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目的探讨脑桥中央髓鞘溶解症(central pontine myelinolysis,CPM)及脑桥外髓鞘溶解症(extral pontine myelinolysis,EPM)的临床及影像学特点,提高对本病认识。方法对解放军白求恩国际和平医院收治的大面积烧伤并发CPM及EPM 1例的临床资料进行回顾性分析,并复习相关文献。结果患者因全身多处甲醛火焰烧伤后30 h,昏迷9 h余入院。急诊头颅CT检查未见明显异常。入院15 d后行MRI检查示脑桥对称性分布病灶,并伴脑桥外病变,主要分布在双侧丘脑、三脑室侧壁、中脑,呈T1WI序列片状稍低信号,T2WI、T2-FLAIR序列稍高信号,弥散加权成像序列高信号,并T1WI序列中间小片状稍高信号。MRI诊断CPM及EPM。给予相关治疗约20 d后因患者病情危重,家属放弃治疗,自动出院。结论大面积烧伤可致患者出现CMP及EPM。头颅MRI检查对髓鞘溶解症有重要诊断价值,T1WI序列出现中间小片状稍高信号,考虑与髓鞘溶解后脂性代谢物有关。
Objective To investigate the clinical and imaging characteristics of central pontine myelinolysis (CPM) and extrinsic pontine myelinolysis (EPM) and to improve their understanding of the disease. Methods A retrospective analysis was performed on the clinical data of 1 case of extensive burn with CPM and EPM admitted to Bethune International Peace Hospital of People’s Liberation Army. The related literatures were reviewed. Results The patients were admitted to the hospital after coma for more than 9 hours after 30 hours of burn with formaldehyde flame. Emergency head CT examination no obvious abnormalities. Thirteen days after admission, MRI examination showed lesions of pontine symmetry distribution, with pontine lesions, mainly located in the bilateral thalamus, the side wall of the third ventricle and the midbrain, with slightly lower signals of T1WI sequence flakes, T2WI and T2-FLAIR sequences Slightly higher signal, diffuse weighted imaging sequence high signal, and slightly higher signal in the middle of the T1WI sequence. MRI diagnosis of CPM and EPM. Relevant treatment for about 20 days after the patient’s condition was critical, family members to give up treatment, discharged automatically. Conclusion Large area burn can cause CMP and EPM in patients. Head MRI examination of myelinolysis has an important diagnostic value, T1WI sequence appears slightly higher signal in the middle of small pieces, consider the myelin dissolved lipid metabolites.