Chang Tzu-Pu, Huang Ching-Feng
Department of Neurosurgery and Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Taichung Branch, Taiwan.
Acta Neurol Taiwan. 2010 Jun;19(2):116-9.
We describe a patient who presented with unilateral paresthesia after acute isolated infarct of the splenium.
A 74-year-old woman presented with acute onset of right sided numbness and tingling. MR imaging of the brain showed hypointensity on T1-weighted images and on apparent diffusion coefficient maps, and hyperintensity on T2-weighted and on diffusion-weighted images in the splenium, suggestive of acute infarction. MR angiography showed narrowing of left posterior cerebral artery with decreased branches. On detailed high cortical function assessment, she did not have frontal lobe dysfunction, alien hand syndrome, apraxia, optic ataxia, cortical sensation dysfunction, alexia, agraphia, visual field defect, nor color agnosia.
Infarcts of the splenium are not common. Splenial lesion may be associated with altered mental status, ataxia, recent seizure, hemispheric disconnection, and dysarthria. The presentation of isolated unilateral paresthesia makes the patient different from those previously described. The paresthesia could be caused by selective lacunar infarcts in the diencephalic and mesencephalic regions or could be caused by the diaschisis in the parietal cortex. Single photon emission CT may be indicated to provide further information of central nervous system dysfunction in splenial lesion.
我们描述了一名在胼胝体急性孤立性梗死出现单侧感觉异常的患者。
一名74岁女性出现急性右侧麻木和刺痛。脑部磁共振成像显示胼胝体在T1加权图像和表观扩散系数图上呈低信号，在T2加权和扩散加权图像上呈高信号，提示急性梗死。磁共振血管造影显示左侧大脑后动脉变窄且分支减少。在详细的高级皮质功能评估中，她没有额叶功能障碍、异己手综合征、失用症、视觉性共济失调、皮质感觉功能障碍、失读症、失写症、视野缺损或颜色失认症。
胼胝体梗死并不常见。胼胝体病变可能与精神状态改变、共济失调、近期癫痫发作、半球分离和构音障碍有关。孤立性单侧感觉异常的表现使该患者与先前描述的患者不同。感觉异常可能由间脑和中脑区域的选择性腔隙性梗死引起，也可能由顶叶皮质的失联络现象引起。可能需要单光子发射计算机断层扫描来提供胼胝体病变中枢神经系统功能障碍的进一步信息。
