可逆性胼胝体压部病灶综合征二例报道并文献复习

Reversible Splenial Lesion Syndrome: Two Cases Report and Literature Review

目的：探讨可逆性胼胝体压部病灶综合征的临床特点、治疗及预后。方法报道沈阳军区总医院2例可逆性胼胝体压部病灶综合征患者的诊治过程，总结其临床特征并复习相关文献。结果患者1诊断为特发性低颅压；患者2诊断为流行性出血热伴低钠血症。2例患者胼胝体压部病灶在颅脑 MRI 上均表现为直径1～2 cm 的局限性卵圆形病灶，位于胼胝体压部的中央，胼胝体其他部分不受累及，T1信号轻度减低，T2和液体衰减反转恢复序列（FLAIR）呈高信号，弥散加权成像（DWI）呈高信号，表观扩散系数（ADC）降低。患者1亦伴有硬膜下积液及硬脑膜强化等低颅压的 MRI 典型表现，而胼胝体病灶无强化。患者1病灶在首次 MRI 检查后3个月复查消失，患者2病灶在首次 MRI 检查后12 d 复查消失。2例患者经支持、对症及针对性治疗临床痊愈。结论可逆性胼胝体压部病灶综合征以颅脑 MRI 发现胼胝体压部可逆性病灶为特点，临床症状轻微，预后良好，病因及发病机制尚不清楚。

Objective To investigate the clinical features,treatment,prognosis of reversible splenial lesion syndrome （RESLES）. Methods The diagnosis and treatment process of two patients with RESLES in General Hospital of Shenyang Military Region was reported. The clinical features of RESLES were summarized and the related literatures were reviewed. Results Patient 1 was diagnosed as spontaneous intracranial hypotension;patient 2 was diagnosed as epidemic hemorrhagic fever with hyponatremia. According to brain MRI,the splenial lesions of them were both manifested as oval lesions with 1 - 2 cm in diameter,and the lesions were located in the center of the splenium of corpus callosum,the other segments of corpus callosum were not involved. On MRI they were characterized by minimal signal reduction on T1 sequence,with high signal intensity on T2 and FLAIR sequences,DWI showed high signal intensity,apparent diffusion coefficient（ADC）values decreased. Case 1 also had typical MRI manifestation of intracranial hypotension,such as diffuse dural enhancement and subdural effusion,lesions of corpus callosum showed no enhancement. 3 months after first MRI examination,the lesions of patient 1 disappeared;12 days after first MRI examination,the lesions of patient 2 disappeared. The two patients completely recovered after symptomatic, supportive and targeted therapy. Conclusion RESLES is characterized by the brain MRI finding of a reversible lesion in the splenium of corpus callosum. Relatively mild symptoms are common in RESLES. The prognosis is favorable in most cases. The etiology and pathogenesis of RESLES are unclear.