Yalcin-Cakmakli Gul, Karli Oguz Kader, Shorbagi Ali, Funda Bas Demet, Ergan-Arsava Begum, Kunt Mahir, Topcuoglu Mehmet Akif
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Intern Med. 2010;49(16):1807-11. doi: 10.2169/internalmedicine.49.3395. Epub 2010 Aug 13.
We report two patients with acute hyponatremic encephalopathy which developed after massive water ingestion for pelvic ultrasound and emphasize the findings of magnetic resonance (MR) imaging including diffusion-weighted imaging (DWI). Both subjects had completely recovered within 24 hours following fluid restriction and salt replacement. MR imaging revealed cortical sulcal narrowing, restricted diffusion and sulcal T2 hyperintensity along with diffuse pial enhancement suggesting diffuse cerebral cortical cytotoxic edema and blood-brain barrier breakdown. In addition to the first illustration of multimodality MR imaging features of water-intoxication, these two cases also highlight the need for standardized practice on the quantity of water intake recommended to distend the bladder for pelvic ultrasound, especially in patients at risk for serum inappropriate ADH syndrome-related hyponatremia.
我们报告了两名因盆腔超声检查大量饮水后发生急性低钠血症性脑病的患者，并着重介绍了磁共振（MR）成像的结果，包括扩散加权成像（DWI）。两名患者在限液和补充盐分后24小时内均完全康复。MR成像显示皮质沟变窄、扩散受限、脑沟T2高信号以及软脑膜弥漫性强化，提示弥漫性大脑皮质细胞毒性水肿和血脑屏障破坏。除了首次展示水中毒的多模态MR成像特征外，这两个病例还凸显了在为盆腔超声检查充盈膀胱而推荐的饮水量方面需要标准化操作，尤其是对于有患抗利尿激素分泌失调综合征相关低钠血症风险的患者。
