点滴学影像英语（附双语病例）

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来源：双语学影像
【双语病例】Acute Toxic Leukoencephalopathy

本期病例选自AJNR Case of the Week

Fatima Mubarak, Shayan Anwar, Zafar Sajjad
Department of Radiology, Aga Khan University Hospital
Karachi, Pakistan

Description

A 29-year-old man with advanced carcinoma of the esophagus. On day 4 of 5-FU infusion the patient developed confusion and aphasia without motor weakness.

29岁男性，进展性食道癌患者。5-FU治疗第4天出现意识不清、失语，肌力正常。

Legends

Initial study, axial T2WI (A) demonstrates diffuse abnormal increased T2-weighted signal involving the deep and subcortical white matter, sparing the U-fibers, associated with abnormal restricted diffusion on DWI. In the follow-up study, following discontinuation of 5-FU, there is complete resolution of the previously noted signal abnormalities (B).

起病初期，横断位T2WI示深部白质及皮层下白质弥漫性高信号，U形纤维不受累，DWI示病变弥散受限。

停止使用5-FU后复查，原病灶完全消失。

Acute Toxic Leukoencephalopathy

急性毒性白质脑病

Acute toxic leukoencephalopathy is a rare complication of chemotherapy, and has been described for various agents such as methotrexate, 5-FU, fludarabine, tacrolimus, and cyclosporine. The more common neuropathologic findings include gliosis, macrophage infiltrate, and demyelinization of white matter.

   急性毒性白质脑病是一种罕见的化疗并发症，既往报道很多药物可引起该病，如甲氨蝶呤、5-FU、氟达拉滨、他克莫司、环孢霉素。最常见的神经病理改变包括神经胶质增生、巨噬细胞浸润、脑白质脱髓鞘。

Clinical Presentation

Change in mental status, seizures, nistagmus, and less frequently, focal neurological deficits。

常见精神异常、癫痫、眼球震颤（？）

局灶性神经功能缺陷较为少见。

注：原文中为nistagmus,眼球震颤是nystagmus。通用？原文错别字？

Key Diagnostic Feature

Diffuse bilateral symmetrical areas of diffusion restriction in subcortical and deep white matter and corpus callosum. There is sparing of cortex and the U-fibers white matter as well as basal ganglia. Following discontinuation of therapy, reversal of findings may occur.

双侧深部白质、皮层下白质及胼胝体弥漫性、对称性弥散受限（DWI高信号），大脑皮层、U形纤维及基底节区不受累。

停药后，病灶可恢复。

DDx

• PRES: Signal abnormalities are more commonly posterior, in watershed areas and involve also the cortex and U fibers. ADC values are positive in DWI ("vasogenic" edema)
  PRES(可逆性后部脑病综合征)：一般病变位置靠后，多位于分水岭区，皮层及U形纤维可受累。DWI示弥散受限，ADC图呈高信号
  
• Encephalitis: More commonly asymmetric with cortical involvement
  脑炎：病变为非对称性，多累及皮层。
• Radiation-induced leukoencephalopathy: Clinical history is the key as they have the same pathological findings and can be indistinguishable on imaging alone
  辐射诱导白质脑病：两者病理表现相同。单纯依靠影像无法鉴别，临床病史是诊断的关键。
• Drug abuse (toluene, ethanol, cocaine, methamphetamine, and heroin) and toxic agents (carbon monoxide, arsenic, and CCl)
  药物依赖（如甲苯、乙醇、可卡因、甲基苯丙胺、海洛因）和毒性物质（一氧化碳、砷、CCl）
  
  

Rx

Discontinuation of treatment

停药

今天学习脑白质病变leukoencephalopathy的累及范围时，提到了几个词：

• cortex 皮层
• white matter 白质
• grey matter 灰质
  
• deep white matter 深部白质
• subcortical white matter 皮层下白质
• U fiber U形纤维
• corpus callosum 胼胝体
• basal ganglia 基底节区