■可逆性脾病变综合征(RESLES)是一种新的临床放射学综合征。我们回顾性分析了130例中国儿童RESLES的临床特征,这是文献中最大的案例系列。
■对2017-2023年江西省儿童医院确诊为RESLES患儿的临床资料进行回顾性分析。130例患者分为≤3岁组(A组)83例和>3岁组(B组)47例。使用卡方检验或Fisher检验来评估数据。
■绝大多数患者(127/130例,97.7%)有感染的前驱症状。A组发生胃肠道前感染(60/83,72.3%)较B组(11/47,23.4%)差异有统计学意义(P<0.05)。B组患者发生呼吸道感染的比例(33/47,70.2%)高于A组(17/83,20.5%),差异有统计学意义(P<0.05)。A组癫痫发作率(82/83,98.8%)高于B组(24/47,51.1%),差异有统计学意义(P<0.05)。B组意识障碍和头痛/头晕(27/47,57.4%;37/47,78.7%)较A组(3/83,3.6%;1/83,1.2%)有统计学意义,分别为(P<0.05)。抽搐伴轻度胃肠炎(CwG)患者A组(50/83,60.2%)较B组(8/47,17.0%)差异有统计学意义(P<0.05)。然而,B组脑炎/脑病(20/47,42.6%)较A组(10/83,12.0%)差异有统计学意义(P<0.05)。MRI显示典型部位的细胞毒性水肿(RESLES1型仅限于call体的脾,RESLES2型扩散到整个call体,邻近的白质,或两者)。初次检查后3天至50天,所有病例的MRI病变均完全恢复。所有儿童均表现出正常的神经发育。
■感染是RESLES的最常见原因。胃肠道感染常见于≤3岁的儿童,而呼吸道感染在>3岁的儿童中很常见。年轻的病人更容易出现抽搐,年龄较大的儿童更容易出现意识障碍和头痛/头晕的症状。RESLES有特征性的MRI表现,预后良好。
UNASSIGNED: Reversible splenial lesion syndrome (RESLES) is a new clinico-radiological syndrome. We retrospectively analyzed the clinical features of 130 children with RESLES in China, which is the largest case series available in the literature.
UNASSIGNED: The clinical data of children diagnosed as RESLES in Jiangxi Provincial Children\'s Hospital between 2017 and 2023 were retrospectively analyzed. The 130 cases were divided into two groups: ≤ 3 years old group (group A) (n = 83) and > 3 years old group (group B) (n = 47). The chi-squared test or Fisher\'s test was used to evaluate the data.
UNASSIGNED: The vast majority of patients (127/130 cases, 97.7%) had prodromal symptoms of infection. Preceding infections of the gastrointestinal tract were statistically more significant in group A (60/83, 72.3%) than in group B (11/47, 23.4%) (P < 0.05). Preceding infections of the respiratory tract were statistically more significant in group B (33/47, 70.2%) than in group A (17/83, 20.5%) (P < 0.05). Seizures were statistically more significant in group A (82/83, 98.8%) than in group B (24/47,51.1%) (P < 0.05). The disturbance of consciousness and headache/dizziness were statistically more significant in group B (27/47, 57.4%; 37/47, 78.7%) than in group A (3/83, 3.6%; 1/83, 1.2%), respectively (P < 0.05). Convulsions with mild gastroenteritis (CwG) were statistically more significant in group A (50/83, 60.2%) than in group B (8/47, 17.0%) (P < 0.05). However, encephalitis/encephalopathy was statistically more significant in group B (20/47, 42.6%) than in group A (10/83, 12.0%) (P < 0.05). MRI showed cytotoxic edema in typical locations (RESLES type-1 limited to the splenium of the corpus callosum and RESLES type-2 spread to the entire corpus callosum, adjacent white matter, or both). There was full recovery of the lesions of MRI in all cases from 3 days to 50 days after the initial examinations. All the children showed normal neurodevelopment.
UNASSIGNED: Infection was the most common cause of RESLES. Infections of the gastrointestinal tract are common in ≤ 3 years old children, while infections of the respiratory tract are common in >3 years old children. Younger patients are more likely to develop convulsions, and older children were more likely to have symptoms with disturbance of consciousness and headache/dizziness. RESLES has characteristic MRI manifestations and a good prognosis.