1例非酒精性Marchiafava-Bignami病报道并文献复习  

Non-Alcoholic Marchiafava–Bignami disease:A Case Report and Literature Review

作　　者：汤可娜 项晓慧 Tang Ke-na;Xiang Xiao-hui(The Fourth Affiliated Hospital of Zhejiang University Medical College,Yiwu 322000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第四医院神经内科,浙江义乌322000

出　　处：《医学食疗与健康》2022年第25期155-158,共4页Medical Diet and Health

基　　金：癫痫患者长程管理中骨质疏松风险评估及预测模型研究(编号:2022503994)。

摘　　要：目的:报道一例非酒精性Marchiafava-Bignami病(MBD)的临床特征。方法:对一例诊断为MBD的患者的临床资料进行回顾性分析。结果:患者为52岁男性,表现为突发头晕、行走不稳,左上肢不听使唤,不能完成买菜、锻炼等日常生活事件,大小便控制欠佳;既往有糖尿病和脑梗死病史,无酗酒史及营养不良。查体:反应迟钝,左上肢异己手表现。患者平均血糖水平4.41 mmol/L,糖化血红蛋白4.4%,监测血糖波动在3.9~16.3 mmol/L,入院时血糖一直偏低。头颅MRI可见T2、FLAIR、DWI双侧胼胝体全程对称性高信号。调整患者降糖方案,对症支持治疗,3个月后病灶明显缩小,9月后病变几乎消失,胼胝体萎缩变薄。文献表明MBD经早期诊断,予维生素B1及激素治疗,可获得较好预后,本例患者经控制血糖等对症治疗后预后尚可。结论:MBD以慢性酒精中毒多见,且多数预后欠佳,但非酒精性MBD且无胼胝体外病变的患者通常预后较好。Objective:To report the clinical features of a non-alcoholic Marchiafava-Bignami disease(MBD).Methods:The clinical data of a patient diagnosed with MBD were analyzed retrospectively.Results:The patient was a 52-year-old man with sudden dizziness,gait disorder,uncontrolled left upper limb,and cannot complete daily life events such as shopping and exercise,with poor urine control.Past history of diabetes and cerebral infarction,no alcoholism and malnutrition.Physical examination:slow reaction,alien hand syndrome of left upper limb.Mean blood glucose level was 4.41 mmol/L,HbA1 c was 4.4%,glucose fluctuation at 3.9-16.3 mmol/L and was always low on admission.In brain MRI,bilateral corpus callosum showed symmetrical hypertensity on T2,FLAIR and DWI.We adjusted the patient's hypoglycemic regimen,given symptomatic supportive treatment.The intracranial lesions were significantly reduced after 3 months,and almost disappeared after 9 months,with the corpus callossum atrophy.The literature shows that if MBD was early diagnosed,and treat it with high doses of hormones and vitamin B1,may have a good prognosis.Our patient had a favorable outcome after symptomatic treatment.Conclusion:MBD was often seen in chronic alcoholism,mostly with poor prognosis.But MBD patients in non-alcoholic who have no lesions except the corpus callosum usually have better prognosis.

关 键 词：胼胝体 MBD 脱髓鞘 非酒精性 

分 类 号：R749.62[医药卫生—神经病学与精神病学]