저혈당에 의한 가역뇌량팽대병변경도뇌병증: 자기공명분광법과 확산텐서영상

Mild Encephalopathy with Reversible Splenial Lesion by Hypoglycemia: Magnetic Resonance Spectroscopy and Diffusion Tensor Image Findings

Article information

J Korean Neurol Assoc. 2018;36(1):61-62
Publication date (electronic) : January 31, 2018
doi : http://dx.doi.org/10.17340/jkna.2018.1.17
Department of Neurology, Veteran Healthcare Service Medical Center, Seoul, Korea
aDepartment of Radiology, Veteran Healthcare Service Medical Center, Seoul, Korea
이슬기, 배희원, 하상원, 김인중a, 강현구a
중앙보훈병원 신경과
a중앙보훈병원 영상의학과
Address for correspondence: Sang-Won Ha, MD Departments of Neurology, Veteran Healthcare Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Korea Tel: +82-2-2225-1324 Fax: +82-2-2225-1327 E-mail: hippocam@naver.com
received : August 6, 2017 , rev-recd : November 27, 2017 , accepted : November 27, 2017 .

당뇨, 허혈심질환이 있는 72세 남자가 기상 시 지남력장애 및 혼동을 보였다. 뇌량팽대에 확산강조영상에서는 고신호강도, 겉보기확산계수지도에서는 저신호강도병변이 보였다(Fig. A, B). 당시 혈당은 36 mg/dL였고, 포도당 정주 직후에 의식이 회복되었다. 발생 6일 후 시행한 확산강조영상에서 병변은 사라졌다.

Figure.

Brain images of patient. Initial diffusion weighted image (A) showed high signal intensity lesion in the splenium of the corpus callosum. The same region exhibited diffusion restriction in apparent diffusion coefficient map (B). On admission day, magnetic resonance spectroscopy (C, D) was done (long TE, 144 ms) and the region of interest (blue square) showed increased lactate peak (yellow arrow). Fractional anisotropy (FA) value of region of interest (green circle) was 0.67 (reference value: 0.78) in FA map of diffusion tensor image (E). Tractography (F) showed no significant interruption of the splenial white matter tract (blue square).

가역뇌량팽대병변경도뇌병증(mild encephalopathy with reversible splenial lesion)은 특징적인 임상영상증후군으로 감염 또는 독성-대사뇌병증에 의해 유발된다. 겉보기확산계수지도에서의 확산제한으로 세포독성부종으로 추정하지만 왜 가역적인지, 왜 뇌량팽대에만 선택적으로 나타나는지는 알려져 있지 않다[1].

내원일에 시행한 자기공명분광법에서 병변에 무산소대사의 표지자인 젖산최고점(lactate peak)의 증가가 보였으며(Fig. C, D), 이는 에너지장애가 기여한 부분이 있음을 시사한다. 이전 보고에서 확산텐서영상의 분할비등방도(fractional anisotropy)는 정상이었으나[2], 증례 환자는 0.67 (참고치 0.78)로 경미한 감소를 보였다(Fig. E). Tractography에서 뇌량팽대 섬유다발의 뚜렷한 손상은 없었다(Fig. F). 뇌백질구조는 유지되는 수초내부종(intramyelinic edema)에 의한 일시적인 확산제한에 의한 것으로 추정된다.

References

1. Cho JS, Ha SW, Han YS, Park SE, Hong KM, Han JH, et al. Mild encephalopathy with reversible lesion in the splenium of the corpus callosum and bilateral frontal white matter. J Clin Neurol 2007;3:53–56.
2. Osuka S, Imai H, Ishikawa E, Matsushita A, Yamamoto T, Nozue H, et al. Mild encephalitis/encephalopathy with a reversible splenial lesion: evaluation by diffusion tensor imaging. Two case reports. Neurol Med Chir (Tokyo) 2010;50:1118–1122.

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Figure.

Brain images of patient. Initial diffusion weighted image (A) showed high signal intensity lesion in the splenium of the corpus callosum. The same region exhibited diffusion restriction in apparent diffusion coefficient map (B). On admission day, magnetic resonance spectroscopy (C, D) was done (long TE, 144 ms) and the region of interest (blue square) showed increased lactate peak (yellow arrow). Fractional anisotropy (FA) value of region of interest (green circle) was 0.67 (reference value: 0.78) in FA map of diffusion tensor image (E). Tractography (F) showed no significant interruption of the splenial white matter tract (blue square).