可逆性胼胝体压部病灶综合征二例报道并文献复习

目的 探讨可逆性胼胝体压部病灶综合征的临床特点、治疗及预后。方法 报道沈阳军区总医院2例可逆性胼胝体压部病灶综合征患者的诊治过程,总结其临床特征并复习相关文献。结果 患者1诊断为特发性低颅压;患者2诊断为流行性出血热伴低钠血症。2例患者胼胝体压部病灶在颅脑MRI上均表现为直径1～2 cm的局限性卵圆形病灶,位于胼胝体压部的中央,胼胝体其他部分不受累及,T1信号轻度减低,T2和液体衰减反转恢复序列（FLAIR）呈高信号,弥散加权成像（DWI）呈高信号,表观扩散系数（ADC）降低。患者1亦伴有硬膜下积液及硬脑膜强化等低颅压的MRI典型表现,而胼胝体病灶无强化。患者1病灶在首次MRI检查后3个月复查消失,患者2病灶在首次MRI检查后12 d复查消失。2例患者经支持、对症及针对性治疗临床痊愈。结论 可逆性胼胝体压部病灶综合征以颅脑MRI发现胼胝体压部可逆性病灶为特点,临床症状轻微,预后良好,病因及发病机制尚不清楚。     

可逆性胼胝体压部综合征1例报告

<正>2011年Carcia-Monco等[1]提出可逆性胼胝体压部综合征(RESLES),是一种可逆性胼胝体压部(SCC)病变为主要特点的临床影像综合征。它可以由感染、高原脑水肿、抗癫痫药物毒性或突然撤药、代谢紊乱等引起的,磁共振(MR)检查胼胝体压部病变短时间消失。RESLES临床报道少见,现报道我院收治1例RESLES患者临床和影像学资料,来分析探讨该病的发病机制和临床、影像特点。     

可逆性胼胝体压部病变综合征5例

目的探讨可逆性胼胝体压部病变综合征的临床特点和MR表现。方法回顾性分析2013年1月—2014年12月首都医科大学宣武医院神经内科收治的可逆性胼胝体压部病变综合征5例患者的临床及影像学资料。结果 5例患者中男3例,女2例。发热4例,腹泻2例,精神行为异常4例,癫痫2例。5例均行腰穿检查,除1例患者CSF白细胞1 340×10~6/L,其余4例CSF常规和生化均正常。5例患者分别于发病后3~11 d行头颅MR检察,均显示为胼胝体压部异常信号,T1WI低或稍低信号,T2WI高或稍高信号。DWI为高信号,增强扫描均无强化。3例给予阿昔洛韦治疗,1例给予罗氏芬和甘露醇治疗,1例给予甲泼尼龙治疗。全部患者在发病后11~26 d复查MR显示病灶消失,发病20~33 d后临床症状完全缓解。结论可逆性胼胝体压部病变综合征可见于多种疾病,临床症状轻微,影像学改变可逆,预后良好。     

儿童可逆性胼胝体压部病变综合征的MRI诊断价值

目的探讨可逆性胼胝体压部病变综合征(RESLES)的MRI特点,提高对其诊断的准确性。方法回顾性分析5例RESLES患儿的临床及MRI资料。全部病例均行MRI平扫。结果 5例患儿首次MRI均表现为胼胝体压部的类圆形或椭圆形孤立性异常信号,T1WI呈等信号2例,稍低信号3例;5例T2WI及FLIAR均呈稍高信号;5例DWI均呈高信号;5例ADC图均呈低信号,ADC值范围0.352~0.526×10-3mm2/s,平均ADC值(mADC)为(0.429±0.072)×10-3mm2/s。所有病灶均无水肿及占位效应。所有患儿经治疗后5-13天复查颅脑MRI,显示病灶均消失。结论 RESLES是一种少见的临床与影像学综合征,临床症状轻微,预后良好,颅脑MRI具有特异性,能为该病的正确诊断提供帮助。     

以晕厥为首发表现的可逆性胼胝体压部病变综合征1例并文献复习

<正>1病例简介患者,女,41岁,因"意识丧失2 min"于2019年1月28日入院。患者入院当天无明显诱因突发意识丧失,摔倒后头部着地,头皮外伤,小便失禁,无手足抽搐、口吐白沫,被家属扶起,约2 min左右后清醒,无特殊不适。遂就诊于我院急诊科,并以"晕厥待查"收住神经内科。既往患者3 d以来有咽痛、发热不适,当时考虑"感冒",未行特殊处理;2017年因巧克力囊肿行手术治疗。家族史无特殊。     

高血糖所致可逆性胼胝体压部病变综合征1例

<正>可逆性胼胝体压部病变综合征（reversible splenial lesion syndrome,RESLES）是由各种病因引起的累及胼胝体压部的一种临床影像学综合征^[1-2]。好发于儿童和青年,无明显性别差异。其具有显著性和短暂性的头部MRI改变,通常表现为胼胝体压部T1WI等或稍低信号,T2WI、FLAIR成像和DWI高信号,ADC低信号,增强扫描病灶无强化征像^[3-4]。2019年5月,阜南县人民医院神经内科收治了1例急性谵妄病人,在完善相应检查时发现其存在RESLES。现作报道。     

低血糖引发可逆性胼胝体压部病变综合征1例

1 临床资料 患者,女,31岁,以“被他人发现意识不清1d”为主诉于2016年7月8日就诊大连医科大学附属第二医院急诊科,行心电图,头CT未见明显异常.电解质、肝生化、血凝常规未见异常.血常规:白细胞14.29×109/L ↑,中性粒细胞百分比91.50％.肾功:尿素:2.20 mmol/L ↓,肌酐:42.70 μmol/L↓.     

病毒感染致胼胝体压部可逆性损伤1例

病人,女,31岁。于2011年6月8日出现发冷,测体温40℃,连续静滴3 d＂氨曲南＂后仍发热,又静滴1次＂痰热清注射液＂后仍发热。6月11日夜间醒后出现口周麻木、瘙痒,吞咽功能正常。6月13日以“发热待查”入住我院胸科,给予头孢哌酮一舒巴坦、病毒唑、生白及补液治疗。患者口周麻木范围扩大至鼻及双侧面颊,麻     

MRI对成人可逆性胼胝体压部病变综合征和脑梗死的鉴别诊断及预后评估

目的 探究成人可逆性胼胝体压部病变综合征(reversible spleniallesion syndrome,RESLES)与脑梗死的MRI表现特征差异,并分析MRI对疾病预后的评估价值.方法 选取21例RESLES患者和39例脑梗死患者作为研究对象,记录两组患者的MRI影像学中的病灶位置、形态和成像特点,分析两组患...     

胼胝体梗死的临床研究进展

在临床上胼胝体梗死是一种少见的脑梗死类型,由于胼胝体同时连接双侧大脑半球,血供丰富,因此胼胝体梗死的发病率较低。目前国内外对于胼胝体梗死的病因学尚无定论。胼胝体梗死后会出现双侧大脑半球失联系现象进而导致一系列临床症状。随着研究的深入,对胼胝体梗死的部位特点、临床表现、诊断和鉴别诊断以及治疗和预后已经有了进一步的认识。本文就胼胝体梗死的临床研究现状进行综述。     

Dementia due to tumours of the corpus callosum

The clinical features of 16 cases of tumours of the corpus callosum are described. Many presented with mental changes which were eventually obvious in all but one of the patients. The need to consider these tumours in the differential diagnosis of dementia is discussed.     

A MRI quantitative study of corpus callosum in normal adults

Objective： To investigate the possible age- and sex-related differences in the various dimensions of corpus callosum among Chinese normal adults. Methods： Magnetic resonance images of 286 healthy adults, including 127 males and 159 females, and ranging in age from 20 to 81 years, were investigated. They were classified into 5 age groups （ 20-29, 30-39, 40-49, 50-59, and 60-81 years old）. Corresponding to the age group sequence above, the male/female ratio of each group respectively was： 25/26, 26/33, 33/50, 32/36, and 11/14. The following dimensions of corpus callosum were systematically measured on the midsagittal Tl-weighted images： frontal to occipital pole （represented as line segment AB）, total longitudinal dimension of the corpus callosum （CD）, the maximum height （EF）, the widths of the genu （CX）, anterior one third （GH）, central region （EZ）, posterior one third （MN） and splenium （YD）. After that, the obtained data was analyzed statistically. Results： （1） The total longitudinal dimension, maximum height, widths of the genu, central region and splenium were proved to be larger in females. But the widths of the anterior one third and posterior one third were similar in-between. In spite of that, a conspicuous sex-related difference was not found. （2） The total longitudinal dimension and the maximum height of the corpus callosum remained stable in all age subgroups. Yet the widths of the genu, anterior one third, central region, posterior one third and splenium had a tendency of decreasing gradually with aging. Statistical difference was seen in the anterior one third, central region, posterior one third （P〈0.05）. Conclusion： There is no sex-related difference in all dimensions of corpus callosum. But, with aging, a significant difference is found in the widths of the anterior one third, central region and posterior one third.     

双侧胼胝体梗死伴发烟雾综合征1例及文献复习

胼胝体梗死在临床较为少见,具体发病机制尚不明确。本文报道1例双侧胼胝体梗死伴发烟雾综合征,并从血管解剖和高危因素角度讨论病因。通过检索近十年国内外相关病例报道,分析总结胼胝体梗死的血管特点及主要病因,以期有助于临床诊疗。     

胼胝体发育不全的MRI诊断

目的分析胼胝体发育不全的MRI表现特点,探讨MRI对胼胝体发育不全的诊断价值。方法回顾性分析36例胼胝体发育不全患者的MRI表现。结果MRI显示胼胝体完全缺如8例,部分缺如23例,胼胝体变薄5例。22例伴有其他先天性脑部畸形,其中合并脂肪瘤7例,灰质异位5例,穿通畸形3例,脑裂畸形2例,Dandy—Walker综合征2例,蛛网膜囊肿并巨脑回1例,脑裂畸形并透明隔缺如1例,Dandy—Walker综合征并脑干发育不良1例。结论MRI可以很好地显示胼胝体发育不全及其所伴发的其他脑部畸形。MRI是诊断胼胝体发育不全的首选及最佳方法。     

儿童川崎病合并轻微脑炎/脑病伴可逆性胼胝体压部病变综合征1例并文献复习

报道1例川崎病合并轻微脑炎/脑病伴可逆性胼胝体压部病变综合征(mild encephalitis/encephalopathy with a reversible splenial lesion,MERS)患儿的临床诊疗经过,并回顾相关文献报道,总结疾病特点,提高对该病的认识。本例患者为7岁余男孩,持续高热6 d,伴草莓舌、双眼球结膜充血、全身大片红斑样充血样皮疹和颈部淋巴结肿大,符合川崎病诊断标准。丙种球蛋白(2 g/kg)静脉滴注24 h后患儿仍有发热,且出现头痛、嗜睡表现,头颅磁共振成像(magnetic resonance imaging,MRI)显示胼胝体压部局限性梭形肿胀,T1稍低、T2稍高异常信号,扩散加权成像(diffusion-weighted images,DWI)呈明显高信号,表观扩散系数(apparent diffusion coefficient,ADC)图呈明显低信号,提示MERS,予甲泼尼龙2 mg/(kg·d)静脉滴注,数小时后患儿热退,头痛、嗜睡症状消失。1周后复查头颅MRI正常,出院时没有神经系统异常和冠状动脉扩张。共检索到符合条件的外文文献12篇,未检索到中文文献,共报道17例川崎病合并MERS患儿,中位年龄6.5岁(1~14岁),其中5岁以上儿童11例,合并冠状动脉扩张者4例。所有患儿均有不同程度的意识障碍、幻视、惊厥等神经系统症状,头颅MRI符合MERS影像学改变,经积极治疗, 所有患儿的神经系统症状完全消失,其中13例患儿复查了头颅MRI,影像学改变均恢复正常,所有患儿均未遗留神经系统后遗症。川崎病合并MERS的病例报道非常少见,并发MERS的川崎病多发生在5岁以上年长儿童,头颅MRI检查有助于早期诊断,及时积极治疗可以使MERS病情短期内逆转,不留神经系统后遗症。     

Hypothalamic disease in association with dysgenesis of the corpus callosum

We describe two cases of dysgenesis of the corpus callosum demonstrated by magnetic resonance. The first patient presented with chronic hyponatraemia. Investigation demonstrated re-setting of the osmoreceptor and thirst centres. The calculated threshold for arginine vasopressin (AVP) release was reduced at 252 mosmol/kg while severe thirst was perceived at a plasma osmolality of 260 mosmol/kg. Insulin-induced hypoglycaemia produced an exaggerated AVP response. The second patient presented with hypothermia. The calculated threshold of AVP release was 296 mosmol/kg with increased sensitivity of AVP response to hypertonic saline. The plasma AVP response to insulin-induced hypoglycaemia was absent. Both cases had normal anterior pituitary function and psychological assessment showed a similar prefrontal defect. Specific tests of callosal function were normal. These cases illustrate the importance of undertaking complete neuroradiological assessment of cases of unexplained hypothalamic disease regardless of the age of presentation to avoid overlooking this rare congenital association.     

Multiple spinal anomalies associated with dysgenesis of the corpus callosum

Background

The coexistence of cranial and spinal anomalies in spina bifida is well known. Although combinations of such anomalies are well recognized, coexistence of six different severe anomalies is extremely uncommon.

Case report

This case illustrates the association of the partial agenesis of the corpus callosum and complex spinal malformation, consisting of meningocele and dermoid sinus, associated with diastematomyelia, syringomyelia, and tethered spinal cord.

Conclusion

Coexistence of six different anomalies is very rare. To our knowledge, no previous cases have been reported in the literature. This report is of interest showing multiple findings on brain and spinal MRI in such a patient.