Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clin Proc. 2011 Nov;86(11):1063-7. doi: 10.4065/mcp.2011.0239. Epub 2011 Oct 13.
To characterize clinical and radiologic features of patients with central pontine myelinolysis (CPM) and identify variables that predict outcome.
We retrospectively studied patients diagnosed as having CPM identified by a search of Mayo Clinic medical records from January 1, 1999, through December 31, 2010. Diagnosis was made by clinical and radiologic features. Favorable outcome was defined by a modified Rankin Scale score of 2 or lower. Volume of signal abnormality on brain magnetic resonance imaging (MRI) was quantified by a neuroradiologist blinded to outcomes. Wilcoxon rank sum tests were used to assess association between volume of signal abnormality and outcomes at discharge and last follow-up.
Of 24 patients, 14 (58%) had only CPM, and 10 (42%) had extrapontine involvement. Hyponatremia was documented in 18 patients (75%), with median sodium nadir of 114 mmol/L. Eighteen patients (75%) had alcoholism, and malnutrition was documented in 12 (50%). Presenting symptoms included encephalopathy (n=18 [75%]), ataxia (n=11 [46%]), dysarthria (n=7 [29%]), eye movement abnormalities (n=6 [25%]), and seizures (n=5 [21%]). Favorable outcome was seen in 15 patients (63%) at last follow-up. Findings on initial brain MRI were normal in 5 patients, but all MRI scans were abnormal with serial imaging. The volume of radiologic signal abnormality was not associated with outcome at discharge or last follow-up (P=.67 and P=.37, respectively).
Clinical outcome in patients with CPM is not predicted by the volume of radiologic T2 signal abnormality on MRI or the severity of hyponatremia. Serial brain imaging is of value because a substantial proportion of patients have normal findings on initial MRI.
描述桥脑中央髓鞘溶解症（CPM）患者的临床和影像学特征，并确定预测结局的变量。
我们通过检索梅奥诊所的医疗记录，对 1999 年 1 月 1 日至 2010 年 12 月 31 日期间诊断为 CPM 的患者进行了回顾性研究。通过临床和影像学特征进行诊断。改良 Rankin 量表评分 2 或更低定义为预后良好。对磁共振成像（MRI）上信号异常的体积进行量化，由一位对结果不知情的神经放射科医生进行。使用 Wilcoxon 秩和检验评估出院时和最后随访时信号异常体积与结局之间的相关性。
在 24 例患者中，14 例（58%）仅存在 CPM，10 例（42%）存在桥外累及。18 例（75%）患者有低钠血症，血清钠最低值为 114mmol/L。18 例（75%）患者有酒精中毒，12 例（50%）有营养不良。首发症状包括脑病（18 例[75%]）、共济失调（11 例[46%]）、构音障碍（7 例[29%]）、眼球运动异常（6 例[25%]）和癫痫发作（5 例[21%]）。在最后一次随访时，15 例患者（63%）预后良好。5 例患者初始脑 MRI 正常，但所有 MRI 扫描均异常，连续影像学检查。放射学信号异常的体积与出院时或最后随访时的结局无关（分别为 P=.67 和 P=.37）。
CPM 患者的临床结局不能通过 MRI 上放射学 T2 信号异常的体积或低钠血症的严重程度来预测。连续脑部成像具有重要价值，因为相当一部分患者在初始 MRI 上有正常表现。
