咪唑类驱虫药致脱髓鞘脑病21例临床分析  

Clinical Analysis of Twenty-one Cases with Demyelinating Encephalopathy Induced by Anthelmintic Imidazoles

作　　者：杨平生[1] 

机构地区：[1]湖南省永州市人民医院神经内科,湖南永州425000

出　　处：《医学临床研究》2004年第7期748-750,共3页Journal of Clinical Research

摘　　要：【目的】探讨咪唑类驱虫药致脱髓鞘脑病的临床特点。【方法】回顾性分析 2 1例咪唑类驱虫药致脱髓鞘脑病患者的临床表现、实验室检查及治疗。【结果】2 1例主要临床表现为 :精神异常 (87.2 % )、意识障碍 (6 8.1% )、运动障碍 (6 6 .7% )等 ,脑脊液呈轻度炎性改变 (6 8.3% )、脑电图异常 (80 .0 % )、MRI异常(10 0 % )。病灶主要分布在大脑皮质下、侧脑室周围白质内 ;肾上腺皮质激素治疗有效 ,但甲基强的松龙冲击组总显效率高于常规地塞米松治疗组 (P <0 .0 5 )。【结论】咪唑类驱虫药致脱髓鞘脑病主要表现为脑部弥漫性受损的症状和体征 ;服用驱虫药史及MRI资料是诊断的关键 ;肾上腺皮质激素尤其是甲基强的松龙疗效显著。Objective To study the clinical features of demyelinating encephalopathy induced by anthelmintic imidazoles(DEIAI).The clinical manifestation ,laboratory examination and treatment of 21 cases with DEIAI were analyzed retrospectively.The main clinical manifestations in these patients were mental symptoms (87.2%),disorders of consciousness (68.1%), motor disorder (66.7%), etc. The examinations of CSF showed mild inflammatory changes (68.3%). Abnormalities in electroencephalography (80%) and MRI(100%) were observed. The MRI of 21 cases displayed multiple white matter lesions scattered in the subcortical and periventricular regions. The therapeutic efficacy of methylprednisolone impact therapy was apparently better than that of routine dexamethasone treatment (P<0.05) .[Conclusion]The main manifestations of DEIAI are symptoms and signs caused by acute or subacute diffuse cerebral lesions. Previous history of anthelmintic administration and MRI data are the keys for its diagnosis. Corticosteroids, especially methylprednisolone, exerts prominent therapeutic efficacy to this disease.

关 键 词：驱虫药/副作用 脑疾病 脱髓鞘疾病/化学诱导 咪唑类/副作用 

分 类 号：R744.5[医药卫生—神经病学与精神病学]