The Department of Neurology of Beijing Jishuitan Hospital has once again successfully diagnosed and treated rare cases

Fever and headache are very common in daily life and are encountered by everyone, but the causes behind them are different, the symptoms can be mild or severe, and the clinical outcome is not consistent. Patients need to seek medical treatment in time, doctors need to identify the cause behind it in time, and then give comprehensive treatment such as cause and symptom based on the diagnosis of the cause, so as to let the patient relieve the pain and restore health as soon as possible.

Not long ago, a female college student came to the emergency department of neurology of The Huilongguan Branch of Jishuitan Hospital due to severe headaches and heavy vision, and after a detailed examination, she was diagnosed with a rare clinical disease - reversible purpurial pressure lesion syndrome (RESLES). After timely and effective treatment in the Department of Neurology, the patient had a good prognosis and has been discharged from the hospital and returned to school.

In the emergency department, the neurologist inquired about the medical history and learned that the patient had fever, dizziness, headache for nearly 1 week, the body temperature reached more than 39 ° C, after the fever clinic examination, to rule out the possibility of new crown pneumonia, consider "acute gastroenteritis", and gave levofloxacin anti-inflammatory, lysine piline antipyretic and rehydration and other treatments. On the 3rd day after the fever clinic, the patient's body temperature gradually returned to normal, but the headache did not alleviate anything, and gradually worsened, and soon there were symptoms of blurred vision and heavy vision, so he came to the hospital's shinuchi emergency department for treatment.

At this time, female college students have poor mental health, painful faces, the right eye is adducted, completely unable to abduct, and the right view, upper right, and lower right view all have diplopia. No significant abnormalities were seen in Cranial CT, but significant swelling of the brain parenchyma was seen on the reading. The neurology emergency doctor initially diagnosed the possibility of intracranial venous sinus thrombosis, and performed meropenem anti-infection, mannitol dehydration and cranial pressure reduction, low molecular weight heparin anticoagulation and other treatments for the patient, and the patient felt that the headache had improved. To confirm the diagnosis, the patient is admitted to the ward the next day.

On the day of admission, the doctor in charge performed a lumbar puncture of cerebrospinal fluid for the patient for the first time. CSF eruption is seen when measuring cranial pressure, suggesting a marked increase in intracranial pressure. Cerebrospinal fluid routine and biochemistry showed normal, but the number of cells increased significantly. The doctor in charge saw that the patient was seriously ill and the clinical progress was rapid, and immediately asked the chief physician Hu Hongtao, the director of the department, to check the patient. Combined with the patient's acute onset, there is a precursor to fever, followed by severe headache, high intracranial pressure, hypersensitivity C-reactive protein significantly increased clinical characteristics, Director Hu remembered the first case of reversible corpus callosum pressure lesion syndrome (RESLES) in the hospital that was treated 6 years ago, the two cases of clinical manifestations have similarities, the middle-aged male patients of that year were induced by RESLES after influenza B virus infection, but the patients did not have paralysis and diplopia that year. This time, the side of the abductor paralysis in young women should be associated with its extremely increased intracranial pressure.

Director Hu pointed out that RESLES should be considered first in this case, and it is necessary to improve the cranial MRI examination as soon as possible (there is a time window due to characteristic imaging performance), and the detection of common respiratory viruses, including influenza viruses, needs to be improved. In terms of treatment, while fighting the virus, attention is paid to strengthening dehydration, and neurotrophic drugs are added at the same time to promote the recovery of nerve function.

The patient completed the cranial magnetic resonance examination that night, and indeed saw an abnormally high signal in the corpus callosum pressure part (in the T2, FLAIR, DWI, etc., the corpus callosum pressure showed an oval high signal), and subsequent pathogenic examination also showed positive influenza B virus antibody IgM. Since then, the diagnosis of RESLES has been definitive. After antiviral, dehydration and cranial pressure reduction, nutritional nerves, hormones and other comprehensive treatment, the patient's headache quickly alleviated, after 8 days of interval, the high signal of the brain MRI purpuratiate pressure disappeared, the lumbar puncture cranial pressure returned to normal, the number of cerebrospinal fluid cells was basically normal, the right eye activity was gradually restored, and the diplopia disappeared.

Reversible corpus callosum pressure lesion syndrome (RESLES) is a clinical and radiographic syndrome caused by multiple etiologies with characteristic imaging manifestations of callosum pressure. The causes include infections, metabolic disorders, the use of antiepileptic drugs, etc., of which infections are common in children and adolescents, the pathogens are mainly viruses, the most common is influenza viruses, and others include rotavirus, measles virus, herpes virus type 6 and so on. Imaging is characterized by ovoid, non-reinforced hyperinspiratory lesions in the supraplexial callosum pressure (SCC) of the brain MRI. Lesions can disappear completely after a period of time, so they may not always be captured. Most of the outcomes are good with aggressive treatment and may not leave neurologic dysfunction.

This case is the second case of RESLES admitted to the Department of Neurology of Jishuitan Hospital, such cases have a sudden onset, rapid progression, and menacing symptoms, but the clinical manifestations are non-specific, and rare in adult patients, and there is a general lack of clinical awareness of the disease, so it is difficult to make a clear diagnosis in time. Both patients were diagnosed and treated effectively in the neurology department of the hospital, and the prognosis was good.

The relevant person in charge of the Department of Neurology of Jishuitan Hospital said that the department will continue to focus on the clinic, carefully treat each patient, continue to learn and practice, and better provide high-quality diagnosis and treatment services for patients.

Text/Beiqing-Beijing headline reporter Jiang Ruojing Correspondent Wang Hongxia

Editor/Tan Weiping