可逆性胼胝体压部病变综合征10例临床与影像特点分析

Clinical and imaging features of reversible splenial lesion syndrome

对山西省人民医院2014年8月至2016年8月诊治的10例可逆性胼胝体压部病变综合征（RESLES）患者的临床、影像学资料,进行回顾性研究分析.10例均为急性或亚急性起病,其中病毒性脑膜炎5例、化脓性脑膜炎2例、结核性脑膜炎1例、精神分裂症患者抗精神病药物治疗1例、癫痫患者苯妥英钠治疗1例;30岁以下者8例;头痛、发热、意识障碍、精神症状为主要特点,7例有前驱感染史,早期出现局灶性神经功能缺损.10例头部MRI检查均示胼胝体压部受累,T2WI呈高信号,T1WI呈低信号,DWI呈斑片状、类圆形、卵圆形或片状高信号,4例无明显强化.9例治疗后MRI示病灶消失,6例治疗1个月后随访未遗留神经功能缺损症状.提示RESLES常继发于感染性疾病,临床症状多为轻度脑炎或脑病的症状.

The clinical data and imaging findings of 10 patients with reversible splenial lesion syndrome （ RESLES ） admitted in Shanxi people′s Hospital from August 2014 to August 2016 were retrospectively analyzed .All 10 patients were acute or subacute onset , the etiology included viral meningitis （ n =5 ） , purulent meningitis （ n =2 ） , tuberculous meningitis （ n =1 ）; and one schizophrenic patient receiving antipsychotic drug and one epileptic patient treated with phenytoin .There were 8 patients under 30 years.The clinical manifestations included headache , fever, disorder of consciousness and mental symptoms.Seven patients had prodromic infections before the onset of the disease and focal neurological defects were present in the early stage .The initial MRI showed isolated splenium of corpus callosum （SCC） lesions with homogeneous hyperintense on T 2WI, hypointense on T1WI, and patchy, round, ovoid, schistose diffusion with hyperintense on DWI in all 10 cases;and there was no significant strengthening on enhanced MRI in 4 cases.The follow-up MRI showed that SCC abnormalities disappeared after treatment in 9 cases and the neurological symptoms disappeared after one-month follow up in 6 cases.The results indicate that RESLES is frequently secondary to infections , and presents the symptoms of mild encephalitis or encephalopathy .