MRI检查癫痫发作为首要症状的可逆性胼胝体压部病变综合征的神经影像特征

Neuroimaging Features of Reversible Splenial Lesion Syndrome with Epilepsy as the Initial Symptom Based on MRI

目的分析以癫痫发作为首要症状的可逆性胼胝体压部病变综合征(RESLES)核磁共振(MRI)影像学特征。方法回顾性分析以癫痫发作为首要症状的RESLES患儿临床特点及MRI影像学特征。结果实验室检查结果提示11例患儿诊断为低钠血症,谷丙转氨酶/谷草转氨酶轻微升高6例,10例患儿出现轻微语言障碍;患儿入院时MRI检查均提示胼胝体压部局限性、孤立性、边界清楚病灶,形状多呈圆形或椭圆形;T_(1)WI呈等或稍低信号,T_(2)WI呈等或稍高信号,FLAIR呈稍高信号,DWI呈稍高信号,ADC呈低信号,ADC值范围:0.24~0.79×10^(-3)mm^(2)/s,增强扫描均无强化,病灶无坏死及囊变,周围未出现明显水肿及占位效应;经对症支持治疗后,患儿临床症状均在1~2周内得以好转并出院,出院后复查MRI发现,27例患儿DWI高信号均完全消失,4例胼胝体压部DWI高信号病灶范围较首次检查时明显缩小,信号明显减弱。结论以癫痫发作为主要临床表现的RESLES患儿头颅MRI表现与神经毒性反应相似,MRI检查可见SCC中病灶多呈圆形或椭圆形,T_(1)WI呈等或稍低信号,T_(2)WI呈等或稍高信号,FLAIR及DWI呈稍高信号,ADC呈低信号,以上异常MRI信号均可在短期内消失或减弱。

Objective To investigate the neuroimaging features of reversible splenial lesion syndrome(RESLES)with epilepsy as the initial symptom based on magnetic resonance imaging(MRI).Methods Clinical characteristics and MRI imaging features of RESLES children with epilepsy as the initial symptom were retrospectively analyzed.Results The results of laboratory examination indicated that 11 children were diagnosed with hyponatremia,6 children had slight elevation of alanine aminotransferase/alanine aminotransferase,and 10 children had mild language disorder.On admission,MRI examination of all the childrenshowed reversible splenial lesions of corpus callosum were localized,isolated and well-defined,most of which were round or oval in shape.MRI showed slight hypointensity on T_(1)WI,slight hyperintensity on T_(2)WI and FLAIR,significant hyperintensity on DWI and significant hypointensity on ADC.ADC values were 0.24~0.79×10^(-3)mm^(2)/s.No obvious enhancement,no necrosis and cystic change in the lesioncould be detected,with no obvious edema and mass effect.After symptomatic support treatment,the children’s clinical symptoms were improved and discharged within 1-2 weeks.After discharge,MRI review found complete lesion disappearance in all the 27 children,and the range of DWI high signal lesions in corpus callosum of 4 patients was significantly reduced and the signal was significantly weakened compared with that in the first examination.Conclusion MRI manifestations ofRESLES with epilepsy as the initial symptom are similar to those of nerve toxicity,and most lesions are round or oval in shape,slight hypointensity on T_(1)WI,slight hyperintensity on T_(2)WI and FLAIR,significant hyperintensity on DWI and significant hypointensity on ADC,while the above abnormal MRI signal can be disappeared or reduced in the a short time.