胼胝体梗死的MRI特征(附78例报告)

目的 探讨胼胝体梗死的磁共振成像(MRI)特征.方法 回顾性分析78例胼胝体梗死患者的影像学及临床资料.结果 单纯胼胝体梗死少见(8/78),多合并颅内其他部位梗死灶.胼胝体梗死部位:膝部16例,体部7例,同时累及膝部、体部15例,压部34例,弥漫性累及6例.累及胼胝体的脑梗死临床表现以肢体瘫痪﹑语言障碍﹑智能与精神障碍较多见.结论 胼胝体梗死并不少见,其临床表现常被合并的梗死病灶所掩盖,MRI是确诊的主要依据.     

胼胝体梗死:临床与影像学特征

目的 探讨胼胝体梗死患者的临床和影像学特征.方法 回顾性收集经颅脑MRI证实的胼胝体梗死患者,对其临床表现和影像学资料进行分析.结果 胼胝体梗死占所有脑梗死患者的1.04％(7/671),其主要危险因素是高血压、冠心病和糖尿病.典型表现包括观念运动性失用(42.9％)、额叶步态(28.6％)和异己手综合征(14.3％),可伴有肢体瘫痪、意识障碍和认知损害等症状.MRI共检出胼胝体病灶8个,以体部多见(62.5％),其次为压部(25.0％)和膝部(1/8,12.5％).额叶(57.1％)、基底节区(42.9％)和枕叶(42.9％)常同时被累及.弥散张量成像显示,l例患者胼胝体体部和膝部纤维连接中断.6例患者血管造影显示血管狭窄或闭塞,其中以椎动脉狭窄最多见(66.7％),其次为大脑前动脉(50.0％),颈总动脉、颈内动脉和大脑中动脉较少见(均为33.3％).结论 胼胝体梗死发生率低,动脉粥样硬化是致病关键,其临床表现多样,与梗死部位有关.     

2型糖尿病合并脑梗死患者的头颅磁共振成像特征分析

目的观察MRI在T2DM合并脑梗死患者中应用。方法选取于2017年1月—2019年6月的60例T2DM与非T2DM合并脑梗死作为观察对象,均接受MRI检查。结果研究组MRI大面积梗死、再发性梗死、多灶性梗死高于对照组(P0.05),大面积梗死MRI为大片状且不均匀或者均匀异常信号影,腔隙性脑梗死梗死灶直径1.5 cm,病灶形态斑点状、斑片状、裂隙状、类圆形等,多发性梗死患者两侧额叶及胼胝体膝部、体部多发片状异常信号,TIWI稍低信号,T2WI稍高信号,FLAIR高信号,DWI稍高信号,增强后病灶环形强化。结论 T2DM是脑梗死的危险因素,要及早治疗。     

胼胝体梗死14例临床分析

目的探讨胼胝体梗死的高危因素,临床表现及诊断分型。方法对14例胼胝体梗死患者的临床资料进行分析。结果胼胝体梗死高危因素主要为高血压病,糖尿病,最主要的临床表现为肢体瘫痪、失语及智能改变、感觉障碍,病变部位以体部及膝部多见。依据CISS标准分型提示胼胝体梗死为动脉粥样硬化性脑梗死。结论胼胝体梗死临床表现非特异性,临床诊断需要依靠MRI检查,病因多为动脉粥样硬化。     

胼胝体梗死临床特点分析

目的探讨胼胝体梗死患者的临床表现、影像学表现以及预后。方法纳入胼胝体梗死患者11例,对其临床特征及头颅CT、MRI表现及预后等进行回顾性分析,总结胼胝体梗死的临床特点。结果胼胝体梗死患者中,梗死范围局限于胼胝体的局限病灶患者占27.3%,合并胼胝体外梗死的弥散性病灶患者占72.7%。胼胝体梗死患者临床可表现为失语、肌力减退、智能障碍、小便失禁、感觉障碍、意识障碍、共济失调、情感障碍等症状,病变除累及胼胝体外还多合并基底节区、额叶、顶叶、颞叶等部位梗死。随访1年,患者痊愈或症状改善为10例(90.9%),恶化1例(9.1%)。结论胼胝体梗死患者临床表现复杂多变,头颅MRI对胼胝体梗死的诊断具有重要价值,经积极治疗预后良好。     

胼胝体梗死的临床与磁共振影像特点

目的探讨胼胝体梗死患者的临床和磁共振检查的影像学特点。方法回顾22例急性胼胝体梗死患者的临床和磁共振检查资料,分析其主要临床特点及其特征性影像学表现。结果胼胝体梗死主要表现为肢体瘫痪、认知功能下降、语言障碍、情感障碍、面舌瘫痪、感觉障碍、偏侧肢体失用。磁共振影像显示,胼胝体体部和膝部梗死患者的大脑前动脉狭窄或闭塞率明显高于胼胝体压部梗死患者（χ2分别为4.996、4.337,P均〈0.05）,胼胝体压部梗死患者的大脑后动脉狭窄或闭塞率明显高于胼胝体体部和膝部梗死患者（χ2分别为4.337、4.996,P均〈0.05）。结论胼胝体梗死临床表现复杂多样,颅脑磁共振检查是确诊胼胝体梗死的依据。     

腔隙性脑梗死CT与MR表现对比研究

目的对比腔隙性脑梗死CT与MRI表现并探讨在腔隙性脑梗死诊断中的价值。方法对180例临床疑似腔隙性脑梗死患者在常规头颅CT、MRI的基础上行FLAIR、DWI和MRA检查,根据影像学结果进行对比分析,选择治疗方案。结果①MRI可以确诊疑似病例患者是负腔隙性脑梗死;②FLAIR可以发现早期脑缺血灶;③DWI可显示常规CT和MRI T1W1、T2W1不能显示的病灶（新鲜病灶）。④MRA显示血管闭塞的部位和狭窄程度。结论通过比较影像学早期诊断腔隙性脑梗死,显示梗死灶与靶血管的关系,早期临床体征可提供切实可行的影像学资料。     

MRI与CT在老年多发性脑梗死病人诊断中的临床结果比较

目的 对比分析MRI与CT影像检查在老年多发性脑梗死病人诊断中的作用.方法 选取我院2008年6月至2009年6月收治的126例老年多发性脑梗死患者作为研究对象,所有患者均进行MRI和CT检查,将患者按照脑梗死发生的时间、梗死部位、梗死灶大小、是否发展为血管性痴呆等情况进行分组统计,比较不同情况下MRI和CT对多发性脑梗死的诊断结果,分析MRI和CT用于诊断老年多发性脑梗死的临床特点.结果 按照梗死发生时间分组,颅脑CT对于早期脑梗死的诊断阳性率明显低于MRI(P ＜0.05);按照梗死灶大小分组,颅脑CT对于小病灶的检出率明显低于MRI;按照梗死部位分组,颅脑CT对于脑干及小脑部位的梗死检出率明显低于MRI;按照是否为血管性痴呆分组,颅脑CT对于非血管性痴呆组患者的梗死检出率明显低于MRI(P ＜0.05),而对于血管性痴呆的梗死阳性检出率比较无显著性差异(P＞0.05).结论 对于多发性脑梗死病人而言,颅脑CT和MRI都是重要的辅助诊断手段,但MRI对于早期、小病灶、后颅凹梗死灶、多发脑梗死痴呆的梗死病灶检出率明显高于CT.     

老年胼胝体脑梗死40例临床特点分析

目的 总结胼胝体梗死的临床特点.方法 老年胼胝体脑梗死患者40例,对其一般情况、发病原因、临床表现、影像学特点及预后进行分析.结果 高危因素主要为动脉粥样硬化,病灶位置以胼胝体膝部、体部和压部多见;临床表现多样,其中运动障碍18/40(45.0％)、高级智能障碍15/40(37.5％)、感觉障碍9/40(22.5％)、言语障碍8/40(20.0％)、精神情绪障碍6/40(15.0％),伴异己手综合症2例、一过性小便失禁2例;治疗总有效率为90％.结论 胼胝体梗死高危因素以动脉粥样硬化为主,临床表现复杂,MRI是最佳诊断手段,早期发现、积极治疗者预后较好.     

胼胝体梗死患者不同梗死部位的磁共振表现与认知障碍特征

目的探讨胼胝体梗死不同梗死部位所致认知障碍及磁共振MRI、DWI检查的特征。方法对39例胼胝体梗死患者进行MRI及DWI扫描,按不同梗死部位分为膝部、体部、压部梗死三组,分析三组的磁共振影像学特征,比较三组美国国立卫生研究院卒中量表(NIHSS)、简易精神状态量表(MMSE)、医院焦虑抑郁量表(HAD)和日常生活能力量表(ADL)检查结果。结果经MRI、DWI检查发现,入组患者均为胼胝体单一部位的新发病变,左右侧均有发病,且左右侧差异不均。单纯的压部梗死较体部和膝部更常见。胼胝体膝部、压部、体部梗死患者的NIHSS和ADL评分无统计学差异(P0.05),体部梗死患者的HAD测定结果明显高于膝部和压部梗死(P0.05)。不同部位胼胝体梗死患者MMSE评分均有降低,但无显著差异(P0.05),膝部梗死患者表达和记忆力评分下降更突出,体部梗死患者语言障碍较压部梗死患者更突出。结论不同部位胼胝体梗死患者均存在不同程度的认知障碍,且胼胝体体部梗死更容易合并脑卒中后焦虑抑郁,膝部梗死表现以表达和记忆力下降为主,体部梗死表现以语言能力下降为主。     

急性胼胝体梗死33例临床及影像学分析

目的探讨急性胼胝体梗死的临床及影像学特征：方法回顾性分析2006年4月-2010年4月安徽医科大学附属省立医院1609例脑梗死患者中,经MRI确诊的33例胼胝体梗死患者的临床及影像学资料结果①该病发生率为2．05％（33／1609）;发病年龄为（63±9）岁,主要危险因素是高血压、高脂血症和糖尿病。②33例中,以肢体瘫痪（93．9％）和认知功能下降（57．6％）最为多见,其次是面、舌瘫（48．5％）,共济失调（45．5％）,感觉障碍（39．4％）,再次是情感障碍和语言障碍（均为30.3％）,而异己手综合征最少见（9．1％）。（3）33例通过MRI检出病灶42个,以体部（42．9％）、压部（35．7％）多见。6例为单纯胼胝体梗死,27例合并颅内其他部位梗死,最多见于基底核区（75．8％）。单侧梗死患者（24／33）多于双侧（9／33）,P〈0．01。④15例行血管造影检查（MRA／CTA／DSA）,大腩的动脉狭窄6例,闭塞3例;胼周动脉狭窄3例,闭塞2例;大脑中动脉狭窄1例,大脑后动脉狭窄3例,闭塞2例;血管形态正常者2例。结论胼胝体梗死发生率相对低,临床表观复杂多样,应重视认知功能的下降和异己手综合征,MRI对胼胝体梗死定位诊断具有重要意义。     

Focal transient lesions of the corpus callosum in systemic lupus erythematosus

Focal lesions limited to the splenium of the corpus callosum are rare and little is known about their etiology. We describe three patients with systemic lupus erythematosus (SLE) that presented transient lesions of the corpus callosum. We reviewed three patients with SLE whose magnetic resonance imaging (MRI) results revealed focal lesions in the splenum of corpus callosum. The medical records, including clinical, serological, and treatment features, were reviewed to determine the etiology of these lesions. Of 115 patients who had MRI for research purposes, three patients with focal nonhemorrhagic lesions of the corpus callosum were identified. All patients had active SLE at the time of MRI. One patient had other findings on MRI, including cerebral venous thrombosis. On follow-up MRI, patients had an inactive disease and the corpus callosum lesions disappeared. A transient lesion in the splenium of corpus callosum seems to be a nonspecific endpoint of different disease processes leading to vasogenic edema. The complete and rapid reversibility in all cases with disease control is emphasized and any invasive diagnostic or therapeutic approach is discouraged.     

Nonconvulsive status epilepticus manifesting as rapidly progressive dementia and infarction in the splenium of the corpus callosum: A case report

Rationale:Nonconvulsive status epilepticus (NCSE) is a heterogeneous disease with multiple subtypes. NCSE poses great diagnostic and therapeutic challenges due to the lack of typical symptoms. Here, we report a case of NCSE manifesting as rapidly progressive dementia (RPD) and infarction in the splenium of the corpus callosum. Additionally, the relevant literature was reviewed.Patient concerns:A 63-year-old man presented with RPD. Electroencephalogram (EEG) revealed NCSE, and brain magnetic resonance imaging (MRI) showed an isolated infarction in the splenium of the corpus callosum. Mini-mental state examination showed moderate cognitive impairment (14/30 points).Diagnosis:A diagnosis of NCSE with RPD and infarction in the splenium of the corpus callosum was made.Interventions:The patient was treated with intravenous diazepam (10 mg), oral levetiracetam (1.0g twice daily), oral sodium valproate (0.2g twice daily), and intramuscular phenobarbital sodium (0.2g once daily).Outcomes:After the treatment, the symptoms were improved. The patient could answer questions. Repeated EEG showed that the background a rhythm was slightly overdeveloped, and no clinical or electrical seizures were observed. After discharge, the patient was treated with oral levetiracetam (1.0g twice daily) and oral sodium valproate (0.2g twice daily) for 6 months. At the last follow-up, the patient had clear consciousness, sensitive response, and fluent answering ability. Repeated mini-mental state examination showed that his cognitive function was significantly improved (28/30 points); nevertheless, the lesion in the splenium of corpus callosum remained unchanged on MRI.Lessons:NCSE manifesting as RPD and infarction in the splenium of the corpus callosum is extremely rare. Epileptic events and focal infarction are usually overlooked in patients with dementia, and the diagnostic value of MRI and EEG should be highlighted     

Legionnaires' disease with hypoperfusion in the cerebellum and frontal lobe on single photon emission computed tomography

A 59-year-old man was admitted for further investigation of headache. Neurological examination revealed memory loss, disorientation, and bilateral intention tremor. Legionella pneumophila antigen was detected in the urine. Brain magnetic resonance diffusion-weighted images showed marked hyperintensity in the splenium of the corpus callosum without other abnormalities. Single photon emission CT with Tc-99m hexamethyl-propyleneamine oxime showed multi-focal hypoperfusion in the brain, involving mainly the cerebellum and frontal lobe. This is the first report demonstrating cerebellar and frontal lobe hypoperfusion without corresponding MRI abnormalities in a patient with central nervous system Legionnaires' disease.     

急性单纯胼胝体梗死的临床诊治分析并文献复习

目的 探讨急性单纯胼胝体梗死的临床特点.方法 连续回顾性分析2010年1月至2018年12月首都医科大学附属复兴医院2694例脑梗死患者中,经MRI确诊的16例急性单纯胼胝体梗死患者临床资料,包括患者性别、年龄、卒中危险因素、影像学特征等,并记录患者胼胝体梗死的部位、胼胝体供血动脉有无狭窄以及颅内外狭窄血管的数量等,评价治疗前与出院时美国国立卫生研究院卒中量表(NIHSS)评分的变化.出院后6个月完成门诊病情评估.16例急性单纯胼胝体梗死患者中,男10例,女6例;年龄46~82岁,平均(69.4±2.3)岁;高血压病14例,2型糖尿病12例,高脂血症11例,冠心病5例(含心房颤动1例),高同型半胱氨酸血症4例,脑梗死6例,脑出血1例;吸烟史8例,饮酒史4例.结果 急性单纯胼胝体梗死占同期脑梗死的发生率为0.6%(16/2694),均伴有多个动脉粥样硬化危险因素,最主要危险因素是高血压病.16例急性单纯胼胝体梗死患者中,病变血管以大脑前动脉狭窄(14例)、大脑中动脉狭窄(10例)和颈内动脉狭窄(8例)多见;病变部位以胼胝体膝部和体部多见(12例),且以单侧受损为主(累及单侧胼胝体15例);临床以肢体瘫痪(13例)、认知障碍(10例)和精神行为异常(8例)为主要表现,偏身感觉异常(2例)、偏盲(1例)及共济失调(3例)较少见;经治疗后多数患者的病情可明显改善.治疗前NIHSS评分为(4.3±1.5)分,出院时NIHSS评分为(2.9±1.2)分,治疗前后的差异有统计学意义(t=3.914,P=0.023).出院6个月门诊随访结果显示,2例基本痊愈,13例显著进步,1例无变化,无死亡患者.结论 急性单纯胼胝体梗死发生率较低,其发病与颅内多支动脉狭窄密切相关,前循环血管可能更易受累.临床症状复杂多样,尤其应关注患者肢体肌力、认知功能及精神行为表现,一般预后良好.     

胼胝体动静脉畸形的临床特点和手术疗效

目的探讨胼胝体动静脉畸形（AVM）的临床特点和手术疗效。方法对2005年9月—2011年8月收治的7例胼胝体AVM患者进行手术治疗。AVM分别位于胼胝体膝部1例,体部额段3例,体部顶段1例,压部2例。5例有脑室出血,对其中1例发生脑疝的患者行急诊手术。对膝部AVM经冠状切口单额开颅,行血肿清除及AVM切除术;对体部额段AVM患者,经前纵裂及额叶皮质造瘘后,经侧脑室切除AVM及清除血肿;对体部顶段AVM及压部AVM患者,经纵裂及顶叶切除AVM。结果①6例患者为中型AVM,最大直径为3～4.5 cm,1例为小型AVM,最大直径为2.5 cm。AVM由胼周动脉、胼缘动脉、后胼周动脉及脉络膜后内侧动脉供血。3例单纯浅静脉引流,2例深静脉引流,2例深、浅静脉同时引流。②7例患者的畸形血管团均获得全切。5例恢复良好,其中2例术后一过性肌力下降,1例出现偏瘫,4～14 d后恢复正常。1例术前脑疝患者术后6个月意识逐渐恢复。1例术中大出血病例术后发生脑积水,行脑室-腹腔分流术,术后意识清楚,遗留四肢痉挛性瘫痪、肌张力增高。③术后对6例行DSA或CTA复查,AVM消失,1例未复查。④临床随访3个月至6年,末次随访时,GOS评分为5分的5例,3分的2例。结论胼胝体AVM位置深在,供血动脉、引流静脉复杂,合理手术入路有助于完全切除AVM,术后疗效较好。     

磁共振成像在脑桥梗死诊断中的价值

目的探讨脑桥梗死的临床与MRI特征。方法回顾性分析96例脑桥梗死患者的临床资料,评估危险因素,分析临床与MRI特点。结果首发临床表现复杂多样,96例患者中,头晕或眩晕79例(82.29%),肢体活动不便76例(79.17%),构音障碍54例(56.25%),中枢性面瘫49例(51.04%),感觉障碍31例(32.29%),中枢性舌瘫25例(26.04%)等表现最常见;多表现为病灶对侧的中枢性面瘫和(或)舌瘫合并肢体瘫和(或)无感觉障碍,而经典脑桥综合征3例(3.13%);病灶在脑桥上段21例(21.88%),中段62例(64.58%),下段13例(13.54%);腹内侧41例(42.71%),腹外侧22例(22.92%),中部16例(16.67%),背内侧11例(11.46%),背外侧6例(6.25%)。结论脑桥梗死常见临床表现为头晕或眩晕,肢体活动受限,构音障碍,中枢性面瘫,感觉障碍,中枢性舌瘫。交叉症状或体征在脑桥梗死患者中并不常见,经典的脑桥综合征病例少见。脑桥梗死以中段最常见,尤其是腹内侧。MRI对脑桥梗死的诊断有极其重要的意义。     

A case of corpus callosum splenium encephalopathy and 2009 influenza A/H1N1

Encephalopathy with reversible lesion of the corpus callosum splenium has a favorable prognosis, but that in 2009 influenza A/H1N1 is unknown. We report a case of clinically mild encephalopathy with a reversible lesion of the corpus callosum splenium in which 2009 influenza A/H1N1 virus was confirmed by laboratory tests. A 15-year-old Japanese girl seen at the emergency unit for loss of consciousness 18 hours after fever onset had been diagnosed with influenza A, and administered zanamivir. Diffusion-weighted magnetic resonance imaging (MRI) indicated lesions of the corpus callosum splenium, and electroencephalography showed slow basic activity, suggesting influenza A related to encephalopathy. She required intensive care with ventilation for two days. Her consciousness had become normal by day 6 after onset, and MRI findings improved on day 7. She recovered without adverse sequelae.     

Abnormal brain MRI signals in the splenium of the corpus callosum, basal ganglia and internal capsule in a suspected case with tuberculous meningitis

A 34-year-old man visited the hospital with chief complaints of headache, fever, and disturbance of consciousness. In view of his clinical condition, the course of the disease, and results of examination, he was diagnosed with viral meningitis and treated accordingly. However, his clinical condition worsened, and MRI revealed abnormal signals in the splenium of the corpus callosum, in the basal ganglia and in the internal capsule, as well as the presence of severe inflammation in the base of the brain. Since he had a high ADA level in the cerebrospinal fluid and was consequently suspected to have tuberculous meningitis, he was placed on antitubercular agents. Then, his clinical condition began to improve. Additional steroid pulse therapy further improved his condition, and abnormal signals in the splenium of the corpus callosum and the basal ganglia resolved. This valuable case suggests that an immune mechanism contributed to the occurrence of central nervous system symptoms associated with tuberculous meningitis.