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目的探讨多系统萎缩(multiple system atrophy,MSA)的临床表现类型与神经影像学改变新特征(脑桥“十字征”和“壳核裂隙征”)的关系,为临床尽早做出诊断提供依据。方法按照Gilman 诊断标准回顾性分析11例 MSA 患者的临床表现、分型和头颅 MRI 资料。结果本组诊断为很可能 MSA 11例,其中橄榄体脑桥小脑萎缩(MSA-C 型)8例。2例在发病后3年头颅 MRI 脑桥“十字征”达Ⅰ期;1例在病后2年达Ⅱ期;3例分别在病后1年、3年、5年达Ⅲ期;另外2例分别在病后2年和7年达Ⅳ期。8例“壳核裂隙征”均为0期。黑质纹状体变性(MSA-P 型)2例:1例病后6年脑桥“十字征”0期,“壳核裂隙征”Ⅰ期,另1例发病后9年“壳核裂隙征”Ⅱ期,脑桥“十字征”Ⅳ期。Shy-Drager 综合征(MSA-A 型)1例:病程5年,MRI 检查脑桥“十字征”和“壳核裂隙征”分期均为0期。结论临床表现与头颅 MRI 检查发现的脑桥“十字征”和“壳核裂隙征”可作为及早识别 MSA-C 型的神经影像学改变特征,“壳核裂隙征”可作为识别 MSA-P 型的神经影像学改变特征。
Objective To investigate the relationship between the clinical manifestations of multiple system atrophy (MSA) and the new features of neuroimaging (pons “cross” and “sclerenchment”) and to make early diagnosis Provide evidence. Methods According to the Gilman diagnostic criteria, clinical manifestations, subtypes and cranial MRI data of 11 MSA patients were retrospectively analyzed. Results This group was diagnosed as possible MSA 11 cases, including olivopontocerebellar atrophy (MSA-C type) in 8 cases. 2 cases were diagnosed as cranial psoriasis “cross syndrome” at stage 3 three years after onset; one case reached stage Ⅱ at 2 years after disease onset; three cases reached stage Ⅲ at 1 year, 3 years and 5 years after disease respectively; 2 cases in the disease after 2 years and 7 years up to stage Ⅳ. 8 cases “shell fissure sign ” are 0 period. 2 cases of nigrostriatum degeneration (MSA-P type): 1 case 6 years after pontine “cross” 0 “,” “shell nucleus fissure sign” stage Ⅰ, another 1 case 9 years after onset “Stem fissure syndrome” Ⅱ, pontine “cross” Ⅳ. Shy-Drager syndrome (MSA-A type) in 1 case: duration of 5 years, MRI examination of the pons “cross sign” and “shell nucleus fissure sign” staging are 0 period. Conclusions The clinical manifestations and cranial plexus “Crosstalk” and “Schistosoma fissure sign” found by MRI can be used to identify early MSA-C neuroimaging changes and the “fissure sign” can be used as Identify MSA-P-type neuroimaging changes.