职业性有机溶剂中毒15例临床表现和影像学特征分析

The analysis of clinical and imaging features in 15 patients with occupational organic solvent poisoning

目的探讨职业性有机溶剂中毒的临床表现、神经影像学特征、治疗及预后。方法回顾性分析15例职业性有机溶剂中毒患者的临床资料。结果 15例患者均急性或亚急性起病,有明确的有机溶剂职业接触史,主要临床表现包括头晕(73.3%)、认知功能下降(60%)、锥体束损害(53.3%)、颅内高压综合征(46.7%)、意识障碍(33.3%);其中14例患者头颅磁共振成像(Magnetic resonance imaging, MRI)显示为弥漫性脑组织肿胀,以双侧大脑半球白质为主,呈"火焰状",10例累及双侧基底节(苍白球),8例累及双侧小脑齿状核,呈"肾形"改变,5例累及双侧丘脑;所有患者使用脱水剂、糖皮质激素及高压氧等综合治疗后,其中12例患者好转出院,无或仅遗留轻微后遗症,3例患者无明显改善,预后差。结论职业性有机溶剂中毒以头晕、认知功能下降、锥体束损害、颅内高压综合征及意识障碍等中毒性脑病表现为主,典型头颅MRI为双侧大脑半球白质、苍白球及小脑齿状核对称性病变,结合患者职业接触史需考虑本病;早期、长程、足量给予脱水剂、糖皮质激素及高压氧等综合治疗,大多数患者预后良好。

Objective To observe the clinical manifestations, neuroimaging features, treatment and prognosis of occupational organic solvent poisoning. Methods The clinical data of 15 patients with occupational organic solvent poisoning were collected for a retrospective analysis. Results The 15 patients were with an acute or subacute onset, and they all had a clear history of occupational exposure to organic solvents. The main clinical manifestations included dizziness(73.3%), cognitive decline(60%), pyramidal tract damage(53.3%), intracranial hypertension syndrome(46.7%) and consciousness disorders(33.3%). Cranial magnetic resonance imaging(MRI) showed diffused brain swelling in 14 patients, which was mainly in the white matter of bilateral cerebral hemispheres, showing a "flame-like" shape. The bilateral basal ganglia(pallidum) were involved in 10 patients, while bilateral cerebellar dentate nuclei were involved in 8 patients, showing a "kidney-shaped" feature. The bilateral thalamus was involved in 5 patients. After comprehensive treatment with dehydration, glucocorticoid and hyperbaric oxygen, 12 patients were discharged with no or only minor sequelae, and 3 patients showed no significant improvement and poor prognosis. Conclusion The manifestations of occupational organic solvent poisoning were mainly toxic encephalopathy, such as dizziness, cognitive decline, pyramidal tract damage, intracranial hypertension syndrome, and consciousness disorders, etc. Typical cranial MRI showed symmetrical lesions in white matter, pallidum and cerebellar dentate nuclei in bilateral hemispheres. The diagnosis should be considered in combination with the patient’s history of occupational exposure. Early long-term and adequate treatment with dehydration, glucocorticoid and hyperbaric oxygen could get a good prognosis in most patients.