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題名 | 有嗅覺先兆的癲癇病患之磁振造影表徵=MRI Findings of the Seizure Patients with Olfactory Epileptic Auras (Uncinate Fits) |
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作者 | 凌憬峰; 張豐基; 林文瓊; 羅兆寶; 鄧木火; 姜仁惠; 張政彥; | 書刊名 | 中華放射線醫學雜誌 |
卷期 | 27:5 2002.10[民91.10] |
頁次 | 頁245-250 |
分類號 | 415.932 |
關鍵詞 | 腦部磁振造影; 癲癇; Magnetic resonance imaging; MRI; Brain; Seizures; |
語文 | 中文(Chinese) |
中文摘要 | 有嗅覺先兆的癲癇發作並不常見,且依過往文獻顯示常與腦顳葉腫瘤有關。本研究即是收集這類癲癇病患,對其磁振造影之表徵作分析,以進一步瞭解腦顳葉腫瘤是否為其主要病理發現。從1987年到1998年在本院接受癲癇手術的病患,共有217人,手術前均經過神經內科醫師之詳細評估,從其中發現有12位病患在癲癇發作前有嗅覺先兆。這12位病患中有11位接受過磁振造影檢查。我們將分析其磁振造影發現,將臨床表現、病灶所在之位置,影響之範圍及病理診斷做一相關性之研究。 12位病患癲癇發作前帶有嗅覺先兆,比例約佔開刀總數之5.5%(12/217),7位為男性,年齡分佈為18~46歲,平均年齡29.6歲。一位早期病患並無磁振造影影像,經電腦斷層攝影及血管攝影診斷為右邊內側顳葉之動靜脈畸型。其餘11位病患之磁振造影有10位均顯示腦部顳葉之病灶,右側6位,左側4位。內側顳葉硬化(病理診斷:膠質化)有六位,腦腫瘤有四位(兩位低分級之星狀細胞瘤,一位分化不良性星狀細胞瘤,一位膠質母細胞瘤)。唯一一位磁振造影無任何發現之患者,以磁振頻譜評估發現左側海馬迴神神經元數目減少功能降低之狀況,手術後之病理診斷亦為膠質化。病灶影響到海馬迴者有8位(71.7%),影響到杏仁核者有6位(54.5%)。手術後追蹤,有8位病患,癲癇發作完全消失,三位有明顯改善,膠質母細胞瘤之病患則死亡。磁振造影可清楚顯示有嗅覺先兆的癲癇病患之病灶所在及擴展之範圍,是極佳之手術前診斷技術,顳葉腫瘤並不一定是這類癲癇先兆的主要病理發現,內側顳葉海馬迴膠質化也是另一種主要的發現。 |
英文摘要 | Olfactory epileptic auras were not common and had usually associated with temporal lobe tumors of the brain in some literatures. This study presented the MRI findings of the seizure patients with the aura of this type to see if the temporal lobe tumors were actualy the main pathological findings. From 1987 to 1998, there were 217 patients received epilepsy surgery in our hospital. We identified 12 patients with olfactory epileptic aure(5.5%), 11 of whom received MRI examinations. We analyzed the location and extension of the brain lesions by MR techniques and correlated the MRI findings with the clinical data and pathological diagnosis. Twelve patients with olfactory aura included seven men and five women. The age distribution was from 18 to 46 years old(mean:29.6). An AVM was found in a patient who just received post-contrast CT scan examination and angiogram. No MRI was done for him and he received lesionectomy. MRI showed lesions in the temporal regions of the brain in ten patients, 6 on right side and 4 on left side. Mesial temporal sclerosis(Pathology;gliosis) was noted in 6 patients and tumor growth in 4 patients(2 low grade astrocytomas, 1 anaplastic astrocytoma and 1 glioblastoma multiforme). The only one with negative MRI presentation showed decreased NAA level in left mesial temporal regions on MR spectroscopy and received left side anterior temporal lobectomy. According to the MRI findings, there were 8 patients(71.7%) with the lesion involvement to the hippocampus and 6 patients(54.5%) to the amygdala. After surgery, 8 of them became seizure patients with glioblastoma multiforme was expired. MRI is the imaging modality of choice to demonstrate the location and extension of brain leaions in seizure patients with olfactory aura. Temporal sclerosis was more common for these patients. |
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