脑桥中央和脑桥外髓鞘溶解症的临床分析和影像学特点

目的 探讨脑桥中央和脑桥外髓鞘溶解症的临床及神经影像学特点.方法 分析5例脑桥中央髓鞘溶解症和2例脑桥外髓鞘溶解症患者的临床特点,包括基础疾病、起病前诱因、临床表现、头颅MRI特点、治疗及预后情况.结果 7例患者均有慢性形成低钠血症后被快速纠正的病史,以意识改变、构音和吞咽困难、四肢瘫痪等为临床表现.5例脑桥中央髓鞘溶解症的MRI表现为脑桥部位对称性的T1加权低信号灶、T2加权高信号灶,均呈典型"蝙蝠翅"样的改变;2例脑桥外髓鞘溶解症者分别在丘脑、基底节区域有对称性的T1加权低信号、T2加权高信号病灶.5例患者基本痊愈.结论 髓鞘溶解症的发病与低钠血症及过快补钠有关,缓慢纠正慢性形成的低钠血症是预防的关键. Abstract： Objective To investigate the clinical features and neuroimaging features of myelinolysis in central pontine and extrapontine. Methods The clinical features of 5 patients with central pontine myelinolysis and 2 cases with extrapontine myelinolysis were analyzed,including the inducing factors,clinicalmanifestations,cranial MRI,treatrnent and prognosis. Results All the seven patients had the history of rapidity of correcting chronic hyponatraemia, The common clinicalrranifestations included change of consciousness, dysphasia,dysphagia tetraplegia etc. The MRI of 5 cases of central pontine myelinolysis showed pontine parts of the symmetry T1-weighed low signal lesions,T2-weighed high signal lesions,all showed typical change like "Bat Wing". Two cases of extrapontine myelinolysis respectively in the hypothalamus、basical ganglia region of summetry T1-weighed low signal,T2-weighed high signal lesions.Five examples were basically cured. Conclusions The incidence of myelinolysis is related to hyponatremia and rapidity of correcting chronic hyponatraemia,and avoiding the rapidity of correcting chronic hyponatraemia is the key point for preventing its happening.

Clinical analysis and neuroimaging features of central pontine and extrapontine myelinolysis