甲苯中毒性脑病3例的随访观察

Follow-up observation of 3 cases with subacute toluene Toxic encephalopathy caused by toluene

目的观察急性甲苯轻度中毒性脑病的临床和磁共振动态变化。方法回顾性分析3例急性甲苯轻度中毒性脑病患者的临床资料,采用简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)对其分别于发病后的7d、1m±3d、3m±5d行认知功能评估。结果3例患者入院时均有头晕、头痛,发病1m时症状缓解,发病3m时出现多梦,密闭拥挤空间易头部不适症状;3例患者首次头部MRI表现为两侧大脑半球白质广泛受累,累及两侧深部核团、内外囊、小脑齿状核,病灶T1WI1例呈低信号,2例呈等信号,T2WI、DWI、FLAIR呈高信号,ADC呈等信号,1例行增强扫描未见强化;发病1m时,3例患者的MRI均无明显变化;发病3m时,3例患者的MRI示原有病灶消失,1例出现脑萎缩表现;1例患者存在认知障碍,发病后7d、1m、3mMMSE、MoCA评分无明显差异。结论职业性急性轻度甲苯中毒性脑病以头部MRI异常为主要特征,临床表现不典型;长期接触甲苯可致脑萎缩,损害认知功能。

Objective To observe the clinical and magnetic resonance changes of acute mild toluene poisoning encephalopathy.Methods The clinical data of 3 patients with acute mild toluene poisoning encephalopathy were retrospectively analyzed.The cognitive function was evaluated by(MMSE),Montreal Cognitive Assessment scale(MoCA) on 7 days,1 month±3 days and 3 months±5 days after onset.Results All the 3 patients had dizziness and headache at admission,symptoms were relieved at 1 month after onset,and many dreams appeared at 3 months after onset,and the symptoms of head discomfort were easy to be found in closed and crowded space.The first time MRI showed extensive involvement of white matter in both hemispheres,involving bilateral deep nuclei,internal and external bursa,dentate nucleus of cerebellum,T1WI in 2 cases,low signal in 1 case,high signal in T2WI and DWI,FLAIR,and isointense in ADC.No enhancement was found in 1 case.At 1 month,the MRI of all the 3 patients had no obvious change,and the MRI of 3 cases showed that the original lesion disappeared,and the brain atrophy appeared in 1 case.There was no significant difference in MMSE,MoCA scores between 7 days,1 month and 3 months after onset of the disease in one patient with cognitive impairment.Conclusion The main characteristics of occupational acute mild toluene poisoning encephalopathy are abnormal brain MRI and atypical clinical manifestations,and long-term exposure to toluene may lead to brain atrophy and impairment of cognitive function.