Trotti Lynn Marie, Bliwise Donald L
Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Clin Neurol Neurosurg. 2017 Jun;157:19-21. doi: 10.1016/j.clineuro.2017.03.010. Epub 2017 Mar 18.
Proper diagnosis of idiopathic hypersomnia necessitates the exclusion of neurologic or medical causes of sleepiness that better explain the clinical syndrome. However, there are no formal guidelines regarding the use of neuroimaging to identify such secondary causes of symptoms. We sought to characterize brain MRI findings in a series of patients with idiopathic hypersomnia.
We reviewed medical records on a consecutive series of 61 patients diagnosed with idiopathic hypersomnia to determine the frequency and results of brain magnetic resonance imaging (MRI).
One-third of patients had undergone brain MRI, with focal neurologic signs or symptoms being the most common indication for neuroimaging. Although seven patients had an identifiable finding on neuroimaging (e.g., chronic microvascular ischemic changes), clinical management was changed as a result of imaging in only three cases. In all three, the imaging finding was predated by clear clinical abnormalities.
Neuroimaging may be a complementary part of an idiopathic hypersomnia evaluation, but the decision to pursue imaging should be made on a case-by-case basis.
正确诊断特发性嗜睡需要排除能更好地解释临床综合征的神经系统或医学原因导致的嗜睡。然而，关于使用神经影像学来识别此类症状的继发原因，目前尚无正式指南。我们试图描述一系列特发性嗜睡患者的脑部磁共振成像（MRI）表现。
我们回顾了连续61例被诊断为特发性嗜睡患者的病历，以确定脑部磁共振成像（MRI）的频率和结果。
三分之一的患者接受了脑部MRI检查，局灶性神经体征或症状是神经影像学检查最常见的指征。虽然7例患者在神经影像学检查中有可识别的发现（如慢性微血管缺血性改变），但仅有3例患者的临床管理因影像学检查结果而改变。在所有这3例中，影像学发现之前都有明确的临床异常表现。
神经影像学检查可能是特发性嗜睡评估的一个补充部分，但是否进行影像学检查应根据具体情况决定。
