癫痫后可逆性脑改变2例并文献分析

Reversible cranial lesions after epilepsy--report of 2 cases and literature review

目的报道2例癫痫患者在癫痫发作后出现的可逆性脑改变,探讨其MRI改变规律和可能的发生机制。方法患者1为28岁男性,约8.5年前(2007年9月15日)曾出现左下肢一过性抽动,次日在左下肢抽动后迅速出现四肢强直伴意识丧失。患者2为20岁女性,约9年前(2007年1月)反复发作四肢抽动伴意识障碍,7.5年前(2008年7月)间断出现精神行为异常。2例经抗癫痫药物治疗后均能有效控制发作,神经系统检查和辅助检查均未发现症状性癫痫的诊断依据。患者1在癫痫发作后第3天(2007年9月18日)、1个月(2007年10月15日)和3个月(2007年12月20日)进行了头颅MRI检查。患者2在首次癫痫发作后1周(2007年1月17日)、1.5年(2008年7月)、约2年(2009年2月)及约3年(2010年2月)时进行了头颅MRI检查。结果患者1在癫痫发作后第3天(2007年9月18日)头颅MRI出现双侧额叶以及左枕叶皮质、皮质下多发长T1、长T2信号和弥散加权成像高信号;发作后1个月(2007年10月15日)异常信号范围明显缩小,3个月(2007年12月20日)异常信号近乎消失。患者2在首次癫痫发作后1周(2007年1月17日)的头颅MRI未见异常,发作后1.5年(2008年7月)头颅MRI示右侧颞叶皮质长T2信号,发作后约2年(2009年2月)和约3年(2010年2月)复查头颅MRI均未见异常。结论癫痫发作可以造成可逆性的单个或多灶性脑损害,病灶出现在额叶、枕叶和颞叶,以皮质受累为主。重复MRI检查有利于诊断和避免对此类病灶的过度治疗。

Objective To report the reversible postictal cranial MRI changes in two epileptic patients and to discuss the pathogenesis of the lesions. Methods The first 28 years old male patient suffered from a generalized seizure secondary to the partialized attack after fever and headache 8. 5year ago. The second female patient,20 years old,complained about episodes of generalized seizure for 9 years,psychomotor seizure for 7. 5 years. The seizures stopped after antiepileptic drug treatment in both patients and the diagnosis of secondary epilepsy was ruled out based on the thorough physical examinations and laboratory tests. We evaluated the first patient’s MRI on the third day,1st and 3rd month after seizure. We also reviewed the second patient’s MRI which was performed 1week,1. 5 years,2 and 3 years respectively after the first attack. Results The first patient was revealed multiple,long T1,long T2 signals in the cortical and subcortical areas of bilateral frontal lobes and right occipital lobe on 3rd day after the attack. The MRI lesions were found to elapse both in size and number in the following three months. In the second patient,cranial MRI showed long T2 signal in the right temporal lobe 1. 5 years after the first attack. The further MRI inspections were unrevealing. Conclusion The reversible intracranial lesions could appear in epileptic patients after once or more attacks. These lesions,whether single or multiple,tend to locate in the area of frontal,occipital and temporal lobe. The dynamic MRI inspection can help to diagnose and avoid unnecessary examinations.