摘要
目的探讨渗透性脱髓鞘综合征的发病机制、临床表现及MRI特点。方法分析1例以脑梗死为首发症状的糖尿病肾病合并无症状性渗透性脱髓鞘综合征患者的临床资料,并结合文献进行分析。结果该患者存在高血糖、高血钾、高尿素氮、高肌酐,长期处于慢性高渗状态。头颅MRI显示脑桥基底部对称长T1长T2信号的蝶形病灶,但患者无脑桥中央髓鞘溶解症的临床表现。经治疗2w复查头颅MRI,脑桥蝶形病变仍清晰,但头颅DWI示其高信号明显变淡。结论长期高渗状态可导致慢性脑桥渗透性脱髓鞘,此时可不出现脑桥中央髓鞘溶解的临床表现,虽经积极治疗,也仅可改善细胞毒性水肿。
Objective To explore the pathogenesis,clinical presetation and MRI features of osmotic demyelination syndrome.Methods The clinical data of one case of diabetic nephropathy and asymptomatic osmotic demyelination syndrome with cerebral infarction as initial presentations was retrospectively analyzed.Results The patient was in chronic hypertonic state,accompanied with the hyperglycemia,hyperkalemia,high urea nitrogen and reatinine.MRI of the brain revealed osmotic demyelinatio with low T1-singal intensities and high T2-singal intensities which were located symmetrically in the pons,but the patient was not accompanied with any clinical presentations of central pontine myelinolysis.After 2 weeks of treatment,checked the MRI of brain again,the second imaging was similar to the prior one,but the DWI showed significantly lower singal intensities.Conclusion Long-term hypertonic state may lead to chronic osmotic demywelination in pons,but without related clinical presentations of central pontine myelinolysis.Although actively treated,only cytotoxic edema changes for the better.
出处
《脑与神经疾病杂志》
2013年第5期363-365,共3页
Journal of Brain and Nervous Diseases
