Okada Kyoko, Nomura Masatoshi, Furusyo Norihiro, Otaguro Shigeru, Nabeshima Shigeki, Hayashi Jun
Department of General Medicine, Kyushu University Hospital, Fukuoka.
Intern Med. 2005 Jul;44(7):739-42. doi: 10.2169/internalmedicine.44.739.
A 37-year-old woman with a history of transphenoidal surgery and gamma knife treatment for prolactinoma was admitted because of pneumoniae with hyponatremia (Na 109 mmol/l). After the careful correction of the serum sodium level within 15 mmol/l/day, the patient developed parkinsonism. MRI of the brain disclosed a signal increase in the bilateral basal ganglias on T2-weighted images, a finding consistent with extrapontine myelinolysis (EPM). Interestingly, the parkinsonism fully disappeared after the replacement therapy of hydrocortisone for adrenal insufficiency due to hypopituitarism, and MRI 5 months later showed complete disappearance of the lesions, indicating the patient had ameliorated from the EPM.
一名37岁女性，有经蝶窦手术和伽玛刀治疗泌乳素瘤病史，因肺炎合并低钠血症（血钠109 mmol/L）入院。在血清钠水平以每天15 mmol/L的速度仔细纠正后，患者出现帕金森综合征。脑部MRI在T2加权图像上显示双侧基底节信号增强，这一发现符合脑桥外髓鞘溶解症（EPM）。有趣的是，在因垂体功能减退导致肾上腺功能不全而进行氢化可的松替代治疗后，帕金森综合征完全消失，5个月后的MRI显示病变完全消失，表明患者的EPM已改善。
