Kawashima Takahisa, Okashiro Masahiro, Ishii Noboru, Takahashi Akira, Yoshida Takeshi, Ando Yukihiro, Lee Chunyong
Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine.
Chudoku Kenkyu. 2007 Apr;20(2):117-24.
We examined the usefulness of Magnetic Resonance Imaging (MRI) test in the acute phase of carbon monoxide intoxication for forecasting delayed encephalopathy (DE). [Case 1] 26-year-old female. COHb 12%. Takotsubo (Ampulla) cardiomyopathy was supervened. Pallidal disorder was recognized in MRI test in the early stage. Although Prophylactic HBO was performed, DE began. 36 days later, disorder was recognized in large area, such as, in cerebral white matter and callosum, and abnormality was found in WMS-R and MMSE. Since HBO was performed, DE subsided. In MRI test, on the other hand, high signal range in cerebral white matter and callosum were gradually decreased and WMS-R and MMSE were improved. [Case 2] 19-year-old female. COHb 9.4%. The state was considered to be mild but pallidal disorder was found in MRI test at the beginning. DE did not start, then the part of pallidal disorder was narrowed. WMS-R and MMSE showed slightly low level. [Case 3] 19-year-old female. COHb 7.3%. The state was considered to be mild and there was no abnormal findings in MRI test in the early stage. DE did not start. [Case 4] 48-year-old male. COHb 48.9%. Rhabdomylosis was supervened, then ischemic change in a left radiate crown was recognized in the early MRI test. Since the third day, disorientation and restlessness had been developed, so that the patient was transferred to psychiatric department, though it was still difficult to distinguish the case from DE. Although the case is relatively mild, pallidal disorder is recognized in the early MRI test. Pallidal disorder alone can cause memory disorder and cognitive impairment. Even if pallidal disorder alone is recognized in the early MRI test, white matter disorder is developed with time, and then DE begins. If there are no typical carbon monoxide intoxication findings, some cases can be suspected as DE. It is useful to perform serial MRI test in order to prepare for delayed encephalopathy in carbon monoxide intoxication.
我们研究了磁共振成像（MRI）检查在一氧化碳中毒急性期预测迟发性脑病（DE）的实用性。[病例1] 一名26岁女性。碳氧血红蛋白（COHb）为12%。并发了应激性心肌病。早期MRI检查发现苍白球病变。尽管进行了预防性高压氧（HBO）治疗，但仍发生了迟发性脑病。36天后，在大脑白质和胼胝体等大面积区域发现病变，韦氏记忆量表修订版（WMS-R）和简易精神状态检查表（MMSE）出现异常。由于进行了高压氧治疗，迟发性脑病症状缓解。另一方面，在MRI检查中，大脑白质和胼胝体的高信号范围逐渐减小，WMS-R和MMSE有所改善。[病例2] 一名19岁女性。COHb为9.4%。病情被认为较轻，但最初MRI检查发现苍白球病变。未发生迟发性脑病，则苍白球病变部分缩小。WMS-R和MMSE显示略低水平。[病例3] 一名19岁女性。COHb为7.3%。病情被认为较轻，早期MRI检查未发现异常。未发生迟发性脑病。[病例4] 一名48岁男性。COHb为48.9%。并发横纹肌溶解症，早期MRI检查发现左侧放射冠缺血性改变。从第三天起，出现定向障碍和烦躁不安，因此患者被转至精神科，尽管仍难以将该病例与迟发性脑病区分开来。尽管该病例相对较轻，但早期MRI检查发现苍白球病变。仅苍白球病变就可导致记忆障碍和认知损害。即使早期MRI检查仅发现苍白球病变，随着时间推移也会出现白质病变，进而发生迟发性脑病。如果没有典型的一氧化碳中毒表现，一些病例可能被怀疑为迟发性脑病。为预防一氧化碳中毒迟发性脑病，进行系列MRI检查是有用的。
