Lin Yu-Wei, Yu Chin-Yin
Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.
Acta Neurol Taiwan. 2009 Sep;18(3):203-6.
A 36-year-old man with staphylococcal meningitis had similar symptoms and MRI characteristics as reversible splenium lesion syndrome described in the literature-hyperdensity on DWI and T2WI/FLAIR, hypodensity on ADC, iso-intensity on T1WI, and no contrast enhancement on midline splenium. The splenium lesion on MRI disappeared as the symptoms improved. The etiology of staphylococcal meningitis was different from other reported cases, and the MRS study showed relatively elevated lactate and myo-inositol of splenium as compared to other selective regions in the brain (both white matter and gray matter), which implies increased anaerobic glycolysis and hyperosmolar state on the splenium. The ratios of NAA/Cr, NAA/Cho, and Cho/Cr were abnormal in all selected regions, indicating that the pathologic change involved the whole brain. More series MRS and other advanced exams to correlate intracranial environment (ex. cerebral blood flow, osmolality, inflammatory process, metabolites distribution, and neurotransmitter changes) are needed to confirm the mechanisms of different etiologies with reversible splenium lesion syndrome.
一名36岁的葡萄球菌性脑膜炎男性患者具有与文献中描述的可逆性胼胝体病变综合征相似的症状和MRI特征——DWI及T2WI/FLAIR序列上呈高信号，ADC图上呈低信号，T1WI序列上等信号，胼胝体中线处无强化。随着症状改善，MRI上的胼胝体病变消失。该葡萄球菌性脑膜炎的病因与其他报道病例不同，MRS研究显示，与大脑其他选定区域（包括白质和灰质）相比，胼胝体的乳酸和肌醇相对升高，这意味着胼胝体存在无氧糖酵解增加和高渗状态。所有选定区域的NAA/Cr、NAA/Cho和Cho/Cr比值均异常，表明病理改变累及整个大脑。需要更多系列的MRS及其他高级检查来关联颅内环境（如脑血流量、渗透压、炎症过程、代谢物分布和神经递质变化），以证实不同病因与可逆性胼胝体病变综合征的机制。
