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[脑动脉炎,一个诊断迷宫]

[Cerebral vasculitis, a diagnostic labyrinth].

作者信息

van Houwelingen R C, Frijns C J M, Toering S T, van Laar P J, Meilof J F

机构信息

Universitair Medisch Centrum Groningen, Groningen.

出版信息

Ned Tijdschr Geneeskd. 2017;161:D1148.

Abstract
  • A diagnosis of cerebral vasculitis is frequently considered in patients with new or progressive neurological symptoms for which there is no other explanation.- A clinician considering a diagnosis of cerebral vasculitis should be well aware of alternative diagnoses, since these are generally more common.- Several consecutive examinations are required for diagnosing cerebral vasculitis, because there is no diagnostic procedure that is highly sensitive as well as highly specific.- The added value of the different procedures may depend on the type of blood vessels involved.- Standard MRI examinations are sensitive but not specific.- Special MRI techniques now make it also possible to make images of the vessel wall itself.- Catheter angiography remains important, especially when non-invasive angiographic techniques do not reveal any abnormalities.- Brain biopsy can provide proof of cerebral vasculitis and also serves to exclude mimicking conditions.
摘要
  • 对于出现新发或进行性神经症状且无其他解释的患者,常考虑诊断为脑动脉炎。

  • 考虑诊断脑动脉炎的临床医生应充分了解其他可替代诊断,因为这些通常更为常见。

  • 诊断脑动脉炎需要进行多次连续检查,因为不存在高度敏感且高度特异的诊断方法。

  • 不同检查方法的附加价值可能取决于受累血管的类型。

  • 标准MRI检查敏感但不特异。

  • 现在特殊的MRI技术也能够对血管壁本身进行成像。

  • 导管血管造影仍然很重要,尤其是在无创血管造影技术未发现任何异常的情况下。

  • 脑活检可提供脑动脉炎的证据,也有助于排除类似疾病。

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