滥用海洛因致迟发性白质脑病(附病理报告和文献复习)

Delayed leukoencephalopathy induced by abuse of heroin (a case of pathology report with review of literature)

目的 :报告滥用海洛因致迟发性白质脑病的临床 ,MRI和病理 ,并结合文献探讨可能的病理机制。方法 :收集 2例长期滥用海洛因引起严重神经功能缺损患者的临床、头颅MRI和脑脊液资料 ,并对 1例进行脑病理活检。结果 :2例患者临床均有严重的智能受损、双侧锥体束及脑干受损 ,1例有严重的双侧小脑受损。头颅MRI示广泛大脑半球白质和脑干T1 略低信号、T2高信号改变 ,1例伴有广泛小脑白质的T1 低信号和T2 高信号改变。病理活检结果示 :大部分髓鞘变性、水肿、松解及融合 ;轴突严重水肿、内有细胞器破坏 ;少量星形细胞变性、无炎症细胞浸润和血脑屏障破坏。结论 :海洛因引起迟发性白质脑病的病理机制尚不清楚 。

Objective: To report the abuse of heroin leading to delayed leukoencephalopathy(DLE) and to investigate the possible mechanism of DLE with review of literature. Methods : To collect clinic, brain MRI and cerebral spinal fluid(CSF) of two patients with severe nerve deficit induced by abuse of heroin and make an examination of brain biopsy. Results : Two patients clinically demonstrated severe intellect damage, bilateral pyramid tracts and brain stem damage, one case with bilateral cerebrum ataxia. Two cases of brain MRI showed T 1 low signal and T 2 high signal of bilateral cerebral white matter and brain stem,one case with cerebellum white matter, brain pathological examination showed myelin severe edema ,spongiosa, and demyelinating; axon swelling and including organella destructive, astral cells degenerative, inflammatory cells such as Mφ cells and lymphocytes unseen and blood brain barrier spared. Conclusion : The mechanism of DLE induced by heroin was unknown. It is possible to correlate with anoxia or individual prediposition.