“虎眼征”对诊断Hallervorden-Spartz病的意义
王诗男;孙斌;
摘要(Abstract):
Hallervorden-Spatz病(HSD)是由于铁代谢障碍导致Fe3+在苍白球、黑质、红核等部位内沉积所引起的一种罕见中枢神经系统变性病,具有很强的临床和遗传异质性。病理特异性的表现为含铁色素聚集,神经轴索肿胀,神经元脱失。临床表现以锥体外系受累为主,以姿势和步态异常、肌张力增高和不自主运动为起始症状,常见舞蹈、手足徐动或震颤;晚期出现构音、吞咽困难、锥体束征和智能障碍。根据临床表现的不同可以分为早发型和晚发型两种类型。头颅MRIT2加权像可见苍白球和黑质呈低信号,并在双侧苍白球前内侧低信号的背景上对称出现高信号,即"虎眼征"。目前尚无明确的生化指标可以帮助诊断该病,脑MRIT2加权像出现"虎眼征"对HSD的生前诊断具有重要意义。
关键词(KeyWords): Hallervorden-Spatz病;T2加权像;虎眼征
基金项目(Foundation):
作者(Authors): 王诗男;孙斌;
参考文献(References):
- [1]Hallervorden J,Spatz H.Eigenartige erkrankung in extrapyramidalen system mit besonder beteiligung des globus pallidusundder substantia nigra[J].Z Ges Neurol Psychiatr,1922,79:254-302.
- [2]Zhou B,Westaway SK,Levinson B,et al.Anovel pantothenate kinase gene(PANK2)is defective in Hallervorden-Spatz syndrome[J].Nat Genet,2001,28(4):345-349.
- [3]Hirsch EC,Faucheux BA.Iron metabolism and Parkinson’s disease[J].Mov Disord,1998,13(suppl1):39-45.
- [4]Galvin JE,Giasson B,Hurtig HI,et al.Neurodegeneration with brain iron accumulation,type1is characterized by α-,β-,andγ-Synuclein neuropathology[J].Am J Patho,2000,157(2):361-368.
- [5]Houlden H,Lincoln S,Farrer M,et al.Compoud heterozygous PANK2mutations confirm HARP and Hallervorden-Spatz syndromes are allelic[J].Neurology,2003,61(10):1423-1426.
- [6]ohnson MA,Kuo YM,Westaway SK,et al.Mitochondrial localization of human PANK2and hypotheses of secondary iron accumulation in pantothenate kinase-associated neurodegeneration[J].Ann N YAcad Sci,2004,1012:282-298.
- [7]Hayflick SJ,Westaway SK,Levinson B,et al.Genetic,clinical and radiographic delineation of Hallervorden-Spatz syndrome[J].N Engl J Med,2003,348(1):33-40.
- [8]Thomas M,Hayflick SJ,Jankovic J.Clinical heterogeneity of neurodegeneration with brain iron accumulation(Hallervorden-Spatz Syndrome)and pantothenate kinase-associated neurodegeneration(PKAN)[J].Mov Disord,2004,19(1):36-42.
- [9]Sethi KD,Adams RJ,Loring DW,et al.Hallervorden-Spatz syndrome:clinical and magnetic resonance imaging correlations[J].Ann Neurol,1988,24(5):692-694.
- [10]Hayflick SJ,Hartman M,Coreyll J,et al.Brain MRI in neurodegenerration with brain iron accumulation with and without PANK2mutations[J].AJNR Am J Neuroradio,2006,27(6):1230-1233.
- [11]张玉虎,唐北沙,郭继峰,等.Hallervorden-Spatz综合征PANK2基因的突变[J].中华医学遗传学杂志,2005,22(2):189-191.
- [12]Swainman KF.Harllervorden-Spatz syndrome[J].Pediatric Neurology,2001,25(2):102-108.
- [13]Hickman SJ,Ward NS,Surtees RA,et al.How broad is the phenotype of Hallervorden-Spatz disease?[J].Acta Neurol Scand,2001,103(3):201-203.
- [14]Baumeister FA,Auer DP,Hortnagel K,et al.The eye-of-the-tiger sign is not a reliable disease marker for Hallervorden-Spatz syndrome[J].Neuropediatrics,2005,36(3):221-222.
- [15]McNeill A,Birchall D,Hayflick SJ,et al.T2*and FSE MRI distinguishes four subtypes of neurodegeneration with brain iron accumulation[J].Neurology,2008,70(18):1614-1619.
- [16]卢文甫,王鲁宁,解恒革,等.Hallervorden-Spatz病的脑MRI研究[J].中国医学影像技术,2001,17(12):1146-1148.
- [17]Dooling EC,Schoene WC,Richardson EP Jr.Hallervorden-Spatz syndrome[J].Arch Neurol,1974,30(1):70-83.
- [18]孙斌,郎森阳,蒲传强,等.苍白球-黑质色素变性一家系3例报告[J].临床神经病学杂志,2002,15(2):94-96.
- [19]Victor M,Ropper AH.The inherited metabolic disease of the neurous system[M].New York:McGraw-Hill Professional,2009.1029-1031.
- [20]Ostergaard JR,Christensen T,Hansen KN.In vivo diagnosis of Harllervorden-Spatz[J].Deve Med and Child Neurol,1995,37(9):827-833.
- [21]Justesen CR,Penn RD,Kroin JS,et al.Stereotactctic pallidotomy in a child with Hallervorden-Spatz disease[J].J Neurosurg,1999,90(3):551-554.