以脑卒中样发病的可逆性胼胝体压部病变综合征Ⅱ型二例

Reversible splenial lesion syndrome typeⅡwith stroke⁃like onset:two cases report

目的报告2例以脑卒中样发病的可逆性胼胝体压部病变综合征(RESLES)Ⅱ型病例,结合文献总结其发病特征及影像学表现,以提高临床医师对RESLES尤其是RESLESⅡ型的认识。方法与结果2例青年男性患者均为广西壮族自治区人民医院2018年7月至2021年6月收治的RESLESⅡ型病例,以言语不清、肢体无力等脑卒中样发作发病,病程中伴头晕、恶心等急性颅内压升高症状;既往有烟酒史或代谢紊乱;体格检查和各项实验室指标无明显异常,头部MRI显示胼胝体压部及周围白质呈对称性、可逆性长T_(1)、长T_(2)和DWI高信号;经抗炎症、改善循环和营养神经等对症治疗后影像学检查可见病灶消退,症状与体征完全缓解。随访期间病情无复发,恢复日常生活与工作,RESLESⅡ型诊断明确。结论对于脑卒中样发作且不存在动脉粥样硬化危险因素的青年患者,应考虑RESLES可能,可通过MRI特别是DWI序列快速明确诊断。

Objective To report 2 cases of reversible splenial lesion syndrome(RESLES)typeⅡpresented with stroke⁃like attacks,and summarize the pathogenesis and imaging findings based on the literature to improve clinicians'understanding of RESLES,especially typeⅡ.Methods and Results The 2 young male patients were both RESLES typeⅡcases admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from July 2018 to June 2021,presented with stroke⁃like attacks such as slurred speech and limb weakness,and developed symptoms of acute intracranial hypertension such as dizziness,nausea,and so on.During the course of the disease,both of them had a history of alcohol consumption and smoking or metabolic disorders,physical examination and laboratory indicators were unremarkable,and head MRI examination showed symmetrical and reversible long T_(1),long T_(2) and DWI hyperintensity lesions in the splenium of corpus callosum and surrounding white matter.After symptomatic treatment such as anti⁃inflammatory,improving blood circulation,and nourishing nerves,imaging findings showed the lesions subsided,and the symptoms and signs were completely relieved.There was no recurrence of the disease during the follow⁃up period,the patients have returned to their daily life and work,and the diagnosis of RESLES typeⅡwas clear.Conclusions For young patients with stroke⁃like attacks and no risk factors for atherosclerosis,the possibility of RESLES should be considered,and MRI especially DWI can quickly confirm the diagnosis.