二氯乙烷中毒性脑病8例临床及影像学分析

Clinical features and Imaging analysis of toxic encephalopathy induced by 1,2- Dichloroethane

目的 探讨1,2-二氯乙烷（1,2-DCE）中毒性脑病的临床表现、影像学特点、治疗与预后的关系.方法 对8例1,2-DCE中毒性脑病患者的临床表现、影像学特点、治疗及预后作回顾性分析.结果 急性或亚急性1,2-DCE中毒性脑病以全脑症状和严重的颅高压为主要临床表现;病变早期CT及MR检查可显示弥漫性脑水肿和脑肿胀,弥散加权成像（DWI）显示大脑皮层下白质对称性弥散性低密度,弥散系数图（ADC）值的下降;随着病变的好转,脑水肿减轻,病灶逐渐减小,病灶区ADC值增高.早期应用足量甘露醇、激素及加用高压氧治疗,能改善预后.结论 1,2-DCE中毒性脑病的诊断主要根据患者有明确毒物接触史、临床表现及影像学特点,早期采取及时正确的治疗措施控制脑水肿,对改善预后具有重要意义.

Objective To explore the clinical features, characteristics of neuroimaging and prognosis of toxic encephalopathy induced by 1,2- Dichloroethane. Methods The clinical features,characteristics of neuroimaging and prognosis in eight cases with toxic encephalopathy induced by 1,2- Dichloroethane were analyzed retrospectively. Results In acute or subacute stage of toxic encephalopathy induced by 1,2- Dichloroethane, the whole brain injury symptoms and severe intracranial hypertension were the main neurological manifestations. CT and MR examination showed diffused encephaledema and brain swelling. DWI test showed the symmetric diffused low density lesions in white matter of cerebral hemisphere,and the average values of ADC decreased significantly. With the disease improving, the brain swelling was alleviated, the brain lesion foci reduced gradually, and the average values of ADC increased. The prognosis will be improved dramatically if sufficient mannitol, hormone and high pressure oxygen were used in the early stage. Conclusion The diagnosis of toxic encephalopathy induced by 1,2- Dichloroethane depends mainly on the clear toxicant contact history, clinical features and characteristics of neuroimaging. Taking effective measures in the early stage to control actively the encephaledema would be beneficial to the prognosis.