脑桥中央髓鞘溶解症和脑桥外髓鞘溶解症5例临床分析

目的　探讨脑桥中央髓鞘溶解症 (CPM)和 /或脑桥外髓鞘溶解症 (EPM)的发病机制及早期预防和诊治原则。方法　对 5例CPM/EPM患者的临床表现、影像学资料及治疗转归进行分析。结果　临床观察发现 :(1)5例患者均存在严重的基础疾病 ,特别是严重的电解质紊乱 (低钠血症 ) ,不同程度的意识障碍 ,吞咽困难 ,构音障碍。 (2 ) 3例有四肢瘫 ,锥体束征阳性 ;1例表现为帕金森综合征。 (3) 5例头颅MRI均阳性。 (4) 5例均临床好转出院 ,生活自理。结论　 (1)CPM和 /或EPM的发生与低钠血症及快速纠正低钠血症有关。 (2 )CPM和 /或EPM并非致死性疾病 ,无论病情多严重 ,均不应放弃治疗。

Central pontine myelinolysis and /or extrapontine myelinolysis:a report of 5 cases

Objective To explore the pathophysiological mechanism,the early diagnosis and treatment of central pontine myelinolysis and /or extrapontine myelinolysis.Methods The data obtained from clinical features,cranial MRI imagine and therapy outcome were thoroughly analyzed.Results (1)All 5 cases of CPM/EPM were occurring in patients who had already had somatic disease and serious systemic functional failure,especially in those who had had seriously water and ion disturbances,such as hyponatremia,All patients had various degree of coma and dysphagia and dysartgria.(2)3 of the 5 patients had quadriplegia and positive pyramidial signs.Another exhibited Parkinsonism.(3)Distribution of Lesions seen on the cranial MRI appeared in all patients,which is the most reliable technique for diagnosing EPM/CPM when patients are still alive.(4)All 5 patients recovered well and could live by themselves.Conclusions The occurrence of hyponatremia and its too rapid correction may be associated with the onset of CPM/EPM.CPM/EPM is not a deadly disease,which can be cured when properly treated.