Hagiwara Koichi, Okada Yoko, Shida Norihiko, Yamashita Yoriaki
Department of Neurology, Matsuyama Red Cross Hospital, Ehime.
Intern Med. 2008;47(5):431-5. doi: 10.2169/internalmedicine.47.0634. Epub 2008 Mar 3.
We observed a 41-year-old woman with severe central pontine myelinolysis (CPM) and unusually extensive extrapontine myelinolysis (EPM), but without evidence of hyponatremia. Increased alcohol consumption in prior months was the main cause of her CPM/EPM. However, in general, EPM is a rare accompaniment in alcoholic patients with CPM without hyponatremia. With regard to our patient, the EPM was unusually widespread; magnetic resonance imaging (MRI) of her brain showed multiple hyperintense lesions on T2-weighted images distributed symmetrically in bilateral caudate nuclei, lentiform nuclei and thalami. Serial follow-up MRI revealed almost complete resolution of EPM after methylprednisolone pulse therapy. By contrast, marked cavitary hypointensity in the pons remained, but complete remission of neurological symptoms was achieved.
我们观察了一名41岁的女性，她患有严重的中央桥脑髓鞘溶解症（CPM）和异常广泛的脑桥外髓鞘溶解症（EPM），但没有低钠血症的证据。前几个月饮酒量增加是其CPM/EPM的主要原因。然而，一般来说，EPM在无低钠血症的酒精性CPM患者中是一种罕见的伴随情况。就我们的患者而言，EPM异常广泛；她脑部的磁共振成像（MRI）在T2加权图像上显示多个高信号病变，对称分布于双侧尾状核、豆状核和丘脑。系列随访MRI显示甲泼尼龙冲击治疗后EPM几乎完全消退。相比之下，脑桥中明显的空洞性低信号仍然存在，但神经症状完全缓解。
