脑桥中央髓鞘溶解症1例报道

Central Pontine Myelinolysis: A Case Report

摘要: 目的：分析脑桥中央髓鞘溶解症(CPM)的病因诱因、临床症状、影像特点，探讨其发病机制、早期诊断、治疗方法，以提高神经内科临床医师对CPM的认识，以期降低CPM发病的可能。CPM致死致残率高，生存者也多有后遗症，对已发病的CPM患者，做到早诊断、早治疗，在避免疾病进展的基础上，为患者争取更好的预后，提高生活质量。方法：通过回顾性分析研究本院收治的一例典型CPM患者的病例资料，并结合过往国内外此类患者的文献学习。结果：患者因高热、呕吐导致低钠血症，后给予补钠治疗，患者发病后未能及时明确诊断，错过急性期最佳治疗时机，治疗后症状未得到缓解，病情进一步加重。讨论：对于电解质紊乱尤其是低钠血症的患者，纠正血钠浓度时应注意限制补钠速度。颅脑MRI尤其是DWI对早期CPM的诊断更敏感。尽早给予激素治疗，或可抑制病情进展，改善患者预后。

Abstract: Purpose: By analyzing the causes, clinical symptoms and imaging characteristics of central pontine myelinolysis (CPM), exploring its pathogenesis, early diagnosis, treatment methods and prognosis, so as to improve clinicians’ understanding of CPM, in order to reduce the possibility of CPM onset. The risk of death and disability from CPM is high, and survivors often have sequelae. For the exist-ing CPM patients, early diagnosis and treatment, on the basis of avoiding disease progression, strive for better prognosis and improve the quality of life for patients. Methods: Through the retrospective analysis of the case data of a CPM patient admitted to our hospital, and combined with the previous literature on such patients at home and abroad to learning. Results: The patient had hyponatremia due to high fever and vomiting, and was later given sodium supplement therapy. Moreover, the pa-tient failed to make a timely diagnosis after the onset, and the best treatment opportunity in the acute period was missed. Therefore, the symptoms were not relieved after treatment, and the con-dition was further aggravated. Conclusion: For patients with electrolyte disorders, especially hypo-natremia, attention should be paid to limit the speed of sodium supplementation when correcting the blood sodium concentration. Cranial MRI and especially DWI is more sensitive to the diagnosis of early CPM. Giving hormone therapy as early as possible may inhibit the progression of the disease and improve patient outcomes.