无低钠血症的脑桥中央髓鞘溶解症的临床及影像学特点分析  

Clinical and imaging characteristics of central pontine myelinolysis without hyponatremia

作　　者：晁琳琳 蔡萌萌 师晶晶 聂肖肖 赵建华[2] Chao Linlin;Cai Mengmeng;Shi Jingjing;Nie Xiaoxiao;Zhao Jianhua(Department of Neurology,Henan Provincial People's Hospital,Xinxiang Medical University,Zhengzhou 453003,China;Department of Neurology,He'nan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]新乡医学院河南省人民医院神经内科,郑州453003 [2]河南省人民医院神经内科,郑州450003

出　　处：《中华神经医学杂志》2023年第12期1260-1263,共4页Chinese Journal of Neuromedicine

基　　金：河南省医学科技攻关计划项目(SBGJ202102034);河南省科技计划重点项目(22210231077)。

摘　　要：目的总结无低钠血症的脑桥中央髓鞘溶解症(CPM)的临床及影像学特点并探讨其发病机制。方法回顾性分析河南省人民医院神经内科自2021年3月至2023年3月收治的6例无低钠血症CPM患者的基本信息、可能病因、既往史、临床表现,以及发病时、发病1个月后、发病3个月后MRI特点。通过改良Rankin量表(mRS)评分评估患者发病后3个月时预后,mRS评分≤2分为预后良好,mRS评分>2分为预后不良。结果 6例无低钠血症的CPM患者中,男性4例,女性2例;4例患者表现为头晕,3例患者表现为头痛,4例患者出现肢体无力,另分别有2例患者出现认知下降、反应迟钝表现。4例CPM患者有高血压病史,5例CPM患者有糖尿病史,1例CPM患者有酒精性肝硬化病史。全部患者给予激素治疗、营养支持及对症治疗,发病3个月后5例患者明显好转,1例预后不良。患者MRI表现为脑桥基底部、双侧脑桥臂对称性异常信号影;T1WI低信号、T2WI高信号、T2-FLAIR高信号、DWI高信号,边界清楚,无明显占位效应及强化。DWI序列诊断早期CPM较敏感,可在临床症状出现24 h内出现高信号改变,发病3个月后转为等信号影。结论无低钠血症的CPM诱因多为高血压、糖尿病、营养不良、慢性酒精中毒等,发病初期MRI可出现"猪鼻征"、"蝙蝠翅征"、"三叉戟征"等特征性改变。Objective To investigate the clinical and imaging characteristics of central pontine myelinolysis(CPM)without hyponatremia and explore its pathogenesis.Methods A retrospective analysis was performed.Six CPM patients without hyponatremia,admitted to Department of Neurology,He'nan Provincial People's Hospital from March 2021 to March 2023 were chosen.Demographic information,causes,medical history,clinical presentations,and MRI features at onset,and 1 and 3 months after onset were analyzed.The prognoses were evaluated by modified Rankin Scale(mRS)scores 3 months after onset:mRS scores≤2 was classified as good prognosis,and mRS scores>2 as poor prognosis.Results In these 6 CPM patients without hyponatremia,4 were males and 2 females;4 patients had dizziness,3 headache,4 limb weakness,2 cognitive decline,and 2 slow reaction.Four CPM patients had a history of hypertension,5 had a history of diabetes,and 1 had a history of alcoholic cirrhosis.Hormone therapy,nutritional support and symptomatic treatment were given;5 patients had obvious improvement,and 1 had poor prognosis 3 months after onset.MRI showed asymmetrical abnormal signal in the basal pons and bilateral brachium pontis,with T1WI hypointensity,T2WI hyperintensity,T2-FLAIR hyperintensity,DWI hyperintensity and clear boundary,and without obvious mass effect or enhancement.DWI sequence enjoyed good diagnostic sensitivity in early stage of CPM:high signal changes could occur within 24 h of clinical symptoms,and isointensity 3 months after onset.Conclusion Causes of CPM without hyponatremia are mostly hypokalemia,diabetes,malnutrition,and chronic alcoholism;its characteristic MRI manifestations are"pig nose sign","bat wing sign"and"trident sign".

关 键 词：脑桥中央髓鞘溶解症 低钠血症 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学]