新型冠状病毒感染相关渗透性脱髓鞘综合征的临床和影像特征分析  

Clinical and imaging analysis of COVID-19-related osmotic demyelination syndrome

作　　者：仇宇悦 毛晨晖 包嘉璐 尚丽 王添艺 李博 黄益炫 姜宇涵 褚姗姗 金蔚 董立羚 冯逢[2] 高晶 Qiu Yuyue;Mao Chenhui;Bao Jialu;Shang Li;Wang Tianyi;Li Bo;Huang Yixuan;Jiang Yuhan;Chu Shanshan;Jin Wei;Dong Liling;Feng Feng;Gao Jing(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,State Key Laboratory of Complex Severe and Rare Diseases,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经科,疑难重症及罕见病国家重点实验室,北京100730 [2]中国医学科学院北京协和医学院北京协和医院放射科,北京100730

出　　处：《中华神经科杂志》2024年第7期763-769,共7页Chinese Journal of Neurology

基　　金：科技部重点研发计划(2020YFA0804500,2022YFA0804501);中国医学科学院医学与健康科技创新工程(2021-I2M-1-020);北京协和医院中央高水平医院临床科研专项(2022-PUMCH-A-254,2022-PUMCH-D-007)。

摘　　要：目的分析新型冠状病毒感染(COVID-19)相关渗透性脱髓鞘综合征(ODS)患者的临床和影像特点,以促进临床早期识别。方法回顾性分析2020年1月至2023年9月北京协和医院神经科诊治的COVID-19相关ODS病例,总结其病史、可能诱因、临床和影像学表现、治疗及预后。结果共纳入5例COVID-19相关ODS患者。所有患者(5/5)在ODS前均存在电解质紊乱,4例明确存在低钠血症。4/5的患者最早表现为意识障碍,随后以肌张力障碍为主。所有患者(5/5)影像学均表现为孤立性脑桥外髓鞘溶解症(EPM),随病程延长信号可恢复,部分见病灶萎缩。患者临床症状在数天至数月内部分缓解。结论COVID相关ODS的发生多与低钠血症相关,EPM多见。COVID-19应被视为ODS的危险因素。Objective To analyze the clinical and imaging features of patients with COVID-19-related osmotic demyelination syndrome(ODS).Methods COVID-19-related ODS cases diagnosed in the Department of Neurology,Peking Union Medical College Hospital from January 2020 to September 2023 were retrospectively reviewed.And their past medical history,possible triggers,clinical manifestations,imaging manifestations,treatment and prognosis were summarized.Results A total of 5 patients with COVID-19-related ODS were included.Electrolyte disturbances acted as an inducement of ODS in all patients(5/5),4 of whom with hyponatremia.Four of 5 patients first presented with disturbance of consciousness,followed by predominant dystonia.Imaging of all patients(5/5)showed isolated extrapontine myelinolysis(EPM).With the prolongation of the course of disease,such signal intensity could return to normal,and lesions showed atrophic changes in some patients.The patients′clinical symptoms were partly relieved within a few days to a few months after treatment.Conclusions COVID-19-related ODS is mostly associated with hyponatremia,and EPM is more common.COVID-19 should be considered as a risk factor for ODS.

关 键 词：渗透性脱髓鞘综合征 新型冠状病毒感染 磁共振成像 临床表现 预后 

分 类 号：R511[医药卫生—内科学] R744.5[医药卫生—临床医学]