急性一氧化碳中毒迟发脑病的临床、影像与脑电图分析  

Clinical,image and EEG analysis on delayed encephalopathy after carbon monoxide poisoning

作　　者：于健[1] 郑奎宏[2] 姚生[3] 任文庆[1] 

机构地区：[1]海军总医院海空勤体检中心,北京100048 [2]海军总医院影像中心,北京100048 [3]海军总医院神经内科,北京100048

出　　处：《转化医学杂志》2014年第2期92-95,共4页Translational Medicine Journal

基　　金：首都医学科研发展基金(2009-3089)

摘　　要：目的探讨一氧化碳中毒迟发脑病(delayed encephalopathy after carbon monoxide poisoning,DEACMP)患者的临床、影像及脑电图改变特点。方法收集海军总医院2010年2月—2012年5月收治的42例DEACMP患者的临床资料,回顾性分析DEACMP发作期的临床资料。结果 42例中男性24例,女性18例;发病年龄37~68岁,平均53.5岁;假愈期5~50 d,平均23 d。DEACMP的首发症状依次为反应迟钝(14例)、言语异常(12例)、傻笑(8例)、记忆力减退(5例)、情感异常(2例)和震颤(1例)。疾病达到高峰时表现为不同的临床症候群;其中,痴呆症候群(41例)表现为言语异常、反应迟钝、记忆力减退、情感异常及精神障碍,运动障碍症候群(38例)表现为肌张力异常、摸索、共济失调、小碎步、肢体瘫痪和震颤,其他症状(30例)表现为二便失禁、癫痫和失语。42例在DEACMP发生后1周内行头MRI检查;其中,脑白质受累型17例,主要表现为侧脑室旁和半卵圆中心的白质脱髓鞘;基底节受累型12例,表现为双侧豆状核及苍白球的弥漫性病变;多灶型13例,病灶弥漫和多部位受累。DEACMP发生后1周内脑电图检查示高度不正常11例,中度不正常13例,不正常9例,轻度不正常5例,正常4例。结论 DEACMP常见的首发症状依次为反应迟钝、言语异常和傻笑;疾病高峰时主要表现为痴呆、精神症状、运动障碍和其他神经功能缺损。影像学主要表现为皮质下白质及基底节区累及,临床特点与颅内责任病灶相关。脑电图特点主要表现为α波频率减慢、节律减少或消失,θ波和δ波增多甚至大量出现。Objective To investigate the changes of clinical,medical imaging and electroen-cephalogram (EEG)for patients suffering from delayed encephalopathy after carbon monoxide poiso-ning CDEACMP.Methods To collect the information for 42 patients in Navy General Hospital from Feb 2010 to May 2012 who were suffering from DEACMP,and then retrospectively analyze the clini-cal data during attack stage of those patients.Results Among the 42 patients,24 of them are male and 18 are female with a wide age range from 37 to 68 years old (average age of 53.5).Clinical quies-cent period is from 5 to 50 days with an average of 23 days.Initial symptoms for DEACMP are slow re-sponse (14 cases),speech abnormality (12 cases),smirking (8 cases),memory deterioration (5 ca-ses),emotional abnormality (2 cases)and tremor (1 case).During peak stage of DEACMP,the pa-tients are showing different clinical features dementia (41 cases)with the symptoms of speech abnor-mality,slow response,memory deterioration,emotional abnormality and mental disorders,dyskinesia (38 cases)with the symptoms of muscular tension abnormality,ataxia,split step,limb para-lysis and tremor.Other symptoms (30 cases)included stool incontinence,epilepsy and aphasia.Forty two pa-tients received MRI examination within 1 week after DEACMP occurring.Affected white matter type (17 cases ) manifested white matter demyelination of adjacent lateral ventricles,semioval center. Affected basal ganglia type (12 cases)manifested diffuse lesions in the bilateral putamen and globus pallidus.Multifocal type (13 cases)manifested diffuse lesions and multi-site involvement.Within 1 week after DEACMP occurring,EEG showed high abnormality in 1 1 cases,moderate abnormality in 13 cases,medial abnormality in 9 cases,mild abnormality in 5 cases,and normality in 4 cases.Conclu-sion The common initial symptoms of DEACMP were slow response,abnormal speaking and giggling. At the peak of the disease,patients mainly manifested dementia,psychiatric symptoms,movement disorders and other neurological def

关 键 词：一氧化碳中毒迟发脑病 临床特点 影像学 脑电图 

分 类 号：R595.1[医药卫生—内科学] R747.9[医药卫生—临床医学]