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您当前的位置:首页 > 神经系统病例 > 中枢神经

海洛因脑病(Heroin induced leukoencephalopathy)MRI病例图片影像诊断分析

时间:2010-10-24  来源:ACR Monday, November 9, 2009  作者:freemanpyw 【复制分享】【讨论-纠错】【举报

YIS影像园XCTMR.com

【讨论】:“Chasing the dragon” also known as “chinesing” or “Chinese blowing” is a practice which involves inhaling the vapor of liquefied heroin. A small amount of white powder is placed on a piece of foil which is then heated from below. A stream of vapor, which looks like a dragon’s tail, arises from the molten heroin (the “dragon”) and the drug user “chases” it with a pipe or straw. This practice has gained popularity because one forgoes the risks associated with IV drug use while still benefiting from a rapid rate of absorption and onset of effect of the drug.YIS影像园XCTMR.com

    “Chasing the dragon”追龙,又被称为“中式”或“中式吹法”,是一种吸入液化的海洛因气体的吸毒方式。一小堆的白粉被放置在一片铝箔上,在下方加热,一股气流看上去像一个龙尾巴, 吸毒者(“追”)使用一个导管或麦秆吸取融化的海洛因(“龙”),这种方式日益流行,因为其避免了静脉注射相关的风险,且仍然可以享受到药物快速吸收和起效的快感。YIS影像园XCTMR.com
YIS影像园XCTMR.com
    Heroin induced spongiform leukoencephalopathy is a progressive disease that was first described in the Netherlands in 1982. The heroin used is often impure with many additives and there is speculation that one of these additives becomes activated when heated and is the cause of the leukoencephalopathy. Since the first reported cases, many substances in the pyrolysate have been studied as potentially leading to the leukoencephalopathy but none has been positively identified. The damage is irreversible and there is no cure for this disease. Treatment is supportive care although there is a questionable benefit to using coenzyme Q and vitamin supplements.YIS影像园XCTMR.com

    海洛因诱发的海绵状白质脑病是一种进行性病变,首次在1982年在荷兰被描述。海洛因使用者经常使用许多添加物,据推测,在加热时这些添加物之一被活化从而引起脑白质病。自从首例报道之后,在这些热解物中的许多物质被研究以明确是那种诱发了白质脑病,但尚没有一种被明确肯定。这种损害是不可逆的,并且尚没有有效的治疗方法。治疗通常是支持疗法,即使使用辅酶Q和维生素是否有效尚有争议。YIS影像园XCTMR.com
YIS影像园XCTMR.com
    Heroin induced leukoencephalopathy is diagnosis often made clinically and should be suspected in patients with a history of "chasing the dragon". The natural course is variable and not well defined. There may be a latent period with a subclinical evolution of white matter degeneration. Additionally, it appears that patients with higher levels of exposures have more severe disease. Patients often present in one of three clinical stages. The first stage consists of cerebellar signs (such as ataxia), apathy and motor restlessness. The second stage is comprised of tremors or myoclonus, chorea and athetosis, and pyramidal tract signs. The third stage consists of hypotonic paresis, stretching spasms, central pyrexia, akintetic mutism, and death. Progression of the disease continues even after cessation of the toxin for up to 6 months.YIS影像园XCTMR.com

    海洛因脑病通常是基于临床来诊断的,当病人有“追龙”史时需要怀疑本病。临床进程是可变的并且不能很确定。可能会有白质退变的亚临床进程的潜伏期。另外,对于其他更严重的病变有高感染率。临床分期分三期,第一期包含有小脑症状(如共济失调),情感冷漠和坐立不安。第二期有震颤、肌痉挛、舞蹈症和手足徐动症以及椎体束征。第三期包含有低张性轻瘫,拉胀性痉挛,中枢性发热,运动不能性缄默,甚至死亡。病变的进程是持续性的,甚至在停止吸毒6个月以上之后。YIS影像园XCTMR.com
YIS影像园XCTMR.com
    On pathology, there is symmetric spongiform degeneration, specifically in the cerebral and cerebellar white matter as well as the corticospinal and solitary tracts. The MR images illustrate this distribution, showing symmetric high signal on both T2-weighted and FLAIR sequences in the white matter of the cerebellum and occipital, parietal, and temporal lobes with relative frontal sparing. Specifically, there is involvement of the cerebellum and the posterior limb of the internal capsule, with sparing of the anterior limb and subcortical white matter. FLAIR images can demonstrate regions of subtle white matter abnormality more reliably and are better at excluding gray matter involvement than the T2 weighted images. There can also be additional signal abnormality in the splenium of the corpus callosum, the corticospinal tracts, and the lemniscal pathway in the brainstem. The spinothalamic tracts are spared which help to distinguish heroin induced leukoencephalopathy from other potential causes of encephalopathy. MRS in patients with heroin leukoencephalopathy has shown abnormally elevated intracerebral lactate in the affected white matter as well as decreased levels of N-acetyl aspartate in the white matter, gray matter, and cerebellum.YIS影像园XCTMR.com

    病理学上,病变表现为对称性的海绵状变性,尤其是在大脑和小脑白质以及皮质脊髓束。MRI影像显示了这种病变的分布方式,表现为T2和Flair序列上在小脑、枕叶、顶叶、颞叶对称性的高信号影,特别的,小脑和内囊后肢受累,但内囊前肢和皮质下白质不会受累。Flair可以显示细微的白质异常,在去除灰质受累上比T2序列更敏感。在胼胝体压部、皮质脊髓束和脑干的丘索通路上也可以出现异常的信号影。脊髓丘脑束的正常可以帮助与其他的脑病相鉴别。MRS显示受累的白质、灰质和小脑内乳酸峰抬高和NAA峰下降。YIS影像园XCTMR.com

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