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目的探讨药物致急性脱髓鞘脑病的各项临床特征及其可能相关原因。方法报道3例病前1-3d服用不明成份药物,且通过影像学检查临床诊断为急性脱髓鞘脑病的病例,综合相关研究文献,分析其临床表现、辅助检查、治疗及预后等情况。结果药物致急性脱髓鞘脑病患者轻者可出现多项精神状态检查异常,重者在短时间内出现意识障碍,缺乏明确的中枢神经系统定位体征;脑电图及地形图表现为弥漫性低功率慢波;头颅核磁共振成像MRI表现为大脑白质区域广泛对称的长或略长T1信号、长T2信号,相应的弥散加权成像显示高信号;激素治疗后部分患者好转,部分患者预后较差,长期随访无复发。结论药物致急性脱髓鞘脑病呈单向病程,突出表现为高级中枢功能障碍,头颅MRI检查对于明确诊断及预后判断较为重要,脑电图及地形图检查在一定程度上反映出弥漫性脑功能的减退,预后可能与个体差异、病变范围及程度、并发症等因素有关。
Objective To investigate the clinical characteristics of acute demyelinating encephalopathy induced by drugs and its possible related reasons. Methods Three cases of unidentified drugs were prescribed 1-3 days before the operation, and the cases of acute demyelinating encephalopathy were diagnosed by imaging examination. The related literatures were reviewed to analyze the clinical manifestations, laboratory examinations, treatment and prognosis. Results Acute demyelinating encephalopathy in patients with mild to mild mental status examination can occur, severe cases of consciousness in a short time, the lack of a clear central nervous system localization signs; EEG and topography showed diffuse low The power of the slow wave; MRI of skull MRI showed broad symmetry of the brain white matter long or slightly longer T1 signal, long T2 signal, the corresponding diffusion-weighted imaging showed high signal; some patients improved after hormone therapy, some patients with poor prognosis, Long-term follow-up without recurrence. Conclusion The drug-induced acute demyelinating encephalopathy showed a one-way disease course, with prominent central dysfunction. The cranial MRI was more important for the definite diagnosis and prognosis judgment. The EEG and topographic examination to a certain extent reflected the diffuse brain function Of the decline, the prognosis may be related to individual differences, the extent and extent of the disease, complications and other factors.