Tsai Ruei-Je, Hsieh Li-Chun, Cheng Sho-Jen, Chen Cheng-Yu
Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei, 110, Taiwan.
Translational Imaging Research Center (TIRC), College of Medicine, Taipei Medical University, 252 Wu Hsing Street, Taipei, 110, Taiwan.
BMC Neurol. 2017 Dec 11;17(1):215. doi: 10.1186/s12883-017-1000-5.
Secondary pallidonigral transneuronal degeneration after a remote primary cerebral infarct can mimic recurrent stroke at clinical presentation. We describe a patient with secondary pallidonigral degeneration following a previous putaminal infarct, which was diagnosed through diffusion-weighted (DWI) and T2-weighted imaging (T2WI).
A 64-year-old man complained of an acute relapse of right-lower-limb weakness following a cerebral infarction 2 months before presentation. Recurrent cerebral stroke was initially diagnosed in the emergency room. DWI of the brain revealed a subacute to chronic infarct in the left putamen and new acute cytotoxic edema in the left substantia nigra (SN) and globus pallidus while T2WI also showed hyperintensity in the same regions. The SN was outside the aforementioned middle cerebral arterial territory, which includes the putamen. These findings are compatible with the diagnosis of acute pallidonigral injury secondary to striatal infarction. The patient had fully recovered from his right-lower-limb weakness after 1 month.
Secondary pallidonigral degeneration may mimic recurrent stroke. DWI along with T2WI facilitates elucidation of this clinicopathological entity, and thus unnecessary treatment can be avoided.
既往原发性脑梗死继发苍白球黑质跨神经元变性在临床表现上可酷似复发性卒中。我们描述一例既往壳核梗死继发苍白球黑质变性的患者，其通过弥散加权成像（DWI）和T2加权成像（T2WI）得以确诊。
一名64岁男性在就诊前2个月发生脑梗死，现主诉右下肢无力急性复发。急诊室最初诊断为复发性脑卒。脑部DWI显示左侧壳核有亚急性至慢性梗死灶，左侧黑质（SN）和苍白球出现新的急性细胞毒性水肿，而T2WI在相同区域也显示高信号。黑质位于上述包括壳核的大脑中动脉供血区之外。这些表现符合纹状体梗死继发急性苍白球黑质损伤的诊断。患者1个月后右下肢无力完全恢复。
继发性苍白球黑质变性可能酷似复发性卒中。DWI联合T2WI有助于明确这一临床病理实体，从而避免不必要的治疗。
