Kaino Kenta, Kumagai Ryo, Furukawa Shoko, Isono Momoko, Muramatsu Aiko, Fujii Masanao, Muta Yumiko, Asada Tomoyuki, Fujihara Kazuya, Yagyu Hiroaki
Department of Endocrinology and Metabolism, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan.
J Diabetes Investig. 2017 May;8(3):392-394. doi: 10.1111/jdi.12597. Epub 2017 Jan 6.
A 27-year-old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion-weighted imaging. The neurological abnormalities disappeared along with improvement of metabolic derangements, and the follow-up magnetic resonance imaging carried out on the 26th day of admission showed complete resolution of the lesions in the splenium of the corpus callosum. These clinical and radiological features are highly suggestive of clinically mild encephalitis/encephalopathy with a reversible splenial lesion. The first case of mild encephalitis/encephalopathy with a reversible splenial lesion caused by olanzapine-induced hyperosmolar hyperglycemic state and neuroleptic malignant syndrome is reported.
一名27岁患有惊恐障碍的女性，每日服用20毫克奥氮平，持续4个月，因意识障碍伴发热、高血糖、高渗状态及肌酸磷酸激酶升高，入住日本茨城县水户市的水户协同综合医院。她被诊断为高渗性高血糖状态和抗精神病药恶性综合征。脑磁共振成像显示胼胝体压部短暂性弥散受限，在弥散加权成像上呈高信号强度。随着代谢紊乱的改善，神经功能异常消失，入院第26天进行的随访磁共振成像显示胼胝体压部病变完全消退。这些临床和影像学特征高度提示为伴有可逆性胼胝体压部病变的临床轻度脑炎/脑病。本文报道了首例由奥氮平诱发的高渗性高血糖状态和抗精神病药恶性综合征引起的伴有可逆性胼胝体压部病变的轻度脑炎/脑病。
