common disease６５

【臨床症状】60代　物忘れ　CTで石灰化多数

【問題】画像所見と診断名は？

MR_20240822122612_Image001
MR_20240822122612_Image002
MR_20240822122612_Image003
MR_20240822122612_Image004
MR_20240822122612_Image005
MR_20240822122612_Image006
MR_20240822122612_Image007
MR_20240822122612_Image008
MR_20240822122612_Image009
MR_20240822122612_Image010
MR_20240822122612_Image011
MR_20240822122612_Image012
MR_20240822122612_Image013
MR_20240822122612_Image014
MR_20240822122612_Image015
MR_20240822122612_Image016
MR_20240822122612_Image017
MR_20240822122612_Image018
MR_20240822122612_Image019
MR_20240822122612_Image020
MR_20240822122612_Image021
MR_20240822122612_Image022
MR_20240822122612_Image023
MR_20240822122612_Image024
MR_20240822122612_Image025
MR_20240822122612_Image026
MR_20240822122612_Image027
MR_20240822122612_Image028
MR_20240822122612_Image029
MR_20240822122612_Image030
MR_20240822122612_Image031
MR_20240822122612_Image032
MR_20240822122612_Image033
MR_20240822122612_Image034
MR_20240822122612_Image035
MR_20240822122612_Image036
MR_20240822122612_Image037
MR_20240822122612_Image038
MR_20240822122612_Image039
MR_20240822122612_Image040
MR_20240822122612_Image041
MR_20240822122612_Image042
MR_20240822122612_Image043
MR_20240822122612_Image044
MR_20240822122612_Image045
MR_20240822122612_Image046
MR_20240822122612_Image047
MR_20240822122612_Image048
MR_20240822122612_Image049
MR_20240822122612_Image050
MR_20240822122612_Image051
MR_20240822122612_Image052
MR_20240822122612_Image053
MR_20240822122612_Image054
MR_20240822122612_Image055
MR_20240822122612_Image056
MR_20240822122612_Image057
MR_20240822122612_Image058
MR_20240822122612_Image059
MR_20240822122612_Image060
MR_20240822122612_Image061
MR_20240822122612_Image062
MR_20240822122612_Image063
MR_20240822122612_Image064
MR_20240822122612_Image065
MR_20240822122612_Image066
MR_20240822122612_Image067
MR_20240822122612_Image068
MR_20240822122612_Image069
MR_20240822122612_Image070
MR_20240822122612_Image071
MR_20240822122612_Image072
MR_20240822122612_Image073
MR_20240822122612_Image074
MR_20240822122612_Image075
MR_20240822122612_Image076
MR_20240822122612_Image077
MR_20240822122612_Image078
MR_20240822122612_Image079
MR_20240822122612_Image080
MR_20240822122612_Image081
MR_20240822122612_Image082
MR_20240822122612_Image083
MR_20240822122612_Image084
MR_20240822122612_Image085
MR_20240822122612_Image086
MR_20240822122612_Image087
MR_20240822122612_Image088
MR_20240822122612_Image089
MR_20240822122612_Image090
MR_20240822122612_Image091
MR_20240822122612_Image092
MR_20240822122612_Image093
MR_20240822122612_Image094
MR_20240822122612_Image095
MR_20240822122612_Image096
MR_20240822122612_Image097
MR_20240822122612_Image098
MR_20240822122612_Image099
MR_20240822122612_Image100
MR_20240822122612_Image101
MR_20240822122612_Image102
MR_20240822122612_Image103
MR_20240822122612_Image104
MR_20240822122612_Image105
MR_20240822122612_Image106
MR_20240822122612_Image107
MR_20240822122612_Image108
MR_20240822122612_Image109
MR_20240822122612_Image110
MR_20240822122612_Image111
MR_20240822122612_Image112
MR_20240822122612_Image113
MR_20240822122612_Image114
MR_20240822122612_Image115
 

    ▶答えはこちら
    • 各種シーケンス、特にT2 starにおいて両側歯状核、視床、淡蒼球の低信号を認める
    • またT1WIにおいては、石灰化の表面効果による高信号化を視床を中心に認める
    • 上記より、Fahr病疑いの診断となった
    • その他の所見として、斑状の虚血巣が右前頭葉上部の白質に認める
    • VSRADは0.53（非提示）、MRAにおいても特に異常所見は認めない
    左からT2WI、T1WI、T2 star

    【Fahr病】

    ・Fahr病は基底核をはじめとした脳内に石灰化を認める病態

    ・通常でも石灰化を認める部位だが、生理的石灰化では説明がつかないほどの石灰化を認める

    ・孤発性で、原因は不明な事が多い

    ・臨床症状は無症状から錐体外路症状、小脳症状、精神症状など多彩な症候を呈しうる

    ・多彩な名称が用いられてきたが、現在は特発性基底核石灰化症（idiopathic basal ganglia calcification：IBGC）の名称が使われる事が多い

    ・IBGCの診断には、加齢性変化、副甲状腺疾患、中毒性疾患、化学放射線療法、全身性エリテマトーデス、ミトコンドリア病など多彩な病態を除外する必要がある

    参考書籍：よくわかる脳MRI 改定第4版