大面积烧伤并发脑桥中央及脑桥外髓鞘溶解症临床报告并文献复习  

Extensive Burns Complicated by Central Pontine and Pontine Outside Myelinolysis: a Case Report and Literature Review

作　　者：祝玉芬 徐硕[1] 康云辉[1] 杜昱平[1] 李香社[2] 王雪笠[3] 

机构地区：[1]解放军白求恩国际和平医院放射诊断科,石家庄050082 [2]解放军白求恩国际和平医院健康管理中心,石家庄050082 [3]解放军白求恩国际和平医院神经内科,石家庄050082

出　　处：《临床误诊误治》2017年第5期55-58,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨脑桥中央髓鞘溶解症(central pontine myelinolysis,CPM)及脑桥外髓鞘溶解症(extral pontine myelinolysis,EPM)的临床及影像学特点,提高对本病认识。方法对解放军白求恩国际和平医院收治的大面积烧伤并发CPM及EPM 1例的临床资料进行回顾性分析,并复习相关文献。结果患者因全身多处甲醛火焰烧伤后30 h,昏迷9 h余入院。急诊头颅CT检查未见明显异常。入院15 d后行MRI检查示脑桥对称性分布病灶,并伴脑桥外病变,主要分布在双侧丘脑、三脑室侧壁、中脑,呈T1WI序列片状稍低信号,T2WI、T2-FLAIR序列稍高信号,弥散加权成像序列高信号,并T1WI序列中间小片状稍高信号。MRI诊断CPM及EPM。给予相关治疗约20 d后因患者病情危重,家属放弃治疗,自动出院。结论大面积烧伤可致患者出现CMP及EPM。头颅MRI检查对髓鞘溶解症有重要诊断价值,T1WI序列出现中间小片状稍高信号,考虑与髓鞘溶解后脂性代谢物有关。Objective To investigate clinical and imaging features of central pontine myelinolysis （CPM） and extra pontine myelinolysis （EPM） in order to improve understanding of the disease. Methods Clinical data of 1 patient with systemic extensive burns complicated by CPM and EPM was retrospective analyzed, and relevant literature was reviewed. Results The patient was admitted for more than 9 hours of coma 30 hours after multiple formaldehyde flame burns. Head CT examination showed no obviously abnormality in emergency department. Magnetic resonance imaging （MRI） examination was performed 15 days after admission, and it showed that symmetry lesion distribution with extra pontine lesions, and they mainly distributed bilateral thalamus, lateral wails of third ventricles and midbrain, which appeared foliated hypo-intense in T1WI, hyper-intense in T2 WI and T2-FLAIR, hyper-intense in diffuse weighing imaging （DWI） and hyper-intense in central pontine in T1WI. MRI diagnosis was CPM and EPM. The patient was treated with related treatment for about 20 days. The family had given up treatment due to patient＇s severe conditions, and then the patient automatic discharged. Conclusion Extensive burns patient may be associated with CPM and EPM. Head MRI examination has important value in diagnosis of myelinolysis. The abnormal hyper-intense in T1WI in central pontine may be correlated with lipoid metabolin after myelinolysis.

关 键 词：烧伤 髓鞘溶解 中心性脑桥 髓鞘溶解 脑桥外 

分 类 号：R445.2[医药卫生—影像医学与核医学] R644[医药卫生—诊断学]