28例中毒性脑病患者临床表现及治疗分析

Clinical manifestation and treament analysis of 28 cases of toxic encephalopathy

目的 分析不同原因引起的中毒性脑病的临床表现及影像学表现,并探讨其治疗方法.方法 对2003年3月至2013年1月经我院临床确诊为中毒性脑病患者共28例进行了回顾性分析,观察不同原因引起的中毒性脑病的临床表现、磁共振（MRI）特点及临床治疗效果.结果 28例中毒性脑病患者头部磁共振均表现是白质、深部核团和灰质的长T1长T2信号.其中13例急性中毒性脑病MR均表现为病灶T1像强化,提示存在血管源性水肿,而DWI序列的高信号提示细胞毒性水肿；28例患者中,13例影像学表现为正效应（脑水肿）,临床表现10例以头痛、呕吐及视乳头水肿为首发症状（76.9％）,8例表现为癫痫发作（61.5％）.经脱水和激素治疗后,11例临床治愈（84.6％）,2例因治疗时间短及停药早而导致死亡（15.4％）.15例影像学表现为负效应（脑萎缩）,有11例以反应迟钝、记忆力下降为首发症状（73.3％）,8例以肢体震颤、走路不稳为首发症状（53.3％）.经治疗临床治愈率达100％.结论 不同原因的中毒性脑病具有一定的影像学特征,且存在细胞内外水肿,治疗上应早期、长程、足量使用脱水及激素治疗.

Objective To study the clinical manifestation and MRI feature of toxic encephalopathy caused by different reasons,and discuss the treatment.Methods Retrospective analysis of the 28 cases of toxic encephalopathy in our hospital from March 2003 to Jan 2013 who suffered by different toxic substance,in order to observe the clinical manifestation,MRI feature and clinical therapeutic effect of them.Results All of the 28 cases were seen long T1 and long T2 signal intensity in the white matter,deep nucleus,and gray matter by MRI.And 13 cases of acute toxic encephalopathy showed T 1-weighted images,which suggesting vasogenic edema,while long intensity in DWI images means cytotoxic edema.Of 28 cases,13 cases were presented positive effect （cerebral edema）,10 cases were manifested headache,vomit and papilloedema（76.9%）,8 cases were seizure（61.5%）.And 11 cases were clinically cured （84.6%） by dehydration and dexamethasone,and 2 cases were dead due to short-time dehydration and untimely drug withdrawal （15.4%）.The other 15 cases were presented negative effect （encephalatrophy）,11 cases were bad-response and declined memory（73.3%）,8 cases were limb tremor and walking instability（53.3%）.All of the 15 cases were cured.Conclusion The toxic encephalopathy caused by different reasons have specific imaging features,and exist both intracellular and extracellular edema,so an early,longrange and full-dose treatment of dehydration and dexamethasone should be useful.