可逆性胼胝体压部孤立病灶综合征:13例临床及影像学研究

Clinical and neuroradiological manifestations of reversible splenial lesion syndrome: a report of 13 cases

目的总结可逆性胼胝体压部病灶综合征的头磁共振影像（MRI）、临床特点、治疗和预后。方法回顾性分析13例伴有胼胝体压部可逆性病灶综合征患者的临床表现和磁共振特点。结果 13例患者中,男11例,女2例,年龄13~58岁,伴发疾病分别为自发性低颅压综合征1例,流行性出血热1例,癫痫撤药1例,垂体危象合并干燥综合征1例,Still病1例,病毒性脑（膜）炎8例。首次MRI检查距发病时间2~39d。病灶均位于胼胝体压部的中央,胼胝体其他部分不受累及,信号特点为FLAIR和T2呈高信号,T1信号轻度减低,DWI高信号,ADC值减低。其中3例行增强扫描,显示病灶无强化。形态上呈卵圆形或回旋镖形。13例患者在首次MRI检查后6~30d复查,显示病灶消失或信号明显减弱,且经对症治疗均达临床痊愈或明显好转。结论可逆性胼胝体压部病灶综合征以头颅MRI发现胼胝体压部中央可逆性病灶为特点,临床症状多样,预后相对良好,发病机制尚不清楚。

Objective To summarize the clinical and MRI imaging features, treatment and prognosis of reversible splenial lesion syndrome（RESLES）. Methods The clinical manifestation and MRI imaging appearances of 13 RESLES patients were retrospectively evaluated and the pertinent literatures of RESLES were reviewed. Results Of the 13 cases（11 males and 2 female, aged from 13 to 58 years）, 1 was complicated with spontaneous intracranial hypotension syndrome, 1 with epidemic hemorrhagic fever, 1 with antiepileptic drug withdraw, 1 with pituitary crisis combining Sjogren syndrome, 1 with still disease, and 8 cases were complicated with viral encephalitis（meningoencephalitis）. The first MRI imaging was performed from 2 to 39 days after onset. All the lesions were measured about 1-2cm, located in the central area and involved no other part of corpus callosum. They were characterized by high signal intensity on FLAIR and T2 sequences, with mild signal reduction on T1 sequence, and hyperintensity on DWI with low apparent diffusion coefficient（ADC） values. The lesions formed as ovoid and boomerang. Following intravenous injection of contrast medium in 3 cases, no enhancement was found in the splenial lesions. All the patients completely recovered or obviously improved after appropriate treatments. The splenial lesions disappeared or obviously weakened on the follow-up MRI imaging, ranging from 6 to 30 days after first MRI imaging. Conclusions RESLES is characterized by the MRI finding as a reversible lesion with transiently reduced diffusion in the splenium of corpus callosum. Symptoms of RESLES are various, the outcome is favorable in most cases, and the etiology and pathogenesis of RESLES are still unclear.