Lee Ho Yun, Chang Kee-Hyun, Kim Ji Hoon, Na Dong Gyu, Kwon Bae Ju, Lee Kwang-Woo, Park Sung Hye
Department of Radiology and Institute of Radiation Medicine, Seoul, Korea.
AJNR Am J Neuroradiol. 2005 Sep;26(8):1996-9.
We report a patient with acute hemorrhagic leukoencephalitis with a focus on serial MR imaging findings. Initial MR imaging of a 42-year-old woman revealed a 2.5-cm focal nonhemorrhagic lesion in the left thalamus and internal capsule. Twenty-four days later, fever and altered consciousness developed, and MR imaging showed huge masslike lesions in both frontal lobes, mainly involving the white matter and the genu of the corpus callosum, with massive edematous swelling that contained multifocal small hemorrhages. Most lesions showed high apparent diffusion coefficient value with peripheral small areas of low apparent diffusion coefficient. On follow-up MR imaging obtained 49 days after initial MR imaging, the lesions progressed with increase in extent and development of rim-enhancing necrosis, despite steroid therapy. Following stereotactic biopsy and subsequent high-dose steroid treatment, the patient recovered with some neurologic sequelae. MR imaging obtained at 72 and 126 days revealed residual necrosis and cerebromalacia in the both frontal lobes.
我们报告一例急性出血性白质脑炎患者，重点关注其系列磁共振成像（MR）表现。一名42岁女性的初始MR成像显示左侧丘脑和内囊有一个2.5厘米的局灶性非出血性病变。24天后，患者出现发热和意识改变，MR成像显示双侧额叶有巨大的肿块样病变，主要累及白质和胼胝体膝部，伴有大量水肿性肿胀，其中包含多灶性小出血。大多数病变表现为高表观扩散系数值，周边有小面积低表观扩散系数区域。在初始MR成像后49天进行的随访MR成像显示，尽管进行了类固醇治疗，病变仍有进展，范围扩大且出现边缘强化坏死。在立体定向活检及随后的高剂量类固醇治疗后，患者康复，但遗留了一些神经后遗症。在72天和126天获得的MR成像显示双侧额叶有残留坏死和脑软化。
