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目的探讨伴胼胝体压部可逆性病变的轻度脑炎/脑病(MERS)的临床特点及头颅影像学特征。方法对诊治的1例MERS患者的临床特点、神经系统异常体征、实验室检查、头颅影像学以及治疗和预后等临床资料进行总结,并结合相关文献复习进行分析。结果 1例MERS患者以呼吸道感染为首发症状,病程第4天出现全头部胀痛,呈持续性、伴恶心等症状。实验室检查:血钠波动在121~133 mmol·L-1。头颅MRI表现为胼胝体压部T2、FLAIR及DWI均可见呈明显高信号的片状病变。经给予抗病毒、控制脑水肿、维持水电解质平衡,并静脉注射免疫球蛋白治疗。1周后复查头颅MRI病变呈T2及FLAIR略高信号、DWI信号完全消失,临床症状基本恢复正常。结论 MERS是一种急性的临床-影像综合征,以病毒感染为最常见病因,临床病程呈良性过程,临床表现缺乏特异性,常出现低钠血症,经早期诊断及治疗后预后良好。
Objective To investigate the clinical features and imaging features of mild encephalitis / encephalopathy (MERS) with reversible lesions of the corpus callosum. Methods Clinical data of 1 patient with MERS diagnosed and treated, abnormal signs of the nervous system, laboratory tests, craniofacial imaging, clinical data of treatment and prognosis were summarized and analyzed with relevant literatures. Results One case of MERS patients with respiratory tract infection as the first symptom, the first four days of the course of headache, persistent, with nausea and other symptoms. Laboratory tests: serum sodium fluctuations in 121 ~ 133 mmol · L-1. Head MRI showed corpus callosum pressure T2, FLAIR and DWI showed obvious high signal patchy lesions. After given antiviral, control brain edema, maintain water and electrolyte balance, and intravenous immunoglobulin therapy. One week later, the skull MRI showed a slightly higher signal of T2 and FLAIR, the signal of DWI completely disappeared, and the clinical symptoms recovered to normal. Conclusions MERS is an acute clinical syndrome. Viral infection is the most common cause. The clinical course is benign. The clinical manifestations are lack of specificity. Hyponatremia often appears and the prognosis is good after early diagnosis and treatment.