Clinical and MRI features of reversible splenial lesion syndrome in adults
-
摘要:
目的分析可逆性胼胝体压部病变综合征的临床表现和影像学表现。 方法回顾性搜集和整理3例可逆性胼胝体压部病变综合征成年患者的临床资料和影像学资料，分析临床表现和影像学表现，并文献复习。 结果2例患者为病毒性脑炎（病例1、2），1例患者为低血糖脑病（病例3），3例患者临床表现复杂多样，无特异性。头颅MRI共同表现为胼胝体压部类圆形或者“回旋镖”形稍长T1长T2信号影，FLAIR序列及DWI序列呈高信号，ADC呈低信号，增强扫描无强化，复查的病例病灶缩小或者消失。 结论可逆性胼胝体压部病变综合征是一种病因多样、临床表现无特异性、影像学特征表现为胼胝体压部可逆性异常信号，MRI检查可以达到早期发现、早期诊断及疗效评估的目的，经对病因合理治疗后通常预后良好。 Abstract:ObjectiveTo analyze the clinical and imaging manifestations of reversible corpus callosum pressure lesion syndrome. MethodsThe clinical and imaging of three cases with reversible splenial lesion syndrome in adults were retrospectively collected and organized. The clinical presentation and imaging manifestations were analyzed, and related literature was reviewed. ResultsTwo cases had viral encephalitis (case 1 and case 2), one case had hypoglycemic encephalopathy (case 3). The clinical manifestations of the three cases were complex and varied without any specificity. Cranial MRI together showed round-like or "boomerang" slightly, slight hypointensity on T1WI, slight hyperintensity on T2WI and FLAIR, significant hyperintensity on DWI and significant hypointensity on ADC. No obvious enhancement could be detected. The lesions in the re-examined cases reduced or disappeared. ConclusionReversible splenial lesion syndrome is one of the complex causes with no characteristic clinical symptoms, imaging manifestations of corpus callosum reversible lesions imaging syndrome. MRI can achieve the goal of early detection, early diagnosis, and assessment of therapeutic efficacy, and the prognosis is usually good after treatment of the etiology. -
Key words:
- encephalitis /
- corpus callosum /
- virus /
- magnetic resonance imaging
-
图 1 病例1入院时MRI表现
A~D: 横轴位胼胝体压部类圆形异常信号病灶, T1WI呈低信号, T2WI、FLAIR及DWI呈高信号（箭头示）; E: FLAIR双侧海马稍高信号（★号示）
Figure 1. MRI findings of case 1 on admission.
图 2 病例1治疗后MRI表现
A~D: 横轴位T1WI、T2WI、FLAIR及DWI胼胝体压部病变完全消失; E: FLAIR双侧海马信号正常.
Figure 2. MRI findings of case 1 on posttreatment.
图 3 例2入院时MRI表现
A~D: 横轴位胼胝体压部类圆形异常信号病灶, T1WI呈稍低信号, T2WI、FLAIR及DWI呈稍高信号（箭头示）; C、E~F: FLAIR双侧额叶、颞叶、岛叶及海马稍高信号（★号示）; G: MRI增强横轴位胼胝体病灶无强化（☆号示）
Figure 3. MRI findings of case 2 on admission.
图 4 病例3入院时CT和MRI表现
A: 横轴位CT平扫胼胝体压部无明显异常发现; B~E: 横轴位MRI平扫胼胝体压部“回旋镖”形异常信号病灶, T1WI呈稍低信号, T2WI、FLAIR及DWI呈高信号（箭头示）.
Figure 4. CT and MRI findings of case 3 on admission.
-
[1] 王德生, 苏庆杰, 龙发青, 等. 病灶弥漫的可逆性胼胝体压部病变综合征4例临床分析[J]. 中风与神经疾病杂志, 2017, 34(8): 734-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ201708016.htm [2] Kim SS, Chang KH, Kim ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity?[J]. AJNRAm J Neuroradiol, 1999, 20(1): 125-9. doi: 10.1097/00002093-199903000-00009 [3] Garcia-Monco JC, Cortina IE, Ferreira E, et al. Reversible splenial lesion syndrome (RESLES): what's in a name?[J]. J Neuroimaging, 2011, 21(2): e1-14. doi: 10.1111/j.1552-6569.2008.00279.x [4] 许晓金, 刘洁, 汪洪, 等. 急性高山病致可逆性胼胝体病变综合征的临床和MRI表现[J]. 临床放射学杂志, 2015, 34(8): 1325-8. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201508041.htm [5] Kashiwagi M, Tanabe T, Shimakawa S, et al. Clinico-radiological spectrum of reversible splenial lesions in children[J]. Brain Dev, 2014, 36(4): 330-6. doi: 10.1016/j.braindev.2013.05.007 [6] 邓明明, 邓方, 黄聪. 成人可逆性胼胝体压部病变综合征的MR、DWI分析及鉴别诊断[J]. 中国CT和MRI杂志, 2020, 18(9): 7-10. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR202009003.htm [7] 连立飞, 李杜娟, 黄丽娜, 等. 低血糖脑病的临床和神经影像学特点[J]. 临床神经病学杂志, 2010, 23(1): 21-3. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSJ201001012.htm [8] Xu W, Zhou Y, Jiang Y, et al. Clinical and magnetic resonance imaging features of reversible splenial lesion syndrome in adults: a small case series [J]. Eur Neurol, 2019, 82(4/5/6): 86-92. http://www.ncbi.nlm.nih.gov/pubmed/31927555 [9] 邢新博, 习伟, 王鑫坤, 等. 磁共振成像表现特征鉴别成人可逆性胼胝体压部病变综合征与胼胝体压部缺血性脑梗死[J]. 中国医学科学院学报, 2018, 40(2): 233-41. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201802014.htm [10] Mathew T, Badachi S, Sarma GR, et al. "Boomerang sign"in rickettsial encephalitis [J]. Neurol India, 2014, 62(3): 336-8. doi: 10.4103/0028-3886.137030 [11] Aksu B, Kurtcan S, Alkan A, et al. Reversible corpus callosum splenial lesion due to steroid therapy[J]. J Neuroimaging, 2015, 25(3): 501-4. doi: 10.1111/jon.12128 [12] Zhang S, Ma Y, Feng J. Clinicoradiological spectrum of reversible splenial lesion syndrome (RESLES) in adults: a retrospective study of a rare entity[J]. Medicine (Madr), 2015, 94(6): e512. doi: 10.1097/MD.0000000000000512 [13] 周勇, 殷洁. 成人急性播散性脑脊髓炎MRI特征分析[J]. 医学影像学杂志, 2019, 29(2): 198-201. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201902010.htm [14] 芮文婷, 姚振威. 多发性硬化的MRI研究进展[J]. 国际医学放射学杂志, 2018, 41(1): 27-31. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC201801006.htm [15] 刘静, 高博, 余永程, 等. 不同临床类型Marchiafava-Bignami病的MRI表现分析[J]. 临床放射学杂志, 2017, 36(1): 19-23. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201701006.htm -
下载:
点击查看大图
计量
- 文章访问数: 734
- HTML全文浏览量: 334
- PDF下载量: 13
- 被引次数: 0
