107例伴有胼胝体压部可逆性病灶的临床症状轻微的脑炎/脑病临床分析  

Clinical study of 107 patients with clinically mild encephalitis/encephalopathy accompanied by a reversible splenium lesion of corpus callosum

作　　者：张扬[1] 陈为安[1] 毕涌[1] 张旭[1] 

机构地区：[1]浙江省温州医科大学附属第一医院神经内科,325000

出　　处：《中华全科医学》2014年第6期875-878,共4页Chinese Journal of General Practice

摘　　要：目的探讨伴有胼胝体压部可逆性病灶的临床症状轻微的脑炎/脑病(MERS)的病因、临床特点、实验室检查、磁共振影像学特征、脑电图特点、治疗、预后及发病机制。方法通过检索中国期刊全文数据库、中国科技期刊万方数据库、Pubmed及Web of science,以2003年11月—2013年11月为限,共检索到中文文献5篇(12例),英文文献29篇(94例),结合温州医科大学附属第一医院神经内科诊治1例,对共107例伴有胼胝体压部可逆性病灶的临床症状轻微的脑炎/脑病患者的临床资料进行回顾性综合分析。结果本病以日本儿童多见(88/107),病因多种多样,以流感病毒A/B(20/107)、轮状病毒(4/107)、腺病毒(4/107)感染多见,患者表现为发热、头痛、呕吐、行为异常、谵妄、短暂性意识障碍及痫性发作,可出现低钠血症(37/107),头颅MRI检查发现孤立的胼胝体压部有可逆性的T2、FLAIR及DWI高信号病灶,部分病例可出现胼胝体外部位DWI高信号病灶,脑电图检查46例患者出现慢波,经抗病毒、抗菌或激素、对症治疗,大多数患者1周内临床症状完全缓解。结论伴有胼胝体压部可逆性病灶的临床症状轻微的脑炎/脑病以头颅MRI上发现胼胝体压部可逆性孤立病灶为特点,无增强效应,病灶在短时间消失,临床症状轻微,预后良好,其发病机制尚不清楚。Objective To explore the etiology and pathophysiology, clinical characteristics,laboratory data, magnetic reso- nance imaging（MRI） and electroencephalography（EEG） findings, therapy, and prognosis of 107 patients with clinically mild encephalitis/eneephalopathy accompanied by a reversible splenium lesion of the corpus callosum （MERS）. Methods The patients with MERS were screened from ＂China National Knowledge Infrastructure＂, ＂Wanfang data＂, ＂Pubmed＂ and ＂Web of Science＂ databases for analysis between November 1,2003 and November 1,2013. We investiga- ted their clinicoradiological and pathological features. Results MERS is relatively commom in children or young adults from Japan. The etiological factors include influenza viruses A/B （20/107） , rotavirus （4/107 ） and adenoviruses infections （4/107）. The prodromal symptoms include fever, headache, vomiting. The most common neurological symptoms is deliri- ous behavior, consciousness disturbance and seizures, most of which completely recover within a month. Hyponatremia is common in patients with MERS. Magnetic resonance imaging showed a solitary lesion of the splenium of the corpus callo- sum that was most prominently visualized on diffusion-weighted imaging（ T2, FLAIR and diffusion-weighted imaging）, and slow waves were observed on EEG in 46 patients. After antiviral, antibacterial, or by hormones, symptomatic treatment, the clinical symptoms of most patients were relieved within 1 week. Conclusion MRI showed high-signal-intensity lesions on T2, FLAIR, and diffusion-weighted imaging patients with MERS. The images were not enhanced by gadolinium, exhibiting rapid and complete resolution of the lesion. The clinical symptoms are of mild and the prognosis of patients is good. Its pathophysiology mechanism remains unclear.

关 键 词：临床症状轻微脑炎 可逆性胼胝体病灶 磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]