热射病致迟发性脑病一例的临床病理报道

A clinical and pathological report of delayed encephalopathy after heat stroke

目的探讨1例热射病致迟发性脑病患者的临床表现、动态影像学变化及脑组织病理特点。方法于2019年10月,回顾性分析1例热射病致迟发性脑病的临床表现、脑脊液、脑电图、影像学及脑活检组织病理。结果患者40岁男性,高温环境作业时出现高热、头晕、意识不清。脑电图见弥漫性慢波活动。影像学早期未见明显异常,数天后逐渐出现丘脑基底节区异常信号;2月余后核磁共振成像(MRI)发现大脑皮层下大面积异常信号,并累及白质。脑活检组织病理见皮层神经元丢失、白质呈疏松样、明显脱髓鞘改变,蛛网膜下腔、脑膜、皮白质均未见到炎性细胞浸润。结论影像学检查动态变化对热射病致脑组织时相性损害的诊断有重要意义;热射病脑损害的病理改变主要为髓鞘脱失。

Objective To explore the clinical manifestations,dynamic neuroimaging changes and brain histopathologic characteristics of a patient with delayed encephalopathy after heat stroke.Methods In October 2019,the clinical manifestations,electroencephalogram,cerebrospinal fluid,imaging changes and brain histopathological characteristics of a patient with brain damage caused by heat stroke were retrospectively analyzed.Results The patient was a 40-year-old male who suddenly appeared dizziness,unconscious,high fever when working in the high temperature environment.The EEG showed diffuse slow wave activity.Early CT was normal,and abnormal signals gradually appeared in the basal ganglia region of the thalamus after a few days.In the late,the MRI found a large area of abnormal signals under the cerebral cortex,and white matter was involved.Pathological examination of brain biopsy showed that cortical neuron loss,loose white matter changes,and significant demyelination changes,while no inflammatory cell infiltration was observed in subarachnoid space,meninges,and dermal white matter.Conclusion Imaging examination dynamic changes of the delayed encephalopathy is important in the heat stroke,and the main pathological manifestation is demyelination.