累及胼胝体的急性播散性脑脊髓炎临床及影像特点  

Clinical features and neuroimaging findings of 12 patients with acute disseminated encephalomyelitis involved in corpus cailusum

作　　者：刘建国[1] 乔文颖[3] 董秦雯[1] 张海玲[1] 郑奎宏 钱海蓉[1] 戚晓昆[1] 

机构地区：[1]海军总医院神经内科,北京100048 [2]海军总医院医学影像中心,北京100048 [3]北京朝阳医院京西院区急诊科

出　　处：《中华医学杂志》2012年第43期3036-3041,共6页National Medical Journal of China

基　　金：首都医学发展科研基金（2009-2054）

摘　　要：目的总结胼胝体受累的急性播散性脑脊髓炎（ADEM）的临床及影像特点，以提高对这种特殊类型的ADEM的临床甄别能力。方法对2010-2012年就诊于海军总医院的12例胼胝体受累的ADEM患者[男9例，女3例，平均年龄（31±14）岁，10-54岁]的临床、影像学资料，进行回顾性分析，采用SPSS18．0软件包对所有数据进行统计学分析。结果（1）均为急性或亚急性起病，发病前疫苗接种史2例、上呼吸道感染或腹泻等感染史5例。（2）起病时发热6例、头痛4例、行走不稳2例，排尿障碍、淡漠、谵妄各1例。（3）临床以脑实质损害症候较为突出：记忆力下降9例，谵妄5例，嗜睡4例；另外，排尿障碍9例，双下肢截瘫4例，行走不稳5例。（4）颅压增高者4例，白细胞增多3例，蛋白增高7例；寡克隆带均为阴性。（5）6例脑内仅胼胝体受累（其中2例合并脊髓受累），胼胝体病灶以压部最为多见（9例），体部受累5例，膝部受累4例，均累及双侧胼胝体；合并脑干、小脑受累各4例；脊髓受累6例。（6）头颅MRI显示：12例T：加权像呈高信号，但显示模糊，其中2例T：加权像病变不显著，需借助DWI或T2FLAIR检出病灶；4／6例增强MRI可见显著强化，呈均匀片状；脊髓MRl显示：6例合并脊髓病灶，且累及4～8个节段，病灶多发且不连续，2例呈少许细线状强化。（7）多数病例在疾病初期诊断困难，曾被误诊为其他疾病：病毒性脑炎5例、结核性脑膜脑炎1例、颅内肿瘤2例、1例因尿潴留收住泌尿外科。结论胼胝体受累的ADEM临床、影像有其自身特点：（1）成年男性可能好发，儿童相对较少，并以发热、头痛、谵妄、嗜睡、记忆力下降、行走不稳、排尿障碍为主要特点；（2）影像学病灶可颅内多发，也可仅见于胼胝体，以胼胝体压部多见，头颅MRI多呈片状长T2信号，DWI与T2FLAIR的阳性率�Objective To summarize the clinical features and neuroimaging findings of the patients with acute disseminated encephalomyelitis （ADEM） involved in corpus callosum （CC） so as to distinguish it from other diseases. Methods A total of 12 ADEM patients with the involvement of CC during the period of 2010 -2012 were recruited. There were 9 males and 3 females with a mean age of 31 ± 14 years （range： 10 - 54）. Their clinical and neuroimaging features were retrospectively reviewed and all data analyzed by SPSS 18.0. Results （ 1 ） All of them had an acute or subacute onset. Two patients had a history of vaccination and 5 suffered upper respiratory tract infection or diarrhea. （ 2 ） The presenting symptoms included fever （ n = 5 ）,headache （ n = 4）, unsteady gait （ n = 2）, urinary retention （ n = 1 ）, indifference （ n = 1 ） and delirium （ n = 1 ）. （ 3 ） The main clinical symptoms included memory loss （ n = 9 ）, delirium （ n = 5 ）, somnolence （ n = 4）, urinary retention （ n = 9）, paraplegia （ n = 9） and unsteady gait （ n = 5 ）. （4） The examinations of cerebrospinal fluid （CSF） revealed increased intracranial pressure （ n = 4 ）, leucocytosis （ n = 3 ） and increased protein （ n = 7） of 7 cases. All oligoclonal bands were negative. （5） The lesions were involved in bilateral CCs in 12 patients. Among them, splenium was the most commonly affected （n = 9 ）, secondly stem （n = 5 ） and lastly genu （n = d）. For 6 patients, the intracranial lesions were all in their CCs. And among them, 2 cases were involved in spinal cord. Except for CC, there were other focal lesions in brain stem and cerebellum （n = 4） and spinal cord （n = 6）. （6）On magnetic resonance imaging （MRI）, all cases showed long T2 signal intensity with blurred images. And among them, 2 cases＇ lesions in brain were discerned only by diffuse weighing imaging （DWI） or T2 fast fluid-attenuated inversion recovery （T2FLAIR） instead of T2- w

关 键 词：胼胝体 急性播散性脑脊髓炎 可逆性胼胝体病变综合征 病毒性脑炎 结 核性脑膜脑炎 

分 类 号：R744.3[医药卫生—神经病学与精神病学]