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.

Clinical diagnosis and treatment of simple acute infarction of corpus callosum and literature review

Objective To explore the clinical characteristics of simple acute infarction of the corpus callosum.Methods We retrospectively analyzed 16 patients who were diagnosed as simple acute infarction of the corpus callosum by magnetic resonance imaging(MRI)in 2694 continuous patients with acute stroke in Fuxing hospital from January 2010 to December 2018.The data of patients were recorded,including gender,age,the risk factors of stroke,imaging characteristics,the location of the corpus callosum infarction,the number of intracranial and extracranial vascular stenosis,and the degree of stenosis in the supplying artery of the corpus callosum.The changes of National Institutes of Health Stroke Scale(NIHSS)scores before and after treatment were evaluated.The outpatient followup was performed six months after discharge.Among the 16 patients with simple acute infarction of the corpus callosum,10 cases were male,and 6 cases were female.Their age ranged from 46 to 82 years,with an average of(69.4±2.3)years.There were 14 patients coexisting with hypertension,12 patients with type 2 diabetes mellitus,11 patients with hyperlipidemia,5 patients with coronary heart disease(including 1 patient with atrial fibrillation),4 patients with hyperhomocysteinemia,6 patients with cerebral infarction,1 patient with cerebral hemorrhage,8 patients with smoking history,and 4 patients with drinking history.Results Simple acute infarction of corpus callosum with multiple risk factors of atherosclerosis accounted for 0.6%(16/2694)of the incidence of acute cerebral infarction.The most important risk factor was hypertension.Among 16 patients with simple acute infarction of the corpus callosum,there was typical of lesion vessel located in the anterior cerebral artery stenosis(14 cases),middle cerebral artery stenosis(10 cases),and internal carotid artery stenosis(8 cases).The most lesion sites located in the knee and body of the corpus callosum(12 cases),especially unilateral damage(15 cases involving the unilateral corpus callosum).The main clinical symptoms were limb paralysis(13 cases),cognitive impairment(10 cases),and mental behavior abnormality(8 cases),while hemianopsia(2 cases),hemianopsia(1 case),and ataxia(3 cases)were rare,which could be improved significantly after treatment in most of the cases.The NIHSS scores before and after treatment were(4.3±1.5)and(2.9±1.2),respectively.The difference before and after treatment was statistically significant(t=3.914,P=0.023).The results of 6 months followup after discharge showed that 2 cases were basic recovery,13 cases were significantly improved,1 case had no change,and no death.Conclusions Simple acute infarction of corpus callosum has a low incidence,which is closely related to the stenosis degree of multiple intracranial arteries.The anterior circulation vessels may be more susceptible.The clinical symptoms are complex and varied,especially the physical strength,cognitive function,and psychobehavioral manifestations of the patients.Generally,the outcome of prognosis is favorable.