1,2-二氯乙烷中毒性脑白质病7例报告  

Seven cases of 1,2-dichloroethance-induced toxic leukoencephalopathy

作　　者：罗伟良[1] 王立志[1] 李博生[1] 

机构地区：[1]广东省惠州市中心人民医院神经内科,惠州516001

出　　处：《中国神经精神疾病杂志》2011年第4期197-200,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的报告7例1,2-二氯乙烷（1,2-DCE）中毒性脑白质病的临床及影像学特征。方法回顾性分析经广东省职业病防治院确诊的7例1,2-二氯乙烷中毒性脑白质病患者的临床资料。结果患者中男3例、女4例,年龄17~46岁。为散发性发病,提示发病存在个体易感因素。主要临床表现包括头痛、呕吐、意识改变、癫痫发作等,3例仅有头痛,经CT和/或MR检查诊断脑白质病而后确诊。腰穿检查脑脊液压力增高,头颅CT均表现为两侧大脑半球脑白质对称性＂佛指状＂密度减低、侧脑室变窄、脑回肿胀和脑沟变浅。头颅MRI均表现两侧大脑半球白质广泛受累,T1WI呈略低信号,T2WI明显高信号,FLAIR亦为高信号,脑回肿胀,脑沟模糊不清,脑沟、脑池变浅,脑室变窄。经脱水降颅压及糖皮质激素等治疗,5例患者症状好转,2例死于脑疝。结论 1,2-二氯乙烷中毒性脑白质病,临床表现以颅高压表现为主,头颅MRI检查T2WI及FLAIR上双侧大脑半球白质高信号是主要的影像学特征,结合接触史调查可做出诊断。治疗以脱水降低颅内压及糖皮质激素为主。Objective This study reported the clinical and neuroimaging features of seven patients with 1,2-Dichloroethane（1,2-DCE） toxic leukoencephalopathy.Methods Retrospective analysis was carried out on 7 cases with 1,2-Dichloroethane（1,2-DCE） toxic leukoencephalopathy who had been identified by Guangdong Prevention and Treatment Center for Occupational Diseases.Results This study included three male and four were female workers with age range from 17 to 46 years.All seven cases were sporadic,indicating predisposing factors.The main clinical symptoms included headache,vomiting,conscious disturbance,seizures.Three cases had headache only and they were identified by cranial CT and/or MRI.Lumbar cerebrospinal fluid pressures were increased in all cases.CT demonstrated hypodensity symmetrically as digitations in the white matters of bilateral cerebral hemisphere,lateral cerebral ventricles narrowing,cerebral convolutions swelling and brain ditch shallowing.Cranial MRI showed T1WI low signal,T2WI and FLAIR high signal in white matters of bilateral cerebral hemisphere,swelling cerebral convolutions,vague brain ditch,shallow brain ditch and cistern and narrow ventricle.After the treatment with dehydrating agent and glucocorticoid,five patients were improved and two patients died of cerebral hernia formation.Conclusions The main clinical symptoms of 1,2-DCE toxic leukoencephalopathy are intracranial hypertension and its main neuroimaging features are T2WI and FLAIR high signal in white matters of bilateral cerebral hemisphere on cranial MRI.The diagnosis of 1,2-DCE toxic leukoencephalopathy can be made by the clinical and neuroimaging features together with occupational exposure history and patients should be treated mainly by dehydrating agent and glucocorticoid.

关 键 词：1 2-二氯乙烷(1 2-DCE) 中毒性脑白质病 X线计算机体层摄影磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学]