脑桥中央髓鞘溶解症的临床和MRI特点(8例报告)  

Clinical features and MRI analysis of central pontine myelinolysis and extrapontine myelinolysis:8 cases report

作　　者：常颖[1] 高垚[2] 李欢[1] 严明兰[3] 

机构地区：[1]吉林大学中日联谊医院神经内一科,吉林长春130033 [2]长春市中心医院神经内科,吉林长春130051 [3]吉林大学中日联谊医院药剂科,吉林长春130033

出　　处：《中风与神经疾病杂志》2011年第12期1121-1124,共4页Journal of Apoplexy and Nervous Diseases

基　　金：吉林省科技厅资助项目(200705310)

摘　　要：目的探讨脑桥中央髓鞘溶解症及脑桥外髓鞘溶解的发病原因、临床特点、治疗、疾病预后及急性期、恢复期MRI影像学特点。方法对2002年～2006年吉林大学中日联谊医院收治的8例CPM患者的病因、临床表现、MRI影像学特点及治疗转归进行回顾性分析。结果 8例患者均有基础疾病。患者表现不同程度的意识障碍、肢体瘫痪、球麻痹;其中1例无相应的临床症状。6例患者在发病早期行头部MRI检查,表现脑桥基底部对称分布的病灶;其中的3例伴有脑桥外的髓鞘溶解,病灶主要分布在丘脑、壳核;其中的2例在发病后的1个月复查头部MRI,发现脑桥病灶有不同程度的缩小,表现T1W1低信号、T2W2高信号;丘脑、壳核的病灶表现T1W1高信号、T2W2高信号。除1例无临床症状及1例肝移植术后患者外,其余6例一经明确诊断,均立即行激素治疗。6例患者基本恢复正常,生活可以自理。结论肝功能损伤、慢性肾功能不全的患者容易出现脑桥中央及脑桥外的髓鞘溶解症;患者激素治疗有效;头部MRI是最有效的检查方法,是确诊的重要依据;疾病恢复期丘脑、壳核病灶的短T1、长T2的影像学改变考虑与髓鞘溶解后的脂类堆积有关。Objective To investigate central pontine and extrapontine myelinolysis（CPM and EPM） on etiology,clinical features,treatment,prognosis and magnetic resonance（MR） imaging finding in acute stage and convalescence stage.Methods Retrospective analysis about 8 patients with diagnosis of central pontine and extrapontine myelinolysis（CPM and EPM） on etiology,clinical features,prognosis,magnetic resonance imaging（MRI） finding and curative effect.Results Overall 8 patients had primary disease.Patients showed different level of conscious disturbance,palsy and glossopharyngeal paralysis.1 case had no correspondence clinical symptom.In 6 patients who had correspondence clinical symptom,initial MR imaging revealed a bilateral symmetry bat wing-shaped lesion within the basilar part of pons.3 patients had cerebral ganglion and putamen abnormalities,which were consistent with extrapontine myelinolysis.The abnormalities in pontine were smaller in 1-month follow-up in the 2 patients rechecked,which appeared hypo-intense in T1 and hyper-intense in T2 on MRI,but the abnormalities in cerebral ganglion and putamen appeared hyper-intense in T1 and T2 on MRI.Expect one with no clinical symptom and one case post liver transplantation,the other 6 cases were treated with glucocorticoids immediately after diagnosis was defined.All 6 cases were cured and could help themselves.Conclusion The hepatic function defect and chronic renal inadequacy might be associated with CPM and EPM.Glucocorticoid is effective for CPM and EPM.MRI is unquestionably superior to other detections in the diagnoses of CPM and EPM.The abnormal hyper-intense in T1 and T2 on MRI in cerebral ganglion and putamen appeared in convalescence were considered to be lipoid accumulate after myelinolysis.

关 键 词：脑桥中央髓鞘溶解 脑桥外髓鞘溶解 核磁共振 

分 类 号：R744.5[医药卫生—神经病学与精神病学]