婴幼儿可逆性胼胝体压部综合征4例临床分析
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摘要
目的探讨可逆性胼胝体压部综合征在婴幼儿病例中的临床表现特点、可能的发病机制以及转归。方法报道4例1.5岁以下确诊病例的临床经过及相关的病原学以及治疗后疾病转归。同时复习相关文献。结果婴幼儿的可逆性胼胝体压部综合征的临床表现通常较不特异,神经系统症状表现多仅为抽搐,或伴有精神差等表现,缺乏特异性。同时症状消失较快,在头颅的MRI上,与感染病因相关的可逆性胼胝体压部综合征的病例,其典型的胼胝体压部的异常信号多在治疗后2周完全消失。而与癫痫相关的消失较慢。结论可逆性胼胝体压部综合征的婴幼儿病例的临床表现多轻微,神经系统症状不突出,预后良好。而与癫痫相关的部分RESLES患儿的影像学恢复,与成人不同,相对较慢。
Objective To explore the clinical features, possible pathogenesis and prognosis of Reversible splenium lesion syndrome(RESLES) in infants.Methods The clinical course of four cases under 1.5 years old and related etiology and disease outcome after treatment were reported,and review the related literature.Results The clinical manifestations of the RESLES in infants and young children are usually nonspecific, and the manifestations of nervous system symptoms are mostly just convulsions, or weak. And those symptoms lasted transient. The abnormal signal in splenium lesion in MRI disappeared quickly 2 weeks after treatment. Especially in the patients who related to the etiology of infection, including the rotavirus and the mycoplasma whereas slowly dispear in patients with epilepsy.Conclusion The clinical manifestations of infants with RESLES are mostly mild, neurological symptoms are not prominent, and the prognosis is good. The restore of MRI in the patients with RESLES associated with epilepsy is relatively slow, different from that of adults.
Objective To explore the clinical features, possible pathogenesis and prognosis of Reversible splenium lesion syndrome(RESLES) in infants.Methods The clinical course of four cases under 1.5 years old and related etiology and disease outcome after treatment were reported,and review the related literature.Results The clinical manifestations of the RESLES in infants and young children are usually nonspecific, and the manifestations of nervous system symptoms are mostly just convulsions, or weak. And those symptoms lasted transient. The abnormal signal in splenium lesion in MRI disappeared quickly 2 weeks after treatment. Especially in the patients who related to the etiology of infection, including the rotavirus and the mycoplasma whereas slowly dispear in patients with epilepsy.Conclusion The clinical manifestations of infants with RESLES are mostly mild, neurological symptoms are not prominent, and the prognosis is good. The restore of MRI in the patients with RESLES associated with epilepsy is relatively slow, different from that of adults.
引文
[1] Garcia-Monco J C,Cortina IE, Ferreira E,et al. Reversible splenial lesion syndrome (RESLES):what’ in a name[J]. J Neuroimaging,2011,21(2):e1-e14.
[2] Kim SS , Chang KH , Kim ST , et al . Focal lesion in the splenium of the corpus callosum in epileptic patients:antiepileptic drug toxicity[J].AJNR Am J Neuroradiol . 1999.20(1):125-129.
[3] Tada H , Takanashi J, Barkovich AJ, at al . Clinically mild encephalitis/encephalopathy with a reversible splenial lesion[J]. Neurology , 2004,63(10):1854-1858.
[4] 方玮,章殷希,丁美萍.可逆性胼胝体压部病变综合征[J].中华神经杂志,2016,49(3):258-260.
[5] 赵立荣,吴晔,郭芒芒,等.伴胼胝体压部可逆性病变的轻度脑炎/脑病儿童病例一例并文献复习[J].中华儿科杂志,2014,52(3):218-222.
[6] Fukuda S,Kishi K,Yasuda K,et al.Rotavirus-associated encephalopathy with a reversible splenial lesion[J].Pediatr Neurol, 2009,40(2):131-133.
[7] Takanashi JI, Barkovich AJ, Yamaguchi KI, et al. Influenzaassociated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review[J]. AJNR Am J Neuroradiol, 2004, 25(5): 798-802.
[8] Arakawa C, Fujita Y, Imai Y, et al. Detection of group a rotavirus RNA and antigens in serum and cerebrospinal fluid from two children with clinically mild encephalopathy with a reversible splenial lesion[J]. Jpn J Infect Dis, 2011, 64(3): 204-207.
[9] Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes[J].Brain Dev,2009,31(7):521-528.
[10] Gtirtler S,Ebner A,Tuxhorn I,et a1. Transient lesion in the splenium of the corpus callosum and antiepileptic drug with-drawal [J].Neurology,2005,65(7):1032-1036.
[11] 宋丹,赵建设,张秀芸,等.儿童可逆性胼胝体压部病变综合征MRI表现及随访观察[J].医学影像杂志,2016,26(5):895-898.
[12] Doherty MD,Jayadev S. Watson NF. et al.Clinical Implications of Splenium Magnetic Resonance Imaging Signal Changes [J]. Arch Neurol. 2005;62(3):433-437.
[13] Miyata R,Tanuma N,Hayashi M,et a1.Oxidative stress in patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) [J].Brain Dev,2012,34(2):124-127.
[2] Kim SS , Chang KH , Kim ST , et al . Focal lesion in the splenium of the corpus callosum in epileptic patients:antiepileptic drug toxicity[J].AJNR Am J Neuroradiol . 1999.20(1):125-129.
[3] Tada H , Takanashi J, Barkovich AJ, at al . Clinically mild encephalitis/encephalopathy with a reversible splenial lesion[J]. Neurology , 2004,63(10):1854-1858.
[4] 方玮,章殷希,丁美萍.可逆性胼胝体压部病变综合征[J].中华神经杂志,2016,49(3):258-260.
[5] 赵立荣,吴晔,郭芒芒,等.伴胼胝体压部可逆性病变的轻度脑炎/脑病儿童病例一例并文献复习[J].中华儿科杂志,2014,52(3):218-222.
[6] Fukuda S,Kishi K,Yasuda K,et al.Rotavirus-associated encephalopathy with a reversible splenial lesion[J].Pediatr Neurol, 2009,40(2):131-133.
[7] Takanashi JI, Barkovich AJ, Yamaguchi KI, et al. Influenzaassociated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review[J]. AJNR Am J Neuroradiol, 2004, 25(5): 798-802.
[8] Arakawa C, Fujita Y, Imai Y, et al. Detection of group a rotavirus RNA and antigens in serum and cerebrospinal fluid from two children with clinically mild encephalopathy with a reversible splenial lesion[J]. Jpn J Infect Dis, 2011, 64(3): 204-207.
[9] Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes[J].Brain Dev,2009,31(7):521-528.
[10] Gtirtler S,Ebner A,Tuxhorn I,et a1. Transient lesion in the splenium of the corpus callosum and antiepileptic drug with-drawal [J].Neurology,2005,65(7):1032-1036.
[11] 宋丹,赵建设,张秀芸,等.儿童可逆性胼胝体压部病变综合征MRI表现及随访观察[J].医学影像杂志,2016,26(5):895-898.
[12] Doherty MD,Jayadev S. Watson NF. et al.Clinical Implications of Splenium Magnetic Resonance Imaging Signal Changes [J]. Arch Neurol. 2005;62(3):433-437.
[13] Miyata R,Tanuma N,Hayashi M,et a1.Oxidative stress in patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) [J].Brain Dev,2012,34(2):124-127.