弥漫性胼胝体梗死1例临床分析并文献复习

正胼胝体血供丰富,临床梗死相对少见,其梗死表现复杂多样,不易早期发现,临床诊断相对困难,主要依靠影像学结果进行确认。为提高对胼胝体梗死的认识程度,现将我院神经内科收治的1例以观念运动性失用、偏瘫为主要临床表现的弥漫性胼胝体梗死患者分析报道如下,并结合既往文献报道对其病因、分型、临床症状及治疗预后等情况进行分析。1病历资料本文对2015年11月入住我院神经内科的1例胼胝体脑梗死患者进行回顾性分析。该患者依据《中国急性缺血性卒     

胼胝体梗死的临床特点

目的探讨胼胝体梗死患者的临床特点。方法回顾性分析39例胼胝体梗死患者的临床资料。结果胼胝体梗死临床表现复杂,经常被并发的其他病灶所掩盖,瘫痪、精神智能障碍以及失用较多见。病灶以胼胝体膝部及体部多见,多并发其他部位梗死灶。胼胝体梗死诊断主要依靠MRI。结论胼胝体梗死临床表现复杂,MRI是确诊的依据,预后好。     

胼胝体梗死的临床特点

目的探讨胼胝体梗死患者的临床特点。方法回顾性分析39例胼胝体梗死患者的临床资料。结果胼胝体梗死临床表现复杂,经常被并发的其他病灶所掩盖,瘫痪、精神智能障碍以及失用较多见。病灶以胼胝体膝部及体部多见,多并发其他部位梗死灶。胼胝体梗死诊断主要依靠MRI。结论胼胝体梗死临床表现复杂,MRI是确诊的依据,预后好。     

纯失读症伴右侧偏盲1例报告并文献复习

目的提高对以纯失读症伴右侧偏盲为主要表现的缺血性脑卒中的认识。方法回顾性分析1例临床表现为纯失读症伴右侧偏盲的脑梗死后病例,复习相关文献分析讨论发病机制。结果患者男性,65岁,右利手,突发右侧视野缺损1个月余。对患者行汉语失语症成套检查方法评估,诊断为纯失读症。头颅MRI显示左枕叶及胼胝体压部梗死。患者脑梗死后表现为右侧偏盲,至右侧视觉信息无法输入;同时有胼胝体压部梗死,左侧视野信息传入右侧初级视觉皮质后,经胼胝体-下部纵行神经纤维到达视觉词形加工区的通路也被阻断。考虑本病例为视觉-初级视觉皮质-视觉词形加工区通路受损导致的纯失读症。结论纯失读症伴右侧偏盲起病的脑梗死表现隐匿,临床易忽略而至眼科就诊,从而失去再灌注治疗机会,提高对此类脑梗死的认识有助于早期诊断治疗,帮助患者恢复社会功能。     

MRI在胼胝体梗死中的诊断价值

目的 探讨胼胝体梗死的磁共振影像特点及其临床特征。方法 对32例胼胝体梗死患者的图像进行分析，分析梗死的部位及在不同扫描序列中的表现，结合患者的临床表现进行对比研究。结果 胼胝体膝部梗死9例、胼胝体体部梗死11例胼胝体压部梗死12例；其中超急性梗塞1例，急性梗死2例，亚急性梗死6例。结论 MRI是诊断胼胝体梗死最有意义的检查方法，可以直接清晰显示梗死的有无、部位、范围，并能对病灶的新旧分期指导临床治疗。     

胼胝体梗死临床分析(附22例病例)

目的探讨胼胝体梗死的高危因素、临床表现以及影像学特点。方法对22例胼胝体梗死患者的临床资料进行回顾性分析。结果该病60～70岁为高发年龄,病因及高危因素主要为高血压病、颈动脉斑块及糖尿病。最主要的临床表现为肌力减退、失语、感觉障碍、智能障碍、小便失禁、共济失调、意识障碍等症状。胼胝体梗死部位以体部、膝部多见,常累及基底节区、额叶、顶叶、颞叶等部位。结论胼胝体梗死因其累及部位不同临床表现不同,其中颈动脉斑块为胼胝体梗死不容忽视的重要高危因素,头颅MRI对胼胝体梗死及累及部位的定位诊断有指导作用。     

主动脉粥样硬化合并动脉瘤致横贯性脊髓梗死:1例报告及专家解读

目的 :探讨主动脉粥样硬化合并动脉瘤致横贯性脊髓梗死的临床表现和影像学特征,以期提高对本病的认识。方法 :报道1例主动脉粥样硬化合并动脉瘤致横贯性脊髓梗死患者的临床诊治经过,邀请神经内科及影像科专家结合相关文献对本病的临床表现及影像学特点进行解读。结果 :1例主动脉粥样硬化合并动脉瘤致横贯性脊髓梗死患者的临床表现为反复双下肢麻木、无力后出现病情进行性加重。脊髓磁共振成像(magnetic resonance imaging,MRI)显示下胸段脊髓及腰髓略肿胀伴信号异常;计算机断层成像血管造影(computed tomography angiography,CTA)显示主动脉弓外壁瘤样扩张伴粥样硬化,内壁多发溃疡伴附壁血栓;双侧颈动脉分叉部及颈内动脉起始端粥样斑块伴管腔狭窄;左侧髂总动脉局段夹层改变,左侧髂内动脉局部附壁血栓形成伴管腔明显狭窄。明确诊断后,将患者转至血管外科行主动脉瘤介入治疗。结论 :脊髓梗死发病率远低于脑梗死,而主动脉疾病是导致脊髓梗死的常见原因。急性起病以及病情迅速发展达到高峰是脊髓梗死的特点,通过结合脑脊液及MRI检查,大多数病例可以得到明确诊断,然而其病因仍有赖于通过CTA和数字减影血管造影(digital substraction angiography,DSA)检查等予以明确。本病缺乏特效的治疗手段,目前仅有少数针对病因的治疗方法。     

胼胝体梗死15例临床分析

目的探讨胼胝体梗死的病因、临床表现及预后,提高对该病的认识。方法对15例胼胝体梗死患者的临床资料进行回顾性分析。结果胼胝体梗死临床表现复杂,经常被其他部位的梗死症状所掩盖。多合并基底节、脑叶、脑干等部位的梗死,诊断主要依靠MRI。结论胼胝体梗死临床表现复杂,MRI是确诊的依据,预后多较好。     

异己手综合征7例临床及影像学分析

目的:探讨异己手综合征(AHS)的病因、临床表现、影像学特点以及预后转归.方法:回顾性分析7例AHS患者的临床及影像学资料.结果:以胼胝体型(6/7例)最为多见,主要表现为非优势手的对抗失用或手间冲突(4/6例),71.4%患者由脑梗死所致,6例患者存在胼胝体病变;5例患者在对因治疗1个月时有不同程度好转.结论:AHS临床表现复杂多样,影像学检查对AHS的病因诊断、指导治疗具有重要意义.     

以精神异常起病的双侧丘脑梗死2例报告

目的分析Percheron动脉梗死的病因、临床特点、影像学表现及预后。方法收集2例Percheron动脉梗死患者的临床资料并复习相关资料。结果 2例Percheron动脉脑梗死以精神智能障碍为主要表现,影像学表现为DWI序列上可见双侧丘脑高信号,预后较好。结论双侧丘脑梗死临床少见,应考虑到Percheron动脉梗死可能,应尽早行头颅磁共振检查明确诊断。     

胼胝体梗死所致的发作性拮抗性失用

目的 探讨胼胝体梗死引起拮抗性失用的特点和机制.方法 对1例表现为发作性拮抗性失用的患者,分别进行神经心理、头颅磁共振、颈CT血管成像检查.结果 神经心理检查提示为拮抗性失用,头MRI示右侧胼胝体梗死,予抗血小板,改善脑循环治疗后发作减少.结论 胼胝体梗死可以引起发作性拮抗性失用为特征的神经心理症状.

Abstract：

Objectives To report the clinical features and treatment in a case with paroxysmal diagonistic ideomotor apraxia after ischemic infarction of the corpus callosum.Methods The neuropsychological tests,brain MRI,the TCD and carotid duplex sonography were carried out in the patient who is right handed and had had presentation of paroxysmal diagonistic ideomotor apraxia for ten days.Results Neuropsychological tests confirmed the diagnosis of paroxysmal diagonistic apraxia in this patient.MRI showed ischemic infarction in the right corpus callosum.The symptomsin the patient were improved after the treatment with aspirin for three months.Conclusion The infarction of corpus callosum may induce paroxysmal diagonistic apraxia.     

Crossed aphasia following an infarction in the right corpus callosum

A 68-year-old right-handed woman with no history of brain damage or familial left-handedness was admitted to our hospital due to the acute onset of speech difficulty; her speech was nonfluent. Literal and phonological paraphasias, agrammatism and paragrammatism were observed. Brain MRI revealed an acute infarction in the right anterior cerebral artery territory, involving the right corpus callosum. Moreover, cerebral blood flow was decreased not only in the area of the right corpus callosum but also in the left fronto-temporal lobe, suggesting crossed diaschisis. This is a rare case of crossed aphasia following an infarction in the right corpus callosum.     

胼胝体梗死的临床研究

目的:探讨胼胝体梗死的临床特点和临床诊断应该注意的方面。方法:收集1995年至2005年住院病例中的18例胼胝体梗死患者,对其进行临床和影像(头CT或MRl)分析和统计学比较。结果:18例患者中,男11例,女7例,高血压11例、糖尿病7例、冠心病2例、高脂血症8例、高同型半胱氨酸血症1例、TIA2例、高血压合并糖尿病5例、吸烟5例、饮酒4例,4例既往无特殊病史。临床症状有偏瘫、语言障碍、智能障碍、情感障碍、感觉障碍、二便障碍、失用等。影像学示:梗死部位有膝部13例、体部7例、压部3例,膝部合并体部5例。TCD示脑动脉硬化12例、颅内血管狭窄或闭塞10例,CA示颈动脉狭窄5例、颈动脉闭塞2例。2例经DSA证实存在动脉闭塞或狭窄。结论:胼胝体梗死多有脑血管病高危因素,临床表现以偏瘫、语言障碍、智能障碍为主,梗死部位多见膝部。病因为脑动脉硬化基础上的血流动力学改变。     

Acute midbrain infarction in a child with intracranial carotid artery hypoplasia and aberrant cerebral vasculature: a case report

Strokes identified in older children typically present with sudden hemiparesis, frequent association with seizures, and occasional accompaniment of hemisensory signs or visual field defects. In this case of a left cerebral peduncle infarction, initially the patient was not found with evident right-side hemiparesis but with right-side paresthesia and mild worsening of her underlying left-side weakness, including weakness of left facial expression and left ptosis. Her right limbs became gradually weaker in the first 2 days. These bizarre clinical presentations, the mild worsening of the underlying left-side weakness, and the delayed presentation of right-side hemiparesis added to the difficulty of making a diagnosis and of the initial localization. In addition, the magnetic resonance angiography incidentally found an abnormal vessel, which was additional and serpiginous to the right posterior fossa. The right internal carotid artery was markedly smaller than the left one, and a defect was seen around the area of the presumed distal right internal carotid artery. The abnormal cerebral vasculature might be the cause of the unique clinical presentation and might be the contributing factor to the recurrence of her stroke. In conclusion, the authors report a special case of recurrent stroke on the basis of aberrant cerebral vasculature.     

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.     

不同部位脑梗死后华勒变性3例报道及文献复习

目的探讨不同部位脑梗死后锥体束华勒变性的发生过程和机制。方法报道3例不同部位脑梗死后华勒变性患者的临床资料,根据临床和影像学特点并结合文献对其进行分析。结果颈内动脉或大脑中动脉供血区急性脑梗死后可出现锥体束和胼胝体华勒变性,表现为同侧锥体束（内囊、大脑脚）与胼胝体出现T2和DWI高信号,ADC低信号,并且DWI和ADC信号改变比T2更明显;而单侧脑桥基底部梗死可于数月后出现双侧脑桥小脑束华勒变性,表现为双侧小脑中脚T2和DWI高信号,ADC等信号。结论脑梗死后华勒变性是疾病的发展过程,应充分认识这一现象,避免临床误诊为新发脑梗死。     

A case of callosal apraxia without agraphia and acquired stuttering associated with callosal infarction]

We report a 52-year-old right-handed man with cerebral infarction of the right anterior cerebral artery area. The MRI findings showed cerebral infarction in the trunk of the right corpus callosum, although some part of the posterior half of the trunk was spared. Some part of right precuneal gyrus, cingulate gyrus were also involved. The clinical feature of this case is characterized by following two points. First, although callosal apraxia is usually accompanied by agraphia, he showed apraxia with the left hand, but showed no agraphia. Secondary, he showed speech dysfluency mainly characterized by initial syllable repetitions. The nature of this speech dysfluency was determined as acquired stuttering. This case suggests that the pathway for praxis locates distinct portion from that for writing on corpus callosum. We analyzed callosal lesions of previous studies reporting callosal apraxia without agraphia, then compared to that of this case. And we also reviewed acquired stuttering report caused by callosal lesions. Consequently, we suggest that apraxia and stuttering were caused by damage of the trunk of the corpus callosum. While writing was preserved by the intact fibers in the posterior half of the trunk.     

Rapidly Progressive Dementia Due to Bilateral Internal Carotid Artery Occlusion with Infarction of the Total Length of the Corpus Callosum

The authors report a patient with rapidly progressive cognitive decline due to bilateral internal carotid artery occlusion (ICAO) resulting in multiple pathologically proven cerebral infarctions including the entire length of the corpus callosum. The gradual evolution of the deficits was suggestive of hemodynamic ischemia. Bilateral ICAO should be considered in the differential diagnosis of patients with rapidly cognitive decline. Although ICAO commonly spares the splenium, complete callosal infarction is possible in the presence of bilateral ICAO.     

Anterior cerebral artery dilation to increase cerebral perfusion in a patient with chronic internal carotid artery occlusion

Chronic internal carotid artery occlusions (CICAO) increase the risk of stroke recurrence and cognitive dysfunction. Here, we describe the case of an adult patient with ipsilateral CICAO who underwent endovascular treatment of anterior cerebral artery stenosis to improve cerebral perfusion. First, the patient presented ataxia and left facial palsy. Magnetic resonance imaging (MRI) showed right hemispherpe cerebral infarct, right CICAO, and sub-occlusive stenosis of the left bulbar internal carotid artery. Stenting of the left carotid artery was performed. One year later, she experienced acute walking imbalance and left hemiparesis. MRI showed new watershed and anterior cerebral artery infarctions, worsening of the right hemisphere hypoperfusion, and a new severe stenosis of the right anterior cerebral artery. Dilation of this stenosis was performed. Perfusion parameters, clinical deficit, and cognitive functions improved after the endovascular treatment, and the patient had no stroke recurrence.     

A patient with Moyamoya-like vessels after radiation therapy for a tumor in the basal ganglia]

A patient with Moyamoya-like vessels after radiation therapy for treatment of a tumor in the basal ganglia is reported. He was diagnosed as Down syndrome at birth. He had a tumor in the left basal ganglionic region at 12 years of the age. The tumor increased in size at age 14. He underwent cerebral angiography, which did not show a stenosis nor occlusion of the internal carotid artery, anterior cerebral artery, nor the middle cerebral artery. He received radiation therapy with a total dose of 56 Gy. He presented a dressing apraxia at age 19. MRI showed cerebral infarction in the left temporo-occipital region. Right internal carotid angiography revealed a severe stenosis of the internal carotid artery and anterior cerebral artery as well as a severe stenosis of the middle cerebral artery on the right side. Moyamoya-like vessels were seen in the basal ganglionic region. Left internal carotid angiography also showed a stenosis of the internal carotid artery and anterior cerebral artery as well as a severe stenosis of the middle cerebral artery on the left side. Moyamoya-like vessels were seen in the basal ganglionic region. Leptomeningeal anastomose and transdural anastomose were bilaterally seen. These arterial occlusion and stenotic phenomenon corresponded to a previous radiation field. These Moyamoya-like vessels with arterial stenosis and occlusion were thought to be due to radiation-induced vasculopathy, because a previous cerebral angiography showed a normal caliber of cerebral arteries. This patient showed that patients with radiation therapy in their early childhood should be carefully observed considering the possibility of this phenomenon.