脑桥中央髓鞘溶解五例临床分析  

Central pontine myelinolysis: a report of 5 cases with autopsy pathological analysis

作　　者：刘雁[1] 董为伟[2] 刘勇[1] 李剑波[3] 卓开能[3] 郑健[1] 彭国光[2] 

机构地区：[1]第三军医大学附属新桥医院神经科,重庆400037 [2]重庆医科大学附属第一医院神经科 [3]重庆医科大学法医系

出　　处：《中华神经科杂志》2001年第6期326-328,共3页Chinese Journal of Neurology

摘　　要：目的　报道 5例脑桥中央髓鞘溶解 (CPM)患者的临床资料及其中 1例的尸解病理检查资料 ,探讨CPM的发病机制及早期预防和诊治原则。方法　对 5例确诊CPM患者的临床表现、影像学资料及其中 1例尸检病理资料进行全面分析。结果　临床观察发现 :① 5例CPM患者均存在严重躯体疾病 ,特别是严重的电解质紊乱 (低钠血症 ) ;② 4例以精神行为异常为最早发现的症状 ;③ 4例出现假性球麻痹 ;④全部出现不同形式的肢体瘫痪 ;⑤头颅MRI 3例阳性 ;⑥ 1例病理检查显示为桥脑髓质非特异性对称性脱髓鞘改变 ;⑦ 5例患者中 4例存活 ,其中 2例恢复独立生活能力。结论　①CPM的发病与严重电解质紊乱 (特别是低钠血症 )及过快补钠有关 ;②CPM是一种自限性疾病 ,无论病情多严重 ,均不应放弃救治机会。Objective A series of 5 patients with central pontine myelinolysis (CPM) confirmed either by cranial MRI,CT image (4 cases) or by autopsy pathological analysis (1 case) was reported. The pathophysiological mechanism,the early diagnosis and the role in prevention were discussed. Methods The creteria obtained from clinical features, cranial MRI and CT imagine as well as autopsy pathological changes were thoroughly analyzed. Results ① All 5 case of CPM were occurring in patients who had already had somatic disease and serious systemic functional failure, especially in those who had had seriously water and ion disturbances, such as hyponatremia. ② In 4 of the 5 patients, psychiatric manifestation tended to show the earliest clinical features. ③ The pseudobulbaral paralysis appeared in 4 patients. ④ Cranial MRI and CT served as the most reliable techniques for diagnosing CPM cases when patients are still alive. ⑤ A variety of paralysis were found in all of the 5 CPM patients. ⑥Pathological analysis demonstrated that there is a symmetric unspecific myelinolysis in areas of basal pontine, caudal middle brain and the superior medulla (1 patient). Conclusion ① The occurrence of hyponatrimia and its too fast correction may be associated with the onset of CPM. ② CPM, a self-restrained disease can be cured from dangerous complications, such as pneumonia, respiratory failure and malnutrition when suitably treated.

关 键 词：髓鞘破坏 中心性脑桥 低钠血症 特发性脱髓鞘病 

分 类 号：R744.5[医药卫生—神经病学与精神病学]