一名巨细胞贫血患者在氧化亚氮麻醉后发生脊髓神经病。
Myeloneuropathy following nitrous oxide anesthaesia in a patient with macrocytic anaemia.
作者信息
Sesso R M, Iunes Y, Melo A C
机构信息
Department of Neurology, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, Brazil.
出版信息
Neuroradiology. 1999 Aug;41(8):588-90. doi: 10.1007/s002340050812.
The neurological condition triggered by anaesthesia with nitrous oxide involves the cyanocobalamine pathway and is characterised by progressive demyelination and axonal lesions of the peripheral nerves and cervicothoracic spinal cord (posterior and anterolateral columns) giving a peripheral neuropathy and very frequently subacute combined degeneration of the spinal cord. It is possible to show these demyelinating lesions by MRI of the spine, allowing early diagnosis and follow-up. We describe a case of myeloneuropathy with onset a few hours after nitrous oxide anaesthesia in a patient with macrocytic anaemia and possible subclinical vitamin B(12) deficiency and MRI evidence of a lesion of the cervical spinal cord. Neurological and haematological improvement followed cyanocobalamine replacement.
由一氧化二氮麻醉引发的神经病症涉及钴胺素途径，其特征为外周神经以及颈胸段脊髓（后柱和前外侧柱）的进行性脱髓鞘和轴突损伤，导致外周神经病变，且常伴有脊髓亚急性联合变性。通过脊柱磁共振成像（MRI）能够显示这些脱髓鞘病变，从而实现早期诊断和随访。我们描述了一例在一氧化二氮麻醉后数小时发病的脊髓神经病病例，该患者患有大细胞性贫血且可能存在亚临床维生素B12缺乏，MRI显示颈段脊髓有病变。补充钴胺素后神经和血液学状况得到改善。
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