Zhu Ruixia, Liu Xu, He Zhiyi
Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
Clin Neurol Neurosurg. 2017 Oct;161:56-58. doi: 10.1016/j.clineuro.2017.08.010. Epub 2017 Aug 25.
Brain abnormalities have frequently been reported in neuromyelitis optica (NMO) patients, but corticospinal tract involvement has rarely been described. Here we review the case of a 56-year-old woman who presented with unusual MRI features involving the whole corticospinal tract, and summarize the clinical features, neuroimaging, and prognosis of the case. The patient presented with bilateral visual loss and developed progressive weakness in both lower limbs, and urinary incontinence 12days later. Brain MRI revealed T2-hyperintensities in the bilateral corticospinal tract (posterior limb of the internal capsule and cerebral peduncle), callosal lesions, and subcortical white matter lesions. Spinal cord MRI showed a longitudinally extensive lesion involving the cervical and lumbar regions. The patient showed minimal improvement after methylprednisolone therapy. Our case suggests that in a patient with NMO, involvement of the whole corticospinal tract with specific brain abnormalities on MRI is indicative of a poor prognosis.
视神经脊髓炎（NMO）患者中经常有脑异常的报道，但皮质脊髓束受累情况鲜有描述。在此，我们回顾了一名56岁女性患者的病例，该患者具有累及整个皮质脊髓束的不寻常MRI特征，并总结了该病例的临床特征、神经影像学表现及预后。患者出现双侧视力丧失，12天后双下肢逐渐出现无力，并伴有尿失禁。脑部MRI显示双侧皮质脊髓束（内囊后肢和大脑脚）T2高信号、胼胝体病变及皮质下白质病变。脊髓MRI显示颈段和腰段有纵向广泛病变。患者接受甲泼尼龙治疗后改善甚微。我们的病例表明，在NMO患者中，MRI显示整个皮质脊髓束受累及特定脑异常提示预后不良。
