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2019年12月28日神經(jīng)2、3群集錦

許鵬

<h3>一、王宇軍老師</h3><h3><br></h3> <h3><font color="#ed2308">答案：顆粒細(xì)胞瘤</font></h3> <p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">延伸學(xué)習(xí)：</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">Radiologic Features</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">The results of the radiologic study are listed in Table 5. Eighty-one cases of imaging manifestation were available. Tumor size was measured by maximum diameter in single patients, varying from 4 to 82 cm (mean  SD, 25.4  13.36 cm). Of the masses, 57.4% (35/61) were located only in the suprasellar compared with only in the intrasellar 16.4% (10/61); masses were found in both in 16 of 61 cases. The masses caused centrifugal displacement of adjacent structures and compression of the associated structures, including compression of the optic chiasm in 39.5% (32/81) and compres- sion of the pituitary stalk in 9.9% (8/81). A few cases showed calcification in 6.2% (5/81) and cystic change in 3.7% (3/81). Computed tomographic examination was measured in 30 patients. Computed tomographic density in 63.3% of patients with GCT showed hyperdense or slightly hyperdense compared with gray matter. Contrast enhancement was typical in 86.7% (26/30) after administration of intravenous contrast material. Most of the im- ages of the 50 patients who underwent MRI showed isointense to the brain on T1-weighted sequences (46.0% [23/50]) and hypo- intense to the white matter on T2-weighted sequences (20.0% [10/50]). Most of the enhancement was heterogeneous (55.6% [15/ 27]) or homogeneous (44.4% [12/27]).</font></h3> <h3><font color="#ed2308">譯文：<span style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;">影像學(xué)特征</span></font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">影像學(xué)研究結(jié)果見表5。81例影像學(xué)表現(xiàn)。腫塊引起鄰近結(jié)構(gòu)的離心移位和相關(guān)結(jié)構(gòu)的壓迫，包括視交叉壓迫39.5%（32/81）和垂體柄壓迫9.9%（8/81）。少數(shù)病例鈣化占6.2%（5/81），囊性變占3.7%（3/81）。63.3%的GCT患者的CT密度較灰質(zhì)高或略高。靜脈注射造影劑后增強率為86.7%（26/30）。大部分增強表現(xiàn)為異質(zhì)性（55.6% [15/27]）或均質(zhì)（44.4% [12/27]）。</font></h3> <h3>二、王宇軍老師</h3><h3>病史：成人</h3> <h3><font color="#ed2308">答案：生殖</font></h3> <h3>三、徐國輝老師</h3> <h3><font color="#ed2308">結(jié)果：結(jié)核</font></h3> <h3>四、陳晨老師</h3> <h3><font color="#ed2308">答案</font></h3> <h3>五、常志強老師</h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;">男性，26歲，頭痛1月余。</h3> <h3><font color="#ed2308">結(jié)果：顱咽管瘤</font></h3> <h3>六、常志強老師</h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;">女性，52歲，間斷性流涎1周。</h3> <h3><font color="#ed2308">結(jié)果：間變星</font></h3> <h3>七、陳晨老師</h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;">男，19，癲癇發(fā)作數(shù)次</h3> <h3><font color="#ed2308">答案：DNET</font></h3> <h3>八、陳晨老師</h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;">男、39，半年前出現(xiàn)變換體位后頭痛</h3> <h3><font color="#ed2308">答案：間變HPC</font></h3> <h3>九、華建軍老師</h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;">男，12歲，頭部外傷后右側(cè)搏動性突眼3年，頭暈頭痛1天。患者于6年前頭部外傷，從約1米高處的拖拉機上仰面摔倒，傷后無昏迷病史，有雙鼻孔少量淡紅色液體流出，在當(dāng)?shù)夭轭^顱CT未見異常，約1周后患兒無其他不適痊愈出院。2年后患兒右眼出現(xiàn)搏動性腫塊及突眼，近三年來逐步加重，1天前出現(xiàn)頭痛暈厥不能站立。</h3> <h3><font color="#ed2308">答案：CCF</font></h3> <p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">主要表現(xiàn)：</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">?右面部、眼眶、右側(cè)海綿竇多發(fā)迂曲血管</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">?橫竇增粗</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">?雙側(cè)大腦半球皮髓質(zhì)交界處廣泛對稱性毛刷樣高密度影（考慮與腦內(nèi)小靜脈長期瘀血有關(guān)）</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">?腦室積血、蛛網(wǎng)膜下腔出血</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">外傷性頸內(nèi)動脈海綿竇瘺</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">是指位于海綿竇內(nèi)的頸內(nèi)動脈或其分支，因外傷破裂直接與靜脈交通，形成動、靜脈瘺，其原因常為顱底骨折而致，在顱腦損傷中的發(fā)生率約為2.5％。</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">由于頸內(nèi)動脈海綿竇段被其出入口處的硬腦膜牢牢固定，故當(dāng)骨折線橫過顱中窩或穿行至鞍旁時，即可撕破該段動脈或其分支。有時亦可因骨折碎片、穿透傷或飛射物直接損傷而造成。</font></h3><p style="white-space: normal; -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto;"><font color="#ed2308">據(jù)統(tǒng)計75％以上的頸內(nèi)動脈海綿竇瘺均為外傷所致。受損的動脈或當(dāng)即破裂或延遲破裂，故傷后至動、靜脈瘺癥狀出現(xiàn)的時間不一，急者立刻出現(xiàn)，遲者數(shù)日、數(shù)周不等，常有一無癥狀的間歇期而后發(fā)病。</font></h3>