radiology, Royal Children's Hospital, Melbourne, Australia.
出版信息
AJNR Am J Neuroradiol. 2003 Sep;24(8):1670-7.
BACKGROUND AND PURPOSE
Ipsilateral loss of anterior temporal gray-white matter definition, due mainly to white matter signal intensity abnormality, is frequently seen on MR images of patients with hippocampal sclerosis. Our aim was to determine the prevalence and clinical correlations of these anterior temporal changes in pediatric cases of hippocampal sclerosis and to determine whether cumulative damage from seizures is important for their development.
METHODS
We reviewed the MR images and clinical details of 54 children (age range, 1.5-19 years) with typical hippocampal sclerosis. Specific imaging features noted included hippocampal sclerosis, anterior temporal changes, anterior temporal atrophy, and extra-hippocampal abnormality.
RESULTS
Thirty-one (57%) of 54 children with hippocampal sclerosis had associated ipsilateral anterior temporal changes. Ipsilateral anterior temporal atrophy was associated with anterior temporal changes (P <.03). Children whose images showed anterior temporal changes were younger at onset of epilepsy (P <.01) and younger at antecedent cerebral insult (P <.03) than those with normal anterior temporal lobes. Most (84%) children whose images showed anterior temporal changes had experienced the onset of epilepsy or antecedent cerebral insult before the age of 2 years (P <.0009). Eighty-one percent of children with anterior temporal changes shown on their images experienced seizures at the time of antecedent insult.
CONCLUSION
Ipsilateral anterior temporal changes identical to those observed in adult cases are seen on the MR images of young children with hippocampal sclerosis, with a similar prevalence, and are associated with either epilepsy onset or seizure-related cerebral insult before the age of 2 years. We suggest that the loss of gray-white matter definition may represent a persistent immature appearance, including an abnormality of myelin or myelination, possibly a result of seizures occurring during maturation of the temporal pole.
背景与目的
在海马硬化患者的磁共振成像（MR）图像上，常可见主要由于白质信号强度异常导致的同侧颞前灰白质界限消失。我们的目的是确定小儿海马硬化病例中这些颞前改变的发生率及其临床相关性，并确定癫痫发作累积损伤对其发展是否重要。
方法
我们回顾了54例（年龄范围1.5 - 19岁）典型海马硬化患儿的MR图像和临床细节。记录的具体影像特征包括海马硬化、颞前改变、颞前萎缩和海马外异常。
结果
54例海马硬化患儿中，31例（57%）存在同侧颞前改变。同侧颞前萎缩与颞前改变相关（P <.03）。图像显示有颞前改变的患儿癫痫发作起始年龄（P <.01）和既往脑损伤年龄（P <.03）均低于颞前叶正常的患儿。图像显示有颞前改变的患儿中，大多数（84%）在2岁前出现癫痫发作或既往脑损伤（P <.0009）。图像显示有颞前改变的患儿中，81%在既往脑损伤时出现癫痫发作。
结论
在小儿海马硬化患者的MR图像上可见与成人病例中观察到的相同的同侧颞前改变，发生率相似，且与2岁前癫痫发作起始或与癫痫发作相关的脑损伤有关。我们认为灰白质界限消失可能代表一种持续的未成熟表现，包括髓鞘或髓鞘形成异常，可能是颞叶极区成熟过程中癫痫发作的结果。
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