1,2-二氯乙烷中毒性脑病的临床及影像学特点分析

Clinical and imaging features of 1,2-dichloroethane toxic encephalopathy

目的探讨亚急性l,2-二氯乙烷中毒性脑病的临床特点。方法回顾性分析1例临床诊断明确的l,2-二氯乙烷中毒性脑病患者的临床表现、辅助检查及救治过程,并结合文献总结其临床特点。结果患者亚急性起病,突出表现为头痛、呕吐、意识障碍等严重高颅压症状及记忆力下降、反应迟钝、理解力及计算障碍等高级皮层功能受损症状;甲状腺功能减退;头颅影像示双侧大脑半球弥漫性脱髓鞘病变,脑组织肿胀,脑室受压,双侧小脑齿状核、双侧苍白球病变,病灶在MRI上T1WI呈低信号,T2WI高信号,在头CT呈低密度影。治疗期间因腰穿脑压正常而停用脱水药物后病情加重,经长期、足量脱水剂、糖皮质激素治疗后症状明显好转,发病6个月后患者临床症状、影像学及甲状腺功能恢复正常。结论 l,2-二氯乙烷中毒性脑病脑水肿严重,持续时间长,充分控制脑水肿是治疗成功的关键。

Objective To explore the clinical and neu roimaging features of toxic encephalopathy induced by 1, 2- dichloroet ha ne（1, 2-DCE）. Methods The clinical, CT/MRI feaures and t reatment of one pat ie nt with toxic encephalopathy induced by 1,2-DCE were obser ved and analyzed ret rospectively. Results The woman presented a subacute onset. The main neu rological manifestations were severe int racranial hy per tension and whole brain injury symptoms. The symptoms included headache, vomiting, conscious disturbance, memory deterioration, delayed reaction and understanding, calculation power deterioration and thyroid hypofunction. Cranial MRI/CT showed diffused encephaledema and brain swelling, vague sulcus, shallow sulcus and cister n and nar row ventricles. MRI showed T1 WI low signals and T2 WI high signals in bilateral hemispheric white matter, cerebellar dentate nucleus and globus pallidus. Lesions appeared as hy podensit y on CT. The patient’s conditions worsened af ter the dehyd rating agent was withd rawn because lumbar cerebrospinal fluid pressures became normal during the treatment. After the full dose and long-term treatment with the dehydrating agent, glucocor ticoid and suppor tive t reatment, the patient improved a great deal. After a follow-up of 6 months, the patient recovered completely. Conclusion Toxic encephalopathy induced by 1,2-DCE shows long-term severe encephaledema, effective control of which is critical to prognosis.