【摘要】 目的探讨低血糖脑损伤的临床表现与早期影像学特征,为诊断与预后判定提供依据。方法 6例入院时血糖为0.48～1.70 mmol/L。胎龄35周~+5至40周,出生体重1545～3900 g。均无窒息史、败血症、颅内感染、遗传代谢及内分泌性疾病。在入院24～48 h 完成 T1WI、T2WI 和DWI 磁共振扫描。结果 6例均有明显的临床表现,以惊厥、萎靡最为常见,其次为呼吸暂停,4例血糖正常时仍有惊厥发生。5例低血糖发生在生后6～53 h,1例在生后12 d。低血糖持续时间[(47.7±38.8)(4～96)]h,最低值[(1.05±0.44)(0.48～1.70)]mmol/L。首次 MRI 检查1例在生后15 d,余在生后2～5 d,受累部位为枕叶(6例)和顶叶(3例)皮层及皮层下白质:DWI 上表现为高信号6例,T1WI 为低信号4例,T2WI 高信号1例。3例在生后第2周接受第2次检查,1例 DWI 转为低信号,余信号正常;3例此时 T1WI 和 T2WI 分别表现为低信号和高信号,局部水肿明显减轻。1例3个月随访发育正常,未见顶枕部萎缩,但内囊后枝和视放射髓鞘化不良。结论枕顶叶是新生儿低血糖脑损伤的主要受累部位,DWI 可以早期反映脑损伤的改变。更多还原

【Abstract】 Objective Severe and persistent hypoglycemia often leads to brain damage in neonatal period although precise definition of hypoglycemia remains controversial.Little is known whether hypoglycemic brain damage happens to the neonates with hypoglycemic symptoms in early neonatal period and no criteria to diagnose the hypoglycemie brain damage are available.The present study aimed to characterize the clinical symptoms and brain damage by MRI diffusion-weighed imaging in the newborn infants with severe hypoglycemia in order to demonstrate the early findings of their brain damage.Methods The 6 newborn infants with severe hypoglycemia(whole blood glucose ranging from 0.48 to 1.7 mmol/L) were enrolled in this study,3 of them were premature infants,2 were small-for-gestational age infants and 1 was an infant born to a diabetie mother.These infants had a gestational age from 35 to 40 weeks and birth weight from 1545 g to 3900 g.They had no history of perinatal asphyxia,findings indicating sepsis, intracranial infection,inborn error of metabolism or endocrine disorders.They reeeived MRI scans from 24 hours to 48 hours after admission with the sequences of T1WI,T2WI and DWI.The parameters for T1WI of FFE CLEAR were TR/TE 126 ms/2.3 ms,Flip 80;for T2WI of TSE SENSE TR/TE 1856-3238 ms/80-100 ms,TSE Faetor 15.The parameters for DWI were TR,/TE 2463 ms/48 ms,EPI factor 45 and b value of 1000,respectively.Two radiologists who knew nothing of the patients’ history judged the scanned results. Results The 6 newborn infants with severe hypoglycemia showed apparent symptoms and signs indicating dysfunction of central nervous system.Repeated seizures,lethargy and apnea were the most common manifestations.Moreover,seizures recurred in 4 newborns when their blood glucoses remained in normal rage.The main types of seizure were focal and multifocal myoclonus.Intermittent widespread low voltage was seen in 2 cases by 24 hour-EEG.The first time of hypoglycemia was detected from 6 hours to 53 hours after birth in 5 cases,but 12 days in one case,the minimum mean value of blood glucose was 1.05±0.44 (0.48-1.70)mmol/L and repeated hypoglycemia persisted for 47.3:1:38.8(4-96)hours.The first MRI scan was accomplished from 2 days to 5 days of life,except for one at 15 days of age.The occipital cortex and white matter were involved most frequently in all cases,but parietal region was involved in 3 cases. Occipital and/or parietal regions showed hyperintensive signals indicating"water restriction(cytotoxic edema)"on DWI for 6 cases at first scan;meanwhile hypointensity on T1WI and hyperintensity on T2WI were seen in 4 cases and one case respectively,the involved area became swollen that the occipital or parietal cortex indistinguishable from subcortical white matter.Three cases received the second scan at about two weeks of age.Hypointensity on T1WI and hyperintensity on T2WI were demonstrated in all,but hypointensity on DWI in one case only and normal signals on DWI in the others.One case was followed-up at 3 month of age,he developed normally,but delayed myelination was found on posterior limb of internal capsule and optic radiation without occipital and parietal cerebral atrophy.Conclusions Cerebral occipital and parietal regions are the most vulnerable in severe hypoglycemic condition,changes of which could appear earlier on DWI than on T1WI and T2WI.But the relationship between the early findings on MRI DWI and prognosis remains to be studied further.更多还原