胼胝体急性梗死临床及MRI分析
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摘要
目的:探讨胼胝体急性梗死患者的临床及MRI表现特征。方法:回顾性分析江苏省丰县人民医院2014年8月至2016年8月经临床证实的28例胼胝体急性梗死患者的临床及MRI资料。结果:所有患者均有1种或1种以上的诸如高血压、冠心病和糖尿病等的危险因素。临床表现主要有观念运动性失用、额叶步态、异己手综合征、肢体瘫痪及智能障碍等。MRI主要表现为胼胝体区T1WI呈低信号、T2WI及FLAIR呈高信号、DWI高信号ADC低信号。主要累及胼胝体体部,其次为膝部及压部。伴额叶等处新鲜梗死14例,伴其他部位陈旧性梗死19例,伴脑白质疏松9例。12例患者同时行MRA检查,均显示颅内动脉血管狭窄或闭塞,其中大脑前动脉最多,其次为椎动脉狭窄,大脑中动脉及颈内动脉狭窄次之。结论:急性胼胝体梗死多存在相关危险因素,临床表现复杂多样,MRI对本症及伴发症的诊断价值极高,值得应用。
Objective: To investigate the clinical manifestation and MRI features of patients with acute infarction of corpus callosum( AICC). Methods: The clinical data of 28 patients with AICC admitted into People's Hospital of Fengxian County from August 2014 to August 2016 confirmed clinically were retrospectively analyzed. Results: All patients had one or more risk factors such as hypertension,coronary heart disease and diabetes etc. The main clinical manifestations were: ideomotor apraxia,frontal gait,alien hand syndrome,limb paralysis,mental retardation,etc. MRI was mainly showed abnormal signal in the corpus callosum,with low signal intensity in T1WI,high signal intensity in T2WI and FLAIR,high signal intensity in DWI and low signal intensity in ADC. Body was mainly involved,followed by knee and splenium. 14 patients were found with fresh infarction in frontal lobe and other areas,19 patients were found with old infarction in other parts,with leukoaraiosis in 9 patients. MRA was performed in 12 patients,followed by vertebral artery,then middle cerebral artery and internal carotid artery. Conclusion: There are many related risk factors in patients with AICC. The clinical manifestations of the ACCI are complex and various. MRI is valuable in the diagnosis of AICC and its complications,so which is worth of application.
Objective: To investigate the clinical manifestation and MRI features of patients with acute infarction of corpus callosum( AICC). Methods: The clinical data of 28 patients with AICC admitted into People's Hospital of Fengxian County from August 2014 to August 2016 confirmed clinically were retrospectively analyzed. Results: All patients had one or more risk factors such as hypertension,coronary heart disease and diabetes etc. The main clinical manifestations were: ideomotor apraxia,frontal gait,alien hand syndrome,limb paralysis,mental retardation,etc. MRI was mainly showed abnormal signal in the corpus callosum,with low signal intensity in T1WI,high signal intensity in T2WI and FLAIR,high signal intensity in DWI and low signal intensity in ADC. Body was mainly involved,followed by knee and splenium. 14 patients were found with fresh infarction in frontal lobe and other areas,19 patients were found with old infarction in other parts,with leukoaraiosis in 9 patients. MRA was performed in 12 patients,followed by vertebral artery,then middle cerebral artery and internal carotid artery. Conclusion: There are many related risk factors in patients with AICC. The clinical manifestations of the ACCI are complex and various. MRI is valuable in the diagnosis of AICC and its complications,so which is worth of application.
引文
[1]鲁光辉,吴健,王志海,等.胼胝体梗死临床特点分析[J].中国循证心血管医学杂志,2014,6(1):102-103,113.
[2]于广会,和清源,刘林祥,等.联合应用磁共振弥散加权成像和T2加权成像在老年脑血管病急性发病中的价值[J].中华老年心脑血管病杂志,2015,17(12):1275-1278.
[3]盛蕾,胡丹,肖婧,等.胼胝体梗死:临床与影像学特征[J].国际脑血管病杂志,2013,21(7):536-540.
[4]付胜奇,张淑玲,张洪涛,等.表现为异己手综合征的短暂性脑缺血发作的临床特点[J].临床神经病学杂志,2013,26(6):451-453.
[5]李新辉,王玉洁,白璇,等.胼胝体梗死的临床与影像学分析[J].国际脑血管病杂志,2011,19(3):209-213.
[6]张春生,董昭樱,张静,等.急性胼胝体梗死的核磁共振表现与临床关系的探讨[J].中风与神经疾病杂志,2008,25(3):295-298.
[7]Yoon SY,Park SH,Hwang JH,et al.Multiple Cerebral Infarctions due to Unilateral Traumatic Vertebral Artery Dissection after Cervical Fractures[J].Korean J Neurotrauma,2016,12(1):34-37.
[8]Mahale R,Mehta A,Buddaraju K,et al.Diffuse corpus callosum infarction-Rare vascular entity with differing etiology[J].J Neurol Sci,2016,360:45-48.
[9]Kaymakamzade B,Eker A.Acute infarction of corpus callosum due to transient obstructive hydrocephalus[J].Neurol Neurochir Pol,2016,50(4):280-283.
[10]王丽娜,王金立,韩国花.胼胝体梗死29例临床分析[J].河北联合大学学报:医学版,2012,14(2):204-205.
[11]郑建乐,胡英嗣.胼胝体脑梗死53例临床分析[J].医学研究杂志,2011,40(12):103-105.
[12]王亭亭,贾志荣,孙葳,等.胼胝体梗死所致的发作性拮抗性失用[J].中华神经科杂志,2011,44(7):479-481.
[13]Zhang J,Xing S,Li J,et al.Isolated astasia manifested by acute infarct of the anterior corpus callosum and cingulate gyrus[J].J Clin Neurosci,2015,22(4):763-764.
[14]Nagaishi A,Narita T,Gondo Y,et al.Left-sided metamorphopsia of the face and simple objects caused by an infarction at the right side of the splenium of the corpus callosum[J].Rinsho Shinkeigaku,2015,55(7):465-471.
[15]叶成斌,刘楠.多序列MRI成像对胼胝体各期脑梗死的诊断价值[J].延安大学学报:医学科学版,2012,10(4):29-31,80.
[16]曹树刚,徐文安,夏明武,等.临床表现为进展性脑卒中的胼胝体梗死八例分析[J].中华老年心脑血管病杂志,2013,15(10):1057-1061.
[17]周军,解绍春,周芳,等.伴有胼胝体压部可逆性病灶的临床症状轻微的脑炎/脑病的磁共振成像诊断[J].实用医学影像杂志,2014,15(4):291-292.
[18]张鹏,牛蕾,刘松,等.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[J].中华神经科杂志,2015,48(4):318-323.
[2]于广会,和清源,刘林祥,等.联合应用磁共振弥散加权成像和T2加权成像在老年脑血管病急性发病中的价值[J].中华老年心脑血管病杂志,2015,17(12):1275-1278.
[3]盛蕾,胡丹,肖婧,等.胼胝体梗死:临床与影像学特征[J].国际脑血管病杂志,2013,21(7):536-540.
[4]付胜奇,张淑玲,张洪涛,等.表现为异己手综合征的短暂性脑缺血发作的临床特点[J].临床神经病学杂志,2013,26(6):451-453.
[5]李新辉,王玉洁,白璇,等.胼胝体梗死的临床与影像学分析[J].国际脑血管病杂志,2011,19(3):209-213.
[6]张春生,董昭樱,张静,等.急性胼胝体梗死的核磁共振表现与临床关系的探讨[J].中风与神经疾病杂志,2008,25(3):295-298.
[7]Yoon SY,Park SH,Hwang JH,et al.Multiple Cerebral Infarctions due to Unilateral Traumatic Vertebral Artery Dissection after Cervical Fractures[J].Korean J Neurotrauma,2016,12(1):34-37.
[8]Mahale R,Mehta A,Buddaraju K,et al.Diffuse corpus callosum infarction-Rare vascular entity with differing etiology[J].J Neurol Sci,2016,360:45-48.
[9]Kaymakamzade B,Eker A.Acute infarction of corpus callosum due to transient obstructive hydrocephalus[J].Neurol Neurochir Pol,2016,50(4):280-283.
[10]王丽娜,王金立,韩国花.胼胝体梗死29例临床分析[J].河北联合大学学报:医学版,2012,14(2):204-205.
[11]郑建乐,胡英嗣.胼胝体脑梗死53例临床分析[J].医学研究杂志,2011,40(12):103-105.
[12]王亭亭,贾志荣,孙葳,等.胼胝体梗死所致的发作性拮抗性失用[J].中华神经科杂志,2011,44(7):479-481.
[13]Zhang J,Xing S,Li J,et al.Isolated astasia manifested by acute infarct of the anterior corpus callosum and cingulate gyrus[J].J Clin Neurosci,2015,22(4):763-764.
[14]Nagaishi A,Narita T,Gondo Y,et al.Left-sided metamorphopsia of the face and simple objects caused by an infarction at the right side of the splenium of the corpus callosum[J].Rinsho Shinkeigaku,2015,55(7):465-471.
[15]叶成斌,刘楠.多序列MRI成像对胼胝体各期脑梗死的诊断价值[J].延安大学学报:医学科学版,2012,10(4):29-31,80.
[16]曹树刚,徐文安,夏明武,等.临床表现为进展性脑卒中的胼胝体梗死八例分析[J].中华老年心脑血管病杂志,2013,15(10):1057-1061.
[17]周军,解绍春,周芳,等.伴有胼胝体压部可逆性病灶的临床症状轻微的脑炎/脑病的磁共振成像诊断[J].实用医学影像杂志,2014,15(4):291-292.
[18]张鹏,牛蕾,刘松,等.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[J].中华神经科杂志,2015,48(4):318-323.