以失用为主要表现的胼胝体梗死

目的探讨胼胝体梗死的临床表现、病因及鉴别诊断特点。方法对2005年7月收治的1例53岁男性胼胝体梗死患者的临床表现、影像学特点、病因机制及其治疗过程进行回顾分析。结果临床主要表现为发作性黑蒙、言语不利,既往有高血压、糖尿病、脑梗死、吸烟、饮酒史,体格检查以失用为主要表现。头部MRI检查可见左侧脑室旁、胼胝体梗死,右侧基底节、脑桥陈旧性腔隙性梗死;脑血管造影检查显示为多发性血管狭窄,其中以左侧大脑中动脉、右侧颈内动脉及基底动脉最为严重。经颈内动脉内膜剥离术及颈内动脉支架植入术治疗,临床症状缓解。结论失用可以是胼胝体梗死的主要表现,其病因是在脑动脉粥样硬化基础上的血流动力学改变,患者预后良好。

Apraxia as main presentation in corpus callosum infarction

Objective To explore the clinical presentation, etiology, and differential diagnosis of corpus callosum infarction. Methods Analyse the clinical presentation, imaging characteristic, etiological mechanism, and treatment of 1 patient (male, 53 years old) suffered with corpus callosum infarction in July, 2005. Results Paroxysmal amaurosis and lalopathy were the main clinical presentations of this patient. The patient had hypertension, diabetes, cerebral infarction, smoking, and drinking history. Apraxia was the main presentation in physical examination. Head MRI showed infarction of left paraventricular and corpus callosum, and old lacuna infarction of right basal ganglion and pons. Cerebral angiography revealed multiple angiostenosis, in which left middle cerebral artery, right internal carotid artery and basilar were very severe. After internal carotid endarterectomy and stenting, clinical symptoms remissed. Conclusion Apraxia could be the main manifestation of corpus callosum infarction. It is due to cerebral atherosclerosis inducing hemodynamic changes. The prognosis is good.