胼胝体梗死的临床与影像学分析

目的 探讨胼胝体梗死患者的临床和影像学特点.方法 收集符合脑梗死诊断的416例患者的临床资料,其中8例经过MRI证实为胼胝体梗死.结果 胼胝体梗死占全部脑梗死患者的1.9%.7例CT扫描未显示胼胝体梗死,经非增强MRI检查显示病灶,另1例经增强MRI检查显示病灶.梗死灶可仅累及胼胝体(膝部、体部或压部),也可合并额叶、...     

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.     

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     

Neurometabolic changes in normal white matter may predict appearance of hyperintense lesions in systemic lupus erythematosus

To determine if neurometabolic changes in the white matter (WM) of systemic lupus erythematosus (SLE) patients may predict the appearance of small hyperintense lesions on T2-weighted magnetic resonance imaging (MRI) inside the magnetic resonance spectroscopy (MRS) region of interest (ROI). We included 30 SLE patients and 23 controls. We performed single voxel proton MRS over the superior-posterior region of the corpus callosum. We measured signals from N-acetyl-compounds (NAA), choline (Cho) and creatine-phosphocreatin (Cr) and determined NAA/Cr and Cho/Cr ratios. After a minimum of 12 months, MRI and MRS were repeated in all patients and nine volunteers. Twenty patients had normal MRI and 10 patients had MRI hyperintense lesions in the MRS ROI at baseline. All patients had hyperintense lesions in the MRS ROI in follow-up MRIs. All SLE patients had increased Cho/Cr values at both MRS when compared with normal controls (P = 0.001). In addition, there was an increase in Cho/Cr values when patients' baseline and follow-up MRS were compared (P = 0.001). We observed a correlation between Cho/Cr ratios and number of WM lesions (r = 0.69; P = 0.001). Increased Cho/Cr in normal appearing WM may be indicative of future appearance of hyperintense T2-weighted MRI lesions in SLE patients.     

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。     

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.     

Lupus anticoagulant: correlation with magnetic resonance imaging of brain lesions.

Brain magnetic resonance imaging (MRI) was performed in 21 patients with systemic lupus erythematosus (SLE) with and without lupus anticoagulant (LAC), one lupus-like patient and 5 patients with primary antiphospholipid antibody syndrome. Thirteen patients had white matter focal brain lesions on MRI, 10 of whom had LAC (p = 0.03). We found no correlation between these lesions and neurologic manifestations, nor any clinical or serologic indices of activity of SLE. Our MRI lesions were similar to those described in multiple sclerosis and may indicate a similar pathologic process.     

Self-remitting Elevation of Adenosine Deaminase Levels in the Cerebrospinal Fluid with Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Case Report and Review of the Literature

A 29-year-old man presented with a high-grade fever, headache, and urinary retention, in addition to meningeal irritation and myoclonus in his upper extremities. A cerebrospinal fluid (CSF) examination showed pleocytosis and high adenosine deaminase (ADA) levels with no evidence of bacterial infection, including Mycobacterium tuberculosis. T2-weighted brain magnetic resonance imaging showed transient hyper-intensity lesions at the splenium of the corpus callosum (SCC), bilateral putamen, and pons during the course of the disease. The CSF was positive for anti-glial fibrillary acidic protein (GFAP) antibodies. He was diagnosed with autoimmune GFAP astrocytopathy. The present case shows that the combination of an elevated ADA level in the CSF and reversible T2-weighted hyper-intensity on the SCC supports the diagnosis of autoimmune GFAP encephalopathy.     

Clinicoradiological Spectrum of Reversible Splenial Lesion Syndrome (RESLES) in Adults: A Retrospective Study of a Rare Entity

The presence of reversible lesions that involve the splenium of the corpus callosum (SCC) has been reported in patients with a broad spectrum of diseases and conditions and is referred to as reversible splenial lesion syndrome (RESLES).To describe the clinicoradiological features and establish a clinical position for this disease, we retrospectively examined the clinicoradiological features of adult RESLES patients, as well as discuss the potential pathophysiological mechanisms of this disease.The clinical and MRI findings of patients who presented with RESLES accompanied by symptoms of neurological disorders were retrospectively reviewed. The patients were classified into 2 subgroups (favorable and poor outcome subgroups), which corresponded to the severity of the disability using the Modified Oxford Handicap Scale. In addition, we compared the clinical and neuroimaging features between the 2 outcome subgroups.Eight patients with RESLES associated with various diseases and conditions were included. The clinical presentation was nonspecific; however, MRI exhibited consistent lesions in the SCC with a hypointensity on apparent diffusion coefficient maps and a hyperintensity via diffusion-weighted imaging, which disappeared after a variable lapse. The number of patients with a severe disturbance of consciousness, extracallosal lesions, or diffuse slow waves in the poor outcome subgroup was significantly increased compared with the favorable outcome subgroup (P < 0.05). Thus, the clinicoradiological spectrum of RESLES could be classified into 2 principal categories according to differential outcomes.RESLES is a rare entity with a broad clinicoradiological spectrum because of the various diseases and conditions. Although the overall symptoms of RESLES patients tend to be alleviated, the prognosis of patients with a severe disturbance of consciousness, extracallosal lesions, or diffuse slow waves is likely unfavorable.     

Marchiafava-Bignami disease. 3 cases with favorable prognosis

INTRODUCTION: Marchiafava-Bignami disease is a complication of chronic alcoholism, with acute or subacute demyelination of the corpus callosum. Although subacute and benign forms of the disease have been described since the development of CT scan and MRI, it has usually a poor prognosis. EXEGESIS: We report three cases of Marchiafava-Bignami disease with favorable outcome. One of the patient was comatose upon hospital admission. Interhemispheric dysconnection syndrome was evidenced in two patients. CT scan and MRI showed lesions extending to the callosal white matter in these patients. CONCLUSION: Potential existence of Marchiafava-Bignami disease should be investigated in patients presenting with chronic alcoholism and mental confusion. However, accompanying coma and white matter demyelination should not necessarily be considered of poor prognosis. Clinical evaluation of interhemispheric dysconnection is of value in patients presenting with chronic alcoholism and mental confusion.     

Predictors of clinical outcome and radiologic progression in patients with neuropsychiatric manifestations of systemic lupus erythematosus

PURPOSE: We sought to identify the predictors of clinical outcome and of the evolution of cerebral abnormalities in patients with neuropsychiatric systemic lupus erythematosus (SLE). SUBJECTS AND METHODS: Thirty-two patients with SLE (including 14 with the antiphospholipid syndrome) who had been hospitalized with primary neuropsychiatric disease were observed prospectively for at least 2 years. Laboratory and clinical characteristics and data from magnetic resonance imaging (MRI) studies obtained during the hospitalization and 2 years later were evaluated. We ascertained nonreversible or new MRI changes and clinical outcomes, including neuropsychiatric events, during follow-up. RESULTS: Cranial MRI scans on admission were abnormal in 26 (81%) of the 32 patients. Patients with the antiphospholipid syndrome were more likely to have focal cerebral white matter lesions (odds ratio [OR] = 12, 95% confidence interval [CI]: 2.0 to 72). After 2 years, neuropsychiatric deficits substantially improved in 22 (69%) of the patients, stabilized in 6 (19%), and deteriorated in 4 (12%). The number of prior neuropsychiatric events was associated with persistent MRI lesions (OR = 4.8 per each event, 95% CI: 1.1 to 21) and unfavorable clinical outcome (OR = 4.3 per each event, 95% CI: 1.4 to 13) at 2 years. The antiphospholipid syndrome also predicted an unfavorable clinical outcome at 2 years (OR = 11, 95% CI: 1.7 to 65). CONCLUSIONS: Among patients with SLE who have neuropsychiatric disease, prior neuropsychiatric events and the antiphospholipid syndrome increase the risk of adverse outcomes.     

Transient splenial lesion of the corpus callosum in H1N1 influenza virus-associated encephalitis/encephalopathy

A 26-year-old man was admitted to our hospital because of high fever, drowsiness, memory disturbance, and disorientation due to H1N1 influenza virus-associated encephalitis/encephalopathy. All of his symptoms rapidly improved following methylprednisolone pulse therapy. The diffusion-weighted image of brain magnetic resonance imaging (MRI) revealed a large transient hyperintense signal lesion on the central splenium of the corpus callosum. This MRI finding in conjunction with a complete clinical recovery has been previously observed in cases of clinically mild seasonal influenza-associated encephalitis/encephalopathy, and can be also a useful clue for the diagnosis of new type of influenza, H1N1 influenza virus infection complicated by encephalitis/encephalopathy.     

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。     

Corpus callosum agenesis and epilepsy in 2 brothers

We report on two brothers with focal epileptic seizures and agenesia of the corpus callosum. The diagnosis of agenesia of the corpus callosum in both was made by CT, both brothers were retarded and both showed focal phenomena which can be interpreted as a consequence of the lacking connection between the two hemispheres. One of the patients showed a remarkable focal miniature spike and wave periodicity in the EEG. Neither of the parents had matching abnormalities.     

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.     

老年脑白质疏松患者胼胝体萎缩与步态障碍的相关性研究

目的探讨老年脑白质疏松患者步态障碍与头颅MRI上胼胝体萎缩的相关性。方法对20例主诉有步态障碍的老年脑白质疏松患者(病例组)进行下肢功能评分和MRI上胼胝体的测量,另选健康体检者8例作为对照组,并进行组间比较及回归分析。结果病例组的胼胝体面积、标准化后的胼胝体面积比率(CCR)、各分段的胼胝体占幕上颅腔面积的百分比均小于对照组(P<0.05)。采用多重逐步回归分析,最后入选的对步态障碍严重程度有显著的、独立的提示作用的自变量只有CCR,回归系数为0.664,P=0.001。经过MRI其他改变校正后仍然独立相关。结论有步态障碍的老年脑白质疏松患者胼胝体面积明显减小,胼胝体萎缩与步态障碍程度有相关性,此相关性独立于脑白质疏松程度、脑萎缩程度等其他脑部病变。     

胼胝体梗死

胼胝体的血液供应丰富,功能复杂,梗死发生率低.胼胝体梗死的危险因素和病因与其他部位梗死无异.该病的临床表现复杂多样,2个经典的临床表现为胼胝体离断综合征和额叶型步态障碍,但临床上以偏瘫、单瘫、失用和智力障碍等多见.CT平扫阳性率低,MRI对胼胝体梗死具有较高的敏感性和特异性.结合病史和影像学检查,胼胝体梗死的诊断并不困难,但需与其他易累及胼胝体的疾病相鉴别.多数胼胝体梗死患者的预后良好.     

Transient Lesion in the Splenium of the Corpus Callosum in Acute Uncomplicated Falciparum Malaria

Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brain. We aimed to determine if 3 Tesla magnetic resonance imaging studies could detect evidence of cerebral abnormalities in these patients. Within 24 hours of admission, initial magnetic resonance imaging examinations found a lesion with restricted water diffusion in the mid-portion of the splenium of the corpus callosum of 4 (40%) of 10 male patients. The four patients who had a splenial lesion initially had evidence of more severe hemolysis and thrombocytopenia than the six patients who had no apparent abnormality. Repeat studies four weeks later found no residua of the lesions and resolution of the hematologic differences. These observations provide evidence for acute cerebral injury in the absence of severe or cerebral malaria.     

Reversible splenial lesion syndrome with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome caused by olanzapine

A 27‐year‐old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion‐weighted imaging. The neurological abnormalities disappeared along with improvement of metabolic derangements, and the follow‐up magnetic resonance imaging carried out on the 26th day of admission showed complete resolution of the lesions in the splenium of the corpus callosum. These clinical and radiological features are highly suggestive of clinically mild encephalitis/encephalopathy with a reversible splenial lesion. The first case of mild encephalitis/encephalopathy with a reversible splenial lesion caused by olanzapine‐induced hyperosmolar hyperglycemic state and neuroleptic malignant syndrome is reported.     

Tacrolimus administration to a patient with cyclosporine-induced encephalopathy after allogeneic bone marrow transplantation

A 25-year-old woman with severe aplastic anemia received allogeneic bone marrow transplantation from an HLA-identical sibling. Pretransplant conditioning comprised 3.6 Gy of total body irradiation and 200 mg/kg cyclophosphamide. Cyclosporine (CSP) and methotrexate were administered to prevent graft-versus-host disease (GVHD). The patient complained of severe headache soon after CSP administration on day-1. On day 3, convulsion developed and she lost consciousness for 15 min. CT and MRI demonstrated low density areas and high signals, respectively, in the frontal and parietooccipital lobes and splenium of the corpus callosum, suggesting brain edema probably induced by CSP. After immediate withdrawal of CSP, glycerol and prednisolone were instituted, and the patient's condition improved. Thereafter, she developed grade II acute GVHD. This was treated with tacrolimus, which produced no adverse effects including central nervous system (CNS) toxicity. This case illustrates that careful management of CNS disorders induced by CSP can be important in patients undergoing allogeneic bone marrow transplantation.