孤立性胼胝体压部梗死与可逆性胼胝体压部病变综合征的临床及影像学特点分析

Clinical and imaging features of isolated infarction of the splenium of the corpus callosum and reversible splenial lesion syndrome

目的比较孤立性胼胝体压部梗死与可逆性胼胝体压部病变综合征(RESLES)患者的临床及磁共振成像(MRI)特点。方法回顾性分析北京老年医院神经内科从2018年12月至2022年11月12例临床诊断为孤立性胼胝体压部脑梗死患者13例及12例RESLES患者的临床资料、影像学特点及随访结果。结果脑梗死组患者年龄大于RESLES组[脑梗死组(67.6±9.2)岁,RESLES组(23.2±17.8)岁],脑梗死组患者均合并1~3个脑血管病危险因素。两组患者影像学均表现为T2加权成像(T2WI)高信号、液体衰减反转恢复(FLAIR)序列高信号、扩散加权成像(DWI)序列高信号,T1加权成像(T1WI)及表观扩散系数(ADC)序列低信号。脑梗死组患者的梗死部位多位于偏侧(1例病灶位于双侧胼胝体,12例病灶位于偏侧),病灶呈点片状;其中,9例患者完成随访,随访期间T1WI、T2WI、FLAIR序列及ADC序列的病灶不消失,1例患者卒中复发。而RESLES组患者的病灶均位于胼胝体中线部位,病灶呈圆形、椭圆形及回旋镖形;所有患者均完成随访,随访期间病灶均表现为减淡或消失。结论脑梗死和RESLES均可导致孤立性胼胝体压部病变,两组疾病患者的危险因素,影像学病灶位置、形态及随访期病灶特点的改变均有助于鉴别诊断。

Objective To compare the clinical characteristics and magnetic resonance imaging(MRI)features of isolated infarction of the splenium of the corpus callosum and reversible splenial lesion syndrome(RESLES).Methods Clinical and imaging findings of 12 patients with a clinical diagnosis of isolated infarction of splenium of the corpus callosum and 13 patients with RESLES from Deportment of Neurology in Beijing Geriatric Hospital between December 2018 and November 2022 and follow-up results were retrospectively analyzed.Results The patients with isolated infarction of SCC were older than the patients with RESLES(age of patients with isolated infarction of SCC:67.6±9.2,age of patients with RESLES:23.2±17.8).All patients with infarction had one to three risk factors for cerebrovascular diseases.Both two groups showed hyperintense lesions on T2WI,fluid-attenuated inversion recovery(FLAIR)and diffusion-weighted imaging(DWI),and hyperintense lesions on T1WI and a low apparent diffusion coefficient(ADC).Most SCC infarctions occurred unilaterally(one case with bilateral lesions and 12 cases with unilateral lesions),with irregular dot-like or patchy lesions.Nine patients in the infarction group completed the follow-up,during which the lesions did not disappear on the T1WI,T2WI,FLAIR and ADC sequence.One patient in this group had a recurrent stroke.In the RESLES group,all lesions were located on the midline of SCC,with round,oval or boomerang-shaped lesions.All patients in the RESLES group completed the follow-up,during which lesions either shrank or disappeared.Conclusions Infarction and RESLES can both result in SCC lesions.The existence of risk factors and imaging features about the locations of lesions,the morphology,and lesion changes during follow-up are helpful in the differential diagnosis.