脑桥外髓鞘溶解症的临床特点(附1例报道及文献分析)

Clinic features of extrapontine myelinolysis:review of literature and 1 case report

目的提高临床医生对脑桥外髓鞘溶解症(extrapontine myelinolysis,EPM)的病因、临床及影像学特点的认识。方法回顾性分析本科收治的1例EPM的临床资料。结果本例患者中年女性,在治疗咯血过程中出现重度低钠血症,病后1周发现血钠为109 mmol/L,给予迅速补钠后渐出现精神行为异常,并进行性加重,头颅MRI示双侧豆状核、尾状核、丘脑对称性异常信号。经积极治疗后疗效不佳,随访6个月病情无恢复。结论 EPM是少见的中枢神经系统髓鞘溶解性疾病,目前认为与过快纠正低钠血症相关,本病重在预防,一旦发生则预后不良,提醒临床医生注意补钠速度以防发生EPM。

Objective To improve the knowledge of the etiology, clinical and MRI features of the extrapontine myelinolysis （EPM）. Methods A retrospective analysis of I case of EPM in our clinic department. Results A middle-aged woman had severe hyponatremia during hemoptysis treatment. The concentration of sodion in serum decreased to 109 mmol/1 in the first week after admission. The patient received rapidly correction of hyponatremia, and then had progressive abnormal psycho-behavior. Brain magnetic resonance imaging （MRI） showed symmetric abnormal signal of lenticular nucleus and thalamus. However, the symptoms were not relieved after active treatment, even after being followed up for six months. Conclusions EPM is a rare demeylinating disease of central nerve system which is known to be associated with rapidly correction of hyponatremia. Because the prognosis of EPM is unfavourable, the prevention of EPM is the most important one. In order to prevent EPM, the sodium correction speed requires more attention by clinician.