Miyata Kei, Imaizumi Toshio, Horita Yoshifumi, Hashimoto Yuji, Tanno Katsutoshi, Koide Akitomo, Niwa Jun
Emergency Care Unit, Hakodate Municipal Hospital, Japan.
No Shinkei Geka. 2003 Nov;31(11):1223-7.
We have observed dot-like low intensity spots (a dot-like hemosiderin spot: dotHS) on T2*-weighted (T2*-w) MRI, subsequently diagnosed histologically as previous microbleeds associated with lipohyalinosis, amyloid angiopathy and cerebral small vessel disease (SVD) including an intracerebral hematoma (ICH) and a lacunar infarction. According to the literature, primary aldosteronism (PA), characterized by hypertension, is related to SVD. A 49-year-old female with a long history of untreated hypertension secondary to PA was admitted to our hospital for medical examinations on July 18th, 2000. She had the stepwise development of dementia, dysarthria and gait disturbance (right hemiparesis). CT and MRI demonstrated multiple lacunar infarctions. She was readmitted to our hospital on Jan 23rd, 2002. A neurological examination revealed right hemiparesis, dysarthria and consciousness disturbance. CT on admission demonstrated ICH in the left midbrain. Six days after the hemorrhage, T2*-w MRI showed thirty-two dotHSs in the basal ganglias and the cortical-subcortical regions. The incidence of ICH in patients with hypertension secondary to PA is reported to be higher than in patients with essential hypertension. Multiple dotHS may be associated with ICH, lacunar infarction, and severe microangiopathy related to hypertension secondary to PA.
我们在T2加权（T2 - w）磁共振成像（MRI）上观察到点状低强度信号灶（点状含铁血黄素沉着斑：dotHS），随后经组织学诊断为既往与脂质性透明变性、淀粉样血管病及包括脑内血肿（ICH）和腔隙性脑梗死在内的脑小血管病（SVD）相关的微出血。根据文献报道，以高血压为特征的原发性醛固酮增多症（PA）与SVD有关。一名49岁女性，因PA继发的高血压长期未治疗，于2000年7月18日入住我院进行医学检查。她出现了痴呆、构音障碍和步态障碍（右侧偏瘫）的逐步发展。CT和MRI显示多发腔隙性脑梗死。她于2002年1月23日再次入院。神经系统检查发现右侧偏瘫、构音障碍和意识障碍。入院时CT显示左侧中脑有ICH。出血6天后，T2* - w MRI显示基底节和皮质 - 皮质下区域有32个dotHS。据报道，PA继发高血压患者的ICH发生率高于原发性高血压患者。多个dotHS可能与ICH、腔隙性脑梗死以及与PA继发高血压相关的严重微血管病变有关。
