脑出血后迟发型、反常性水肿4例报道及其发生机制初探

目的：报道4例脑出血后迟发型反常性水肿患者的临床特征，同时利用影像学检测的方法，对其发生机制进行初步的探讨。对象和方法：本研究报道的4例脑出血后迟发型反常性水肿患者均为2005．6～2006．3月间我院住院患者。作者利用CT、MR等影像学检测方法，对甘露醇影像学特征和患者脑水肿影像学特征进行对比分析，提出脑出血后迟发型反常性水肿的发生机制的假说。结果：甘露醇CT扫描显示低密度的CT影像学特征，同时，随着甘露醇浓度的降低，其CT密度值也相应的减小。核磁共振扫描结果提示，与脑组织相比，甘露醇表现短T1、长T2信号的磁场特征。研究结果表明，脑出血后迟发型反常性水肿患者的水肿表现与甘露醇CT、MR影像特征十分相似。结论：脑出血后迟发型反常性水肿的临床转归、影像学特征与常规脑水肿不同，可能是一个独立的病理实体。该病理过程的发生可能与脑出血后甘露醇的大量、长时程应用有关。

Objective：To report the clinical characteristics of cerebral edema of four cerebral hemorrhagic patients and investigate its probable mechanism with computed topography and magnetic resonance imaging technique. Subjective and methods： The patients enrolled in our study were all inpatients of our hospital consecutively selected during Jun 2005 to Mar 2006. With CT and MR, we contrast the characteristics of cerebral edema of these four patients and that of mannitol and establish the hypothesis on this special pathologic phenomenon. Results： The mannitol appears low density in CT imaging, and its CT value was parallel with its concentration. Contrasted with normal brain tissue, mannitol manifest high signal in T1 and T2 magnetic resonance imaging. The characteristics of cerebral edema of patients enrolled in our study on CT and MR is similar to that of mannitol. Conclusion： The clinical and imeging characteristic of delayed uncommon edema post cerebral hemorrhage is different from that of common edema happened after cerebral hemorrhage, it might be a special independent etiology. The occurrence of this pathological phenomenon perhaps is related to high dose and long distance applying of mannitol.