Neurology:成人起病神经元核内包涵体病的锯齿边缘征

2019-05-31 zyx整理 神经科病例撷英拾粹

66岁女性,表现为痴呆,尿失禁和发作性昏迷3年,家族史无殊。脑MRI可见脑白质病变和沿着皮髓质交界区的DWI高信号

66岁女性,表现为痴呆,尿失禁和发作性昏迷3年,家族史无殊。脑MRI可见脑白质病变和沿着皮髓质交界区的DWI高信号(锯齿边缘征[zigzag edging sign])(图1)。皮肤活检发现汗腺和血管周围细胞的核内包涵体(图2)。未见FMR1基因CGG重复。最终确诊为神经元核内包涵体病(NIID)。

成人起病NIID是一种临床异质性神经退行性疾病。DWI上锯齿边缘征是一强有力的诊断线索。明确诊断需要皮肤活检提示核内包涵体和遗传学检测排除脆性X综合征。


(图1:脑MRI可见双侧大脑白质病变,呈T1WI[A]低信号,T2WI[B]和FLAIR[C]高信号,DWI[D]上可见沿着皮髓质交界区的高信号)


(图2:电镜下可见汗腺[A-B]和血管周围细胞[C-D]核内包涵体[箭])

原始出处:Chen L, Chen A, Lei S,et al. Teaching NeuroImages: The zigzag edging sign of adult-onset neuronal intranuclear inclusion disease. Neurology. 2019 May 7;92(19):e2295-e2296.

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