海洛因海绵状白质脑病的临床及影像学探讨(附1例报告)  

Clinical and Neuro-imaging Manifestations of Heroin Spongiform Leukoencephalopathy

作　　者：刘君[1] 王春雪[1] 牛松涛[1] 唐鹤飞[1] 陈亚亮[2] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科 [2]首都医科大学解剖学教研室

出　　处：《首都医科大学学报》2005年第4期502-504,共3页Journal of Capital Medical University

摘　　要：目的分析和探讨海洛因海绵状白质脑病(HSLE)的临床特点和影像学特征,及其与吸毒方式和戒毒的相关性。方法详细报道1例HSLE病人的临床及影像特点,并结合国内文献进行分析。结果本例患者经鼻烫吸摄入海洛因10年,间断戒毒4次。慢性起病,逐渐加重;主要表现为记忆力减退、反应迟钝、小脑性共济失调及双下肢音叉震动觉减退。MRI可见双侧小脑半球近中线实质内(齿状核及其附近白质)、内囊后肢、双侧侧脑室旁、半卵圆中心及皮质下白质的后2/3、中脑等处多发对称长T1、长T2信号;经高压氧、纳洛酮、金钠多、胞二磷胆碱、能量合剂及各种维生素等综合治疗,病情略好转。结论HSLE的发病与经鼻烫吸海洛因及戒毒密切相关,并且MRI有特异性表现,建议在戒毒治疗的同时应用神经保护剂,或许可减少HSLE的发生或减轻HSLE的临床症状。Objective To observe clinical manifestations, characteristics of CT and MRI imaging of characteristics and investigate diagnostic the principles of heroin spongiform leukoencephalopathy （HSLA） and to recommend therapeutic strategies. Methods Clinical and imaging data of one case with HSLA were reviewed references nation wide. Results This case had a history of inhaling heated heroin through nose for 10 years and had intermittent drug abstinence 4 times. The pathological process is chronic with graduall deterioration and the main clinical manifestations were memory declining, clumsy, cerebellum ataxia as well as decreased deep sensation of both legs. Symmetric long T1 and long T2 were detected on MRI across cerebellum, post branch of internal capsule, around both lateral ventrical, and subcortical white matter as well as midbrain. Clinical symptoms had improved with the treatment of hyperbaric oxygen, Naloxone,Ginkgo biloba, Citicoline, ATP, multiple vitamins. Conclusion Inhaling heated heroin via nose and abstinence of drug are main causes of HSLE. Thus, we suggest neuroprotective treatment before abstinence of drug should be strengthened in order to lower incidence or alleviate clinical symptoms of FISLA closely related to drug abstinence.

关 键 词：海洛因 白质脑病 

分 类 号：R745.1[医药卫生—神经病学与精神病学]