急性CO中毒迟发性脑病临床及MRI特点探讨

The clinical and imaging characteristics of delayed encephalopathy after acute carbon monoxide poisoning

目的探讨急性CO中毒迟发性脑病的临床及MRI特点。方法回顾性分析14例急性CO中毒迟发性脑病的临床资料。结果首发症状智能下降(MMSE评分<20分)14例(100%),尿失禁11例(78%);有6例患者HCT升高较明显,均值0.503±0.027;磁共振改变分白质弥漫性病变、皮质改变和神经核团改变3类,多合并存在;14例予改善循环治疗,9例予激素等治疗,好转率85%,未使用激素的5例皆好转。结论HCT升高可能是引起脑微循环障碍导致急性CO中毒迟发性脑病原因之一,治疗上应严密监测患者该值的变化,监测和治疗的时间应不少于3～6个月;除常规高压氧治疗外,还应实施改善脑循环和抗血小板聚集的治疗;DTI显示的FA值普遍减低,说明脑内长束纤维有脱髓鞘改变,激素的使用可能有一定作用,但治疗前最好进行DTI扫描,以便个体化治疗。

Objective To discuss the clinical and imaging characteristics of delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods： The clinical data of 14 patients with DEACMP were respectively analyzed. Results： Initial symptom included mentally falling （MMSE rate 〈 20 points） in 14 patients （100%）, incontinence of urine in 11 patients （78%）. Relatively significant increase of hematoma （HCT） （average level 0.503±0.027） was found in 6 patients. Three kinds of brain magnetic resonance imaging （MRI） appearance including diffuse white matter lesion, cortical lesion and basal nuclei lesion often existed in association. Therapy for improving circulation was given in 14 patients, and therapy with hormone was given in 9 patients; with 85% improvement rate. 5 patients without hormone therapy but with improving circulation therapy also received improvement. Conclusion： High level of HCT might be one of the causes of DECACMP due to acute disturbance of brain micro-circulation. Close monitoring the change of HCT levels should be adopted for at least 3-6 months during therapy. Therapy for improving circulation and for anti-agglutination of platelets should be performed besides the routine high-tension oxygen therapy. Low FA value on DTI indicates the occurrence of a demyelization change in the brain long tract fibers, which indicated therapeutic effect of hormone treatment. And, therefore it would be better to perform DTI scan before therapy for individualized therapy.