与颅内动脉瘤性蛛网膜下腔出血相关的胼胝体细胞毒性损伤的临床特征。
Clinical Features of Cytotoxic Lesions of the Corpus Callosum Associated with Aneurysmal Subarachnoid Hemorrhage.
机构信息
From the Department Neurosurgery (H.T., K.Y., S.M., K.H., M.U.), Kawasaki Medical School, Kurashiki, Okayama, Japan
Department Neurosurgery (H.T.), Oita Oka Hospital, Oita, Japan.
出版信息
AJNR Am J Neuroradiol. 2021 Jun;42(6):1046-1051. doi: 10.3174/ajnr.A7055. Epub 2021 Mar 4.
BACKGROUND AND PURPOSE
Patients with SAH due to a ruptured intracranial aneurysm occasionally show reversible high-signal lesions in the splenium of the corpus callosum on DWI. These lesions are called cytotoxic lesions of the corpus callosum. This study retrospectively reviewed cases of aneurysmal SAH and investigated clinical features of cytotoxic lesions of the corpus callosum associated with SAH.
MATERIALS AND METHODS
Participants comprised 259 patients with aneurysmal SAH who had undergone curative treatment at our hospital. We examined the following items related to cytotoxic lesions of the corpus callosum: occurrence rate, timing of appearance and disappearance of the lesions, lesion size, aneurysm location, severity of SAH, treatment method, clinical course, and outcome.
RESULTS
Among the 259 cases, DWI detected cytotoxic lesions of the corpus callosum in 33 patients (12.7%). The mean periods from the onset of SAH to detection and disappearance of cytotoxic lesions of the corpus callosum were 6.3 days (range, 0-25 days) and 35.7 days (range, 9-78 days), respectively. Cytotoxic lesions of the corpus callosum were classified into 2 types: a small type localized in the splenium in 26 cases (78.9%) and a large type spread along the ventricle in 7 cases (21.2%). The severity of SAH, coiling, hydrocephalus, and poor mRS score at discharge were significantly higher in the group with cytotoxic lesions of the corpus callosum. However, multivariate analysis did not identify cytotoxic lesions of the corpus callosum as a risk factor for poor outcome.
CONCLUSIONS
Cytotoxic lesions of the corpus callosum appear at a frequency of 12.7% in patients with aneurysmal SAH. Cytotoxic lesions of the corpus callosum associated with SAH take several days to appear and subsequently resolve within about a month. Cytotoxic lesions of the corpus callosum were likely to occur in patients with high-grade SAH but did not represent a predictor of poor outcome.
背景与目的
因颅内破裂动脉瘤导致蛛网膜下腔出血（SAH）的患者偶尔在 DWI 上显示胼胝体压部可逆性高信号病变，这些病变被称为胼胝体细胞毒性病变。本研究回顾性分析了颅内破裂动脉瘤性 SAH 患者的病例，并研究了与 SAH 相关的胼胝体细胞毒性病变的临床特征。
材料与方法
参与者包括在我院接受治疗的 259 例颅内破裂动脉瘤性 SAH 患者。我们检查了与胼胝体细胞毒性病变相关的以下项目：病变发生率、病变出现和消失的时间、病变大小、动脉瘤位置、SAH 严重程度、治疗方法、临床病程和结局。
结果
在 259 例患者中，DWI 检测到 33 例（12.7%）存在胼胝体细胞毒性病变。胼胝体细胞毒性病变从 SAH 发病到检测和消失的平均时间分别为 6.3 天（范围：0-25 天）和 35.7 天（范围：9-78 天）。胼胝体细胞毒性病变分为 2 型：26 例（78.9%）为局限于胼胝体压部的小病灶，7 例（21.2%）为沿脑室分布的大病灶。存在胼胝体细胞毒性病变的患者的 SAH 严重程度、血管内治疗、脑积水和出院时 mRS 评分较差，均显著高于无胼胝体细胞毒性病变的患者。然而，多因素分析并未将胼胝体细胞毒性病变视为不良结局的危险因素。
结论
在颅内破裂动脉瘤性 SAH 患者中，胼胝体细胞毒性病变的发生率为 12.7%。胼胝体细胞毒性病变与 SAH 出现的时间为数天，随后在大约 1 个月内消退。胼胝体细胞毒性病变可能发生于高分级 SAH 患者，但不代表不良结局的预测因素。
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