可逆性胼胝体压部病变综合征1例

2018-11-20 佚名 影像园

患者,男,14岁,发热头痛10天,呕吐1天。

【所属科室】

神经内科

【基本资料】

患者,男,14岁

【主诉】

发热头痛10天,呕吐1天。

治疗前

















治疗后

















【影像表现】

胼胝体压部见结节样稍长T1稍长T2信号,FLAIR呈稍高信号,DWI呈高信号。复查后异常信号消失。
 

可逆性胼胝体压部病变综合征
 
【病例小结】

可逆性胼胝体压部病变综合征(reversible splenial lesion syndrome,RESLES)是近几年才提出的一种新的具有典型特征的临床与影像学综合征。演变过程伴随胼胝体外(如脑干)病灶出现,提示预后不良。RESLES病因复杂多样,常被认为与病毒性脑炎、癫痫发作或药物戒断、代谢障碍及高原水肿等有关;其发病机制尚不明确,普遍认为可能与细胞毒性水肿有关,由于多种因素作用于胼胝体压部,影响脑血容量和水电解质平衡,从而导致出现暂时性局部能量代谢和离子转运异常,使水分子扩散受限,引起一过性髓鞘内细胞毒性水肿。RESLES常有感染病史,临床症状缺乏特异性,多表现为发热,伴头痛、呕吐、癫痫发作、意识模糊,好发于中青年,儿童也不少见。

RESLES患者MRI征象具有一定特征性,早期表现为胼胝体压部孤立性、边界清楚的病灶,多为圆形或椭圆形,少数为斑片状,以中央区对称分布为主,T1WI呈等信号或稍低信号,T2WI呈稍高信号,FLAIR为稍高信号,DWI呈明显高信号,信号较均匀,一般无坏死及囊变,病变周围无明显水肿,无占位效应。1个月内复查MRI胼胝体压部病变可基本消失或明显好转,表现为可逆性改变。DWI序列对病变显示敏感性高,能较早显示胼胝体压部的高信号病变,病理基础为细胞毒性水肿,水分子扩散受限所致。本例患者是青少年男性,有发烧病史,MRI上可见胼胝体压部结节样稍长T1、稍长T2信号,FLAIR呈稍高信号,DWI呈高信号。复查后异常信号消失。

RESLES需与急性播散性脑脊髓炎、胼胝体梗死、多发性硬化、胼胝体变性鉴别。急性播散性脑脊髓炎表现为脑实质内多发片状或斑点状异常信号,分布不对称,多位于广泛白质区,可累及基底节、丘脑、胼胝体等,最常累及胼胝体体部或膝部,而压部受累少见。胼胝体梗死患者年龄一般偏大,存在血管性病变等高危因素;单发罕见,一般伴随有其他部位的梗死,常见胼胝体压部单侧,容易累及体部,病变边缘模糊。胼胝体变性为一种罕见的、中老年男性多发疾病,多累及胼胝体体部及膝部,较少累及压部,以对称性分布为特征;急性期可有占位征象,增强扫描有强化,慢性期胼胝体多萎缩变薄,可有局灶性坏死灶。多发性硬化病灶多发,常位于胼胝体和透明隔交界面,表现为与侧脑室相连,由室管膜下呈放射状突入胼胝体内,致胼胝体边界凹凸不平,多见于中青年女性,单独累及胼胝体压部少见,且急性期增强扫描可见强化。

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    2018-11-25 12417917m85暂无昵称

    小孩先天胼胝体发育不良,可以医治不?

    0

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    2018-11-24 清风拂面

    谢谢分享学习

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