可逆性胼胝体压部病变的临床分析

Clinical Analysis on Reversible Splenial Lesions of the Corpus Callosum

目的探讨可逆性胼胝体压部病变的临床特征和致病机制。方法总结Pubmed和Springer数据库中2000年1月1日-2011年8月1日报道的年龄>6岁的可逆性胼胝体压部病变患者的临床特征,分析该病可能的致病机制。结果 14例患者中男7例,女7例;年龄(27.4±15.6)岁,最小7岁,最大58岁;病因为发热、疫苗接种、感染、癫痫发作、接受抗癫痫药物或突然停用抗癫痫药治疗、接受四环素或氟尿嘧啶治疗、营养不良、慢性酒精消耗,临床症状出现率50%,为视幻觉、错觉、定向功能障碍、意识模糊、嗜睡、共济失调步态、急性尿潴留;可逆性胼胝体病变持续时间为(20.6±14.5)d,最短2 d,最长50 d,影像学特征是T1加权成像低或等信号,T2加权成像、弥散加权成像高信号,表观弥散系数成像低信号,水抑制成像常无明显结构或信号异常发现,T1-钆对比剂增强成像无病灶强化。结论可逆性胼胝体压部病变病因多样,临床表现复杂,致病机制可能主要为低钠血症、低血糖、精氨酸血管加压素功能紊乱、感染或药物毒性等导致胼胝体压部细胞毒性水肿。

Objective To evaluate the clinical characteristics and pathophysiological mechanism of reversible splenial lesions of the corpus callosum（RSLCC）.Methods The patients with RSLCC and older than 6 years were screened from ＂Pubmed＂ and ＂Springer＂ databases for analysis between January 1,2000 and August 1,2011.We analyzed their clinical characteristics and the pathophysiological mechanisms.Results The mean age of 14 RSLCC patients,including 7 males and 7 females,were（27.4 ± 15.6） years,ranging from 7 to 58 years.Causes of the disease in these patients were fever,vaccination injection,infection,seizure,anti-epileptic drug or acute withdrawal of antiepileptic drug,tetracycline therapy,5-fluorouracil treatment,malnutrition,chronic alcoholism.The appearance rate of clinical representations was 50%,which included visual hallucinations,delusion,disorientation,confusion,gait ataxia,acute urinary retention.The mean interval to disappearance of RSLCC was（20.6 ± 14.5）days,ranging from 2 to 50 days.The magnetic resonance imaging of abnormality in RSLCC were hypo-or isointense on T1 weight imaging（T1WI） without Gd-enhancement,hyperintense on T2 weight imaging（T2WI） and diffusion-weighted imaging（DWI） with or without fluid-attenuated inversion recovery（FLAIR）,hypointense on apparent diffusion coefficient（ADC）.Conclusions The causes of RSLCC are diverse.The representations of RSLCC are complicated.The pathophysiological mechanism is cytotoxic edema probably caused by hyponatremia,hypoglycemia,dysfunction of arginine-vasopressin or infectious and toxic agents to splenial of the corpus callosum.