急性孤立性胼胝体梗死的临床特点及预后分析

Clinical features and prognosis analysis of acute isolated corpus callosum infarction

目的探讨急性孤立性胼胝体梗死患者的临床特征及预后情况。方法回顾性选择2017年2月—2021年2月在北京老年医院神经内科与中日友好医院神经内科住院确诊的急性孤立性胼胝体梗死患者的临床资料和影像学资料。患者按照梗死部位、梗死大小和预后情况进行分组。其中,按照梗死部位分为单部位病变组与多部位病变组;按照梗死大小分为大病灶组与小病灶组;按照预后情况分为预后良好组和预后不良组。观察分析此类疾病的临床特点、病因学和预后情况。结果共纳入52例患者。其中,男32例(61.5%),女20例(38.5%),平均(65.4±7.1)岁。常见危险因素为高血压(44例,84.6%)、高脂血症(32例,61.5%)、糖尿病(28例,53.8%)。梗死部位以单部位病变组中的压部最常见(24例,46.2%)。绝大多数患者(92.3%)临床症状无特异性,出现胼胝体离断综合征4例(7.7%)。TOAST病因分型中以大动脉粥样硬化型(large-artery atherosclerosis,LAA)多见(25例,48.1%),其次为小动脉闭塞型(14例,26.9%),LAA责任血管病变以大脑后动脉P1/P2段(10例)与大脑前动脉A1/A2(9例)多见。单多部位病变组间及大小病灶组间病因学比较,差异均无统计学意义(P>0.05)。44例(84.6%)预后良好,8例(15.4%)预后不良。合并多重危险因素、病灶累及范围多且梗死面积大是影响患者预后的因素(P<0.05)。结论急性孤立性胼胝体梗死是少见类型的缺血性脑卒中,以压部受累最多见,其临床表现多无特异性,少数可表现为离断综合征。病因学以大LAA居多。此类患者整体预后良好,不良预后可能与合并多重危险因素及梗死范围广相关。

Objective To investigate the clinical features and prognosis of acute isolated corpus callosum infarction.Methods The clinical and imaging data of patients with acute isolated corpus callosum infarction diagnosed in the Department of Neurology of Beijing Geriatric Hospital and the Department of Neurology of China-Japan Friendship Hospital from February 2017 to February 2021 were retrospectively selected.Patients were divided into groups according to infarction location,infarction size and prognosis.According to the infarction location,the patients were divided into single-site lesion group and multi-site lesions group.According to the infarction size,the patients were divided into large lesion group and small lesion group.According to the prognosis,the patients were divided into good prognosis group and poor prognosis group.The clinical characteristics,etiology and prognosis of these diseases were observed and analyzed.Results A total of 52 patients were included.Among them,there were 32 males(61.5%)and 20 females(38.5%),with an average age of(65.4±7.1)years.The most common risk factors were hypertension(44 cases,84.6%),hyperlipidemia(32 cases,61.5%),and diabetes(28 cases,53.8%).The most common infarction site was splenium in the single-site lesion group(24 cases,46.2%).The vast majority of patients(92.3%)had nonspecific clinical symptoms,and only 4(7.7%)had corpus callosum disconnection syndrome.In the TOAST etiological classification,Large-artery atherosclerosis(LAA)was the most common(25 cases,48.1%),followed by small-artery occlusion(14 cases,26.9%),the responsible vascular lesions were the most common in the P1/P2 segment of posterior cerebral artery(10 cases)and the A1/A2 segment of anterior cerebral artery(9 cases).There was no significant difference in etiology between the groups with different infarction location and the groups with different infarction size(P>0.05).Forty-four cases(84.6%)had a good prognosis,and 8 cases(15.4%)had a poor prognosis.Combined with multiple risk factors,multiple involvement of lesions and large infarction size were associated with poor prognosis(P<0.05).Conclusions Acute isolated corpus callosum infarction is a rare type of ischemic stroke,with the most common involvement of splenium.Its clinical manifestations are mostly nonspecific,and a few may be manifested as disconnection syndrome.The etiology is mostly LAA,and the overall prognosis of such patients is good,and the poor prognosis may be related to the combination of multiple risk factors and the wide range of infarcts.