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作者报告3例桥脑中央髓鞘溶解(CPM)并结合文献报告的110例,讨论其病原学、诊断和治疗。本病于50年代起始被描述。当时正热衷于对戒酒者补液。通常的发病经过是:酒精中毒、营养不良和肝病患者入院时精神错乱。经一般治疗后病情好转,但在继续补液及镇静治疗时,患者发生桥脑病灶的症状,呈现截瘫或四肢瘫、构音不良和吞咽困难,常伴重度低血钠。重者表现为“闭锁综合征”。可能伴有低血压。听觉诱发电位检查可以证实诊断。CT扫描显示轻度脑萎缩。EEG、头颅平片、CSF压力及化验均可正常。ECG与电解质紊乱相符。主要的病理改变为桥脑中央水肿、软化、髓鞘溶解,并可见大量的泡沫状巨噬细胞。
The authors report 3 cases of central pontine myelinolysis (CPM) combined with the literature reported in 110 cases, discuss the etiology, diagnosis and treatment. The disease was described in the 1950s. At that time, they were keen on rehydration. The usual pathological changes are: alcoholism, malnutrition, and liver disorders when admitted to hospital. After the general treatment condition improved, but continued to rehydration and sedation treatment, patients with pontine lesion symptoms, paraplegia or quadriplegia, dysarthria and dysphagia, often accompanied by severe hyponatremia. Serious performance of “lock syndrome.” May be accompanied by hypotension. Auditory evoked potentials can confirm the diagnosis. CT scan showed mild brain atrophy. EEG, skull plain film, CSF pressure and test can be normal. ECG is consistent with electrolyte imbalance. The main pathological changes were pontine central edema, softening, myelin dissolution, and a large amount of foamy macrophages.