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。     

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。     

胼胝体脑梗死12例临床分析

目的探讨胼胝体梗死(CCI)的高危因素,临床表现及诊断分型。方法分析本院2008年至2013年的12例CCI患者的临床资料。结果 CCI临床表现复杂多样,以肢体瘫痪、语言障碍及智能障碍为主,病变部位以体部及膝部多见,高危因素主要为高血压病及糖尿病。结论 CCI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基础上的血流动力学改变。     

前、后循环脑梗死患者的颈动脉超声对照研究

目的通过对前循环及后循环脑梗死患者颈总动脉、颈内动脉及无名动脉分叉处的超声比较,探讨颈动脉及无名动脉病变与脑梗死部位的关系。方法利用彩超及B-flow技术对88例后循环梗死及109例前循环梗死病人进行检测,比较2组动脉硬化斑块的位置、性质及血管有无重度病变。结果 2组患者斑块（包括稳定性斑块及不稳定斑块）不同部位的发生率比较差异均无统计学意义（P〉0.05）;前循环梗死组不同部位不稳定斑块的发生率比较差异有统计学意义（P〈0.05）。而后循环梗死组不同部位不稳定斑块的发生率比较差异无统计学意义（P〉0.05）;2组血管重度病变比较差异有统计学意义（P〈0.05）。结论不稳定性斑块尤其是颈动脉及无名动脉均存在不稳定斑块,更易导致前循环梗死,动脉重度病变是导致脑梗死的重要危险因素。     

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。     

老年腔隙性梗死后影响认知功能障碍的危险因素分析

目的探讨老年腔隙性梗死后影响认知功能障碍的危险因素。方法对2组患者临床资料进行回顾性分析,准确记录所得数据,分析相关危险因素。结果研究组并发认知功能障碍患者的高血脂、糖尿病、内囊基底节区、大脑皮质、丘脑腔隙性梗死例数均显著高于对照组未并发认知功能障碍的老年腔隙性梗死患者(P0.05);2组吸烟率、性别、年龄、颈动脉斑块发生率对比差异无统计学意义(P0.05)。结论准确掌握老年腔隙性梗死后并发认知功能障碍主要危险因素,对高危人群积极给予各项干预措施降低其认知功能障碍发生率,保障患者生活质量及生命安全。     

胼胝体梗死的临床特点分析

目的探讨胼胝体梗死的临床特点,提高对胼胝体梗死的认识。方法对21例胼胝体梗死患者的临床和MRI资料进行回顾性分析。结果 21例胼胝体梗死患者,男12例,女9例,影像学示膝部梗死5例,体部10例,压部3例,膝部合并体部3例,临床表现为精神及智能障碍、失语、偏瘫、感觉障碍、小便失禁等。结论胼胝体梗死患者发生率低,症状复杂多变,易误诊。MRI扫描结合弥散加权成像(DWI)横断扫描是诊断胼胝体梗死的准确方法。     

颈动脉病变与前循环梗死亚型关系

目的研究颈动脉病变与前循环梗死亚型之间的关系。方法采用彩色多普勒超声对116例颈内动脉系统脑梗死患者双侧颈总及颈内动脉进行探查,观察颈动脉病变特点,分析不同类型粥样斑块与脑梗死亚型的相关性。结果①68·2%的脑梗死患者存在不同程度的颈动脉病变,69·8%的患者颈动脉轻度狭窄;②左侧半球梗死的患者其同侧颈动脉粥样斑块数量远大于对侧,右侧半球梗死的患者其同侧斑块数量也大于对侧(P<0·005),同时随着颈部病变血管和斑块数量增加,颅内病变范围及程度也增加(P<0·005);③皮质支及动脉主干型脑梗死患者中不稳定性斑块35例,稳定性斑块9例;中央支梗死、分水岭区梗死及白质损害患者中不稳定性斑块分别为5例、4例、9例,稳定性斑块为17例、7例、20例。结论①颈内动脉系统病变与前循环梗死相关,同时颈动脉狭窄程度并不是前循环梗死唯一相关因素,颈动脉粥样斑块性质可能与其密切相关;②颈动脉病变与颅内病灶存在对应关系,同时颈动脉粥样硬化的程度和范围与脑梗死的程度相关,而且Willis环不仅对脑血流供应起调节和代偿作用,同时也促使微血栓向对侧及其他血管转移;③不稳定性斑块与皮质支脑梗死及动脉主干型脑梗死相关而稳定性斑块则与中央支脑梗死、分水岭区梗死及弥漫白质损害相关。     

Clinical and topographical range of callosal infarction: a clinical and radiological correlation study.

A prospective clinical and radiological correlation study was performed to determine the frequency, and the clinical and radiological features of callosal infarction. From 1 January 1993 to the end of December 1993 282 cases of cerebral infarction seen in the Neurology service of the University Hospital of Dijon were studied prospectively. Eight cases with callosal ischaemic lesions were identified by CT and MRI. A callosal disconnection syndrome occurred in only five of eight patients, related to a single, large infarct or several infarctions in the anterior part of the corpus callosum. Clinical features were characterised by left ideomotor apraxia, construction apraxia, and left agraphia in all five cases. Alien hand was noted in only two cases. There were gait disorders in three cases with MRI features of multiple lacunes in a large part of the corpus callosum, and also the subcortical areas of both hemispheres. It is emphasised that callosal infarctions are not rare and that they contribute to the clinical features of strokes. As well as the classic incomplete callosal disconnection syndrome, these callosal ischaemic lesions may induce non-specific gait disorders.     

Isolated corpus callosal infarction secondary to pericallosal artery disease presenting as alien hand syndrome

Two patients are described with the callosal type of alien hand syndrome. Both presented with abnormal feelings in the left upper limb and intermanual conflict without clinical evidence of callosal apraxia or frontal lobe dysfunction such as motor deficit or reflexive grasping. Imaging studies disclosed subacute infarction in the body and splenium of the corpus callosum due to pericallosal artery disease. These patients were unique in their presentation as a callosal type of alien hand syndrome secondary to ischaemic stroke.     

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.     

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.     

Callosal alien hand sign following a right parietal lobe infarction

Callosal alien hand syndrome is characterized primarily by intermanual conflict and is associated with an anterior callosal lesion. We report a patient who presented with topographical disorientation and the callosal type alien hand sign. An MRI of the brain showed a right parietal lobe infarction. This is a rare example of callosal alien hand sign associated with a right parietal lesion. The right parietal lobe appeared to be responsible for the callosal hand sign in this patient, possibly due to interference with peristriate outflow pathways toward the parietal zones, where visual somatosensory interactions are likely to occur.     

Callosal disconnection syndrome due to acute disseminated enchephalomyelitis]

We have reported a very rare case of a patient with callosal disconnection syndrome due to acute disseminated enchephalomyelitis (ADEM). A 54-year-old right-handed woman developed sudden consciousness disturbance and fever after 2 weeks when she had common cold. She did not have a history of stuttering. On admission, the neurological finding showed consciousness disturbance, and exaggerated muscle stretch reflex in four extremities without meningeal irritation. The cerebrospinal fluid examination revealed the cell counts of 273/mm3, the protein of 348 mg/dl and the myelin basic protein 18.3 pg/ml. The brain MRI demonstrated a focal high signal intensity in the right cerebellar peduncle, right temporal lobe, left occipital lobe and corpus callosum on the T2-weighted and FLAIR images. The lesion of corpus callosum was the trunk and splenium, sparing the dorsal side of splenium. Her diagnosis was ADEM. The steroid pulse therapy (metylpredinisolone 1 g/day for 3 days) improved the consciousness disturbance. After 6 weeks from the onset, the neuropsycological examination was performed. The remarkable findings included pure alexia without color naming defects, the acquired stuttering and one-way disturbance of somesthetic transfer from the left hand to the right. This patient may contribute to the study of functional localization of the corpus callosum.     

MRI表现酷似颅内感染的多灶性脑梗死1例报告

目的:报道1例头颅MRI表现酷似颅内感染的多灶性脑梗死。方法:患者行头颅MRI检查,脑脊液等检测,脑标本行多部位病理检查。结果:MRI:两侧额叶及胼胝体膝部、体部多发片状异常信号,T1WI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。病理诊断:脑动脉重度粥样硬化伴大脑顶叶、基底节、胼胝体及脑桥多发梗死伴出血灶形成。结论:多灶性脑梗死头颅MRI增强亦可出现酷似颅内感染的多灶性环型增强。     

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。