急性高原病相关的可逆性胼胝体压部病变综合征的临床症状及MRI表现

Clinical symptoms and MRI findings of reversible splenial lesion syndrome associated with acute mountain sickness

目的探讨急性高原病相关的可逆性胼胝体压部病变综合征(RESLES)的临床症状及磁共振成像(MRI)表现。方法回顾性分析6例经临床及影像学证实的急性高原病相关RESLES病例的临床资料,探讨患者的一般情况、临床表现、实验室检查结果、治疗情况、疾病转归、预后情况及MRI表现。结果 6例患者出现不同程度的头痛、头晕、耳鸣、视物模糊等症状,部分患者出现视觉异常,其中2例伴有高原性肺水肿。治疗前,头颅MRI表现为胼胝体压部(SCC)异常信号改变,呈边界清晰的圆形或椭圆形,1例累及胼胝体膝部及深部脑白质,呈对称分布,扩散加权成像(DWI)呈高信号、表观弥散系数(ADC)序列呈低信号。经对症治疗后临床症状均消失,大多数患者在10 d左右临床症状缓解,复查MRI SCC异常信号消失,所有病例均未出现后遗症。结论急性高原病相关RESLES的临床表现多样,应结合特殊的高原环境暴露史及相关症状进行诊断,该病有自限性,预后良好,MRI表现为病灶可逆。

Objective To investigate the clinical symptoms and magnetic resonance imaging(MRI)findings of reversible splenial lesion syndrome(RESLES)associated with acute mountain sickness.Methods The clinical data of 6 patients with RESLES associated with acute mountain sickness confirmed by clinical examination and imaging were analyzed retrospectively.The general situation,clinical manifestations,laboratory examination results,treatment,disease outcome,prognosis and MRI findings of the patients were discussed.Results Six patients had different degrees of headache,dizziness,tinnitus,blurred vision and other symptoms,some patients had visual abnormalities,including 2 patients with high altitude pulmonary edema.Before treatment,head MRI showed abnormal signal changes in the splenium of corpus callosum(SCC),which was round or oval with clear boundary.One case involved the knees and deep white matter of the corpus callosum,which was symmetrically distributed.Diffusion weighted imaging(DWI)showed high signal and apparent diffusion coefficient(ADC)sequence showed low signal.After symptomatic treatment,the clinical symptoms disappeared,most of the patients relieved about 10 d,and the abnormal signal of SCC disappeared after MRI reexamination.No sequelae occurred in all cases.Conclusion The clinical manifestations of RESLES associated with acute mountain sickness are diverse,and the diagnosis should be combined with the special exposure history to altitude environment and related symptoms.The disease has self limitation,good prognosis and reversible lesions on MRI.