急性高山病致可逆性胼胝体病变综合征的临床和MRI表现

The Clinical and MRI of Reversible Splenial Lesion Syndrome in Acute Mountain Sickness

目的探讨急性高山病(AMS)所致可逆性胼胝体病变综合征(RESLES)患者的临床特征和影像学演变特点。方法对5例AMS患者的临床及治疗前、后的MRI资料进行回顾性分析。结果 5例中,3例伴有高原性肺水肿(HAPE),均有视乳头充血或水肿,其中血常规检查2例显示白细胞和嗜中性粒细胞百分比明显升高。治疗前5例头颅MRI均表现为胼胝体压部椭圆形、边界清楚的异常信号,T1WI呈稍低信号,T2WI呈稍高信号,液体衰减反转恢复(Flair)呈高信号,扩散加权成像(DWI)呈显著高信号,相应表观扩散系数(ADC)呈显著低信号;其中1例严重高原性脑水肿(HACE)患者胼胝体膝部、体部和深部白质区还可见对称性类似信号。治疗后所有患者临床症状消失,复查MRI显示原有病灶完全消失。结论 AMS所致RESLES的临床及和MRI表现有一定特征性,其病理生理机制还需要进一步的探究。

Objective To investigate the clinical and MRI of reversible splenial lesion syndrome（ RESLES） in acute mountain sickness. Methods The clinical data and MRI findings of five patients with acute mountain sickness before and after treatment were retrospectively analyzed. Results Three of five patients had pulmonary edema; they all had nipples congestion or edema. Blood routine examination showed white blood cells and neutrophil percentage increased in two patients. MRI before treatment revealed focal oval lesion located in the splenium of corpus callosum with clear boundary,slightly hypointensity on T1 WI,slightly hyperintensity on T2 WI,hyperintensity on Flair,significantly hyperintensity on DWI and significantly hypointensity on ADC. MRI of one patient with severe High Altitude Cerebral Edema（ HACE） demonstrated similar lesions in the genu and body of corpus callosum and the cerebral deep white matter. All patients completely recovered after treatment and the changes had resolved entirely with follow up MRI. Conclusion The clinical and MRI manifestations of RESLES in acute mountain sickness have certain characteristic,the pathophysiological mechanism of it need further exploration.