伴胼胝体压部可逆性病变的轻度脑炎／脑病11例临床及影像学表现  

Clinical and imaging findings of 11 patients with mild encephalitis/encephalopathy with a reversible splenial lesion

作　　者：张鹏[1] 牛蕾[1] 刘松[1] 郑雪平[2] 刘学军[1] 冯卫华[1] 隋庆兰[1] 徐文坚[1] 

机构地区：[1]青岛大学附属医院放射科,266003 [2]青岛大学附属医院神经科

出　　处：《中华神经科杂志》2015年第4期318-323,共6页Chinese Journal of Neurology

摘　　要：目的探讨伴胼胝体压部可逆性病变的轻度脑炎／脑病（ mild encephalitis/encephalopathy with a reversible splenial lesion ,MERS）的临床表现及影像学特点。方法对11例诊断为MERS患者的临床及影像学资料进行回顾性分析，其中成人4例，青少年及儿童7例，总结其临床及影像学特点。结果11例MERS患者均有前驱感染史。脑炎／脑病症状表现为头痛伴嗜睡6例、意识模糊3例、癫痫2例、幻视2例、谵妄1例。11例患者症状均于2周内明显缓解。影像学检查11例均表现为孤立性胼胝体压部病变，其中9例表现为胼胝体压部中央部类圆形异常信号，2例为累及整个胼胝体压部的弧形异常信号；病灶于T2WI、弥散加权成像（DWU均呈高信号并伴表观弥散系数（ADC）明显减低；复查MRI病灶均于4周内消失。结论MERS起病前多有前驱感染史，临床表现为头痛、意识障碍、癫痫、幻视等神经系统症状。影像学上多表现为MRI上胼胝体压部类圆形或弧形病灶，DWI呈高信号伴ADC图降低。MERS预后良好。部分患者MRI上病灶的出现可滞后于脑病症状。Objective To investigate the clinical and imaging features of mild encephalitis/ encephalopathy with a reversible splenial lesion （MERS）. Methods The clinical and imaging data of 11 patients diagnosed with MERS were retrospectively analyzed, including 4 adults and 7 adolescents and children. The clinical and imaging features of these patients were summarized. Results Eleven MERS patients had a history of precursor infection. Encephalopathy symptoms included headache and drowsy in 6 cases, disturbance of consciousness in 3, epilepsy in 2, illusion in 2 and delirium in 1. The symptoms of all the MERS patients obviously alleviated in 2 weeks. MRI showed all cases as isolation of splenium of corpus callosum lesions, including 9 cases of circular abnormal signals in central of splenium of corpus callosum and 2 cases of arc-shaped abnormal signals in splenium of corpus callosum. The abnormal signal showed high- signal on T2-weighted and diffusion-weighted with low-signal on apparent diffusion coefficient images in the splenium of corpus callosum. After the onset of 4 weeks, MRI returned to normal, and the corpus callosum of abnormal signal lesions disappeared. Conclusions Most patients have a history of precursor infection before the onset of the MERS. The clinical manifestations of MERS patients include encephalopathy symptoms such as headache, disturbance of consciousness, seizures, illusion, etc. MRI shows circular or arc-shaped lesions in splenium of corpus callosum, which demonstrate high-signal on diffusion-weighted and low-signal on apparent diffusion coefficient images. Prognosis of MERS patients is mostly good. Some patients＇ lesions on MRI appear later than the onset of encephalopathy symptoms.

关 键 词：脑炎 意识障碍 癫痫 胼胝体 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]