Izumi T, Kusaka H, Matsuura S, Sumimoto T
Department of Neurology, Tsukazaki Memorial Hospital.
Rinsho Shinkeigaku. 1995 Jan;35(1):55-9.
Two cases of acute leukoencephalopathy are reported. Both patients were Filipino women who had lived together in Japan for one month at the time of the onset. The first patient, 26 years old, suddenly developed right hemiplegia without fever. Small, high signal intensity lesions of the cerebral white matter were disseminated on T2-weighted magnetic resonance images. One week later, the patient became delirious, developed seizures, and lapsed into a comatose state with spastic quadriplegia. Corticosteroid was administered, resulting in improvement of consciousness levels. The patient was transferred to our hospital. Neurological examination disclosed severe pseudobulbar palsy and spastic quadriplegia without meningeal signs. Results of a cerebrospinal fluid examination were unremarkable. With magnetic resonance imaging, large irregularly-shaped lesions were seen in both centrum semiovale as high signal intensity areas on T2-weighted images and low signal intensity areas on T1-weighted images. Concentric structures in the lesions were particularly observed on T1-weighted images. One year later, the patient improved from a bedridden state to a wheel-chair bound state. The second patient, 23 years old, also developed right hemiplegia one week after the onset of the first case. MR imaging revealed small disseminated lesions in the cerebral white matter similar to those disclosed in the first case. From the onset, the patient was given corticosteroid, and experienced good recovery within one month. The clinical features, results of the laboratory examination, and MRI findings particularly in the first case suggest the diagnosis of so-called Baló's concentric sclerosis, despite the absence of pathological confirmation.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了两例急性白质脑病病例。两名患者均为菲律宾女性,发病时在日本共同生活了一个月。首例患者为26岁女性,突然出现右侧偏瘫,无发热。在T2加权磁共振图像上,脑白质出现散在的小的高信号强度病灶。一周后,患者出现谵妄、癫痫发作,并陷入昏迷状态,伴有痉挛性四肢瘫。给予皮质类固醇治疗后,意识水平有所改善。患者被转至我院。神经系统检查发现严重的假性球麻痹和痉挛性四肢瘫,无脑膜刺激征。脑脊液检查结果无异常。磁共振成像显示双侧半卵圆中心有大的不规则形病灶,在T2加权图像上为高信号强度区,在T1加权图像上为低信号强度区。在T1加权图像上特别观察到病灶内的同心结构。一年后,患者从卧床状态改善为轮椅辅助状态。第二例患者为23岁女性,在首例患者发病一周后也出现了右侧偏瘫。磁共振成像显示脑白质内有散在的小病灶,与首例患者相似。从发病开始,该患者即接受皮质类固醇治疗,并在一个月内恢复良好。尽管缺乏病理证实,但首例患者的临床特征、实验室检查结果及磁共振成像表现提示诊断为所谓的巴洛同心性硬化症。(摘要截取自250字)