海洛因海绵状白质脑病的临床和病理(附1例报告)

Clinical manifestation and pathological features of heroin spongiform leucoencephalopathy: report of a case

报道1例海洛因海绵状白质脑病的临床和病理，并复习文献进行分析。 海洛因海绵状白质脑病具有如下特点：有经鼻吸海洛因史；亚急性或急性起病；多以小脑受损为首发症状，亦可表现为突然昏迷、抽搐；以运动障碍为主；脑脊液正常；尿吗啡实验可为阴性；影像学具有特征性的脑白质广泛受累，小脑白质受累最早、最严重，病变双侧对称，CT呈低密度，无占位效应，增强无强化。主要病理改变为脑白质海绵状变性。推测病因可能与海洛因不纯含有杂质有关。有海洛因吸入史者，一旦出现脑部症状，要及早行影像学检查，明确诊断。本病为我国大陆第1次在海洛因吸食者中发现，对预防和治疗吸毒所引起的并发症有指导意义。

This was a report of clinical manifestation and CT and pathlogical features in a patient with heroin spongiform leucoencephalopathy. By analyzing the clinical characteristics, CT and biopsy findings of 1 patient and reviewing literatures , the characteristics of pathology and clinic of heroin spongiform leucoencephalopathy are as followed: (1)There is the history of inhalation of the pyrolysate of impure heroin. (2) The onset, usually acute or subacute. (3) The onset was characterized by a cerebellar signs, including progressive dysarthria,cerebellar ataxia, and dystonia. (4) The central motor system was predominanatly involved. (5) CSF is normal. (6) The test of urine for morphine may be negative. (7) Brain computed tomography imaging may reveal extensive symmetric white matter involvement of bilateral cerebral hemispheres , especially cerebellar hemispheres.The lesions which are not contrast enhancing is hypodense on CT. (8) Spongiform changes morphologically characterizes the lesions. The inhaling 'heroin' pyrolysate could lead to spongiform leucoencephalopathy. There have been suspicions about possible contamination of small batches of the drug by an unknown substance that is activated by heating. The patients, who have the history of inhaling 'heroin' pyrolysate, should be immediately examined by CT or MRI when the signs of brain damage, especially cerebellar signs. It is the first time that the disease have been reported in China(except Taiwan), and the statement has important significance for prevention and treatment the complication from taking heroin.