Zhu H B, Ouyang G L, Lai Y Y, Zhong S Q
Department of Neurology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019 Feb 20;37(2):133-136. doi: 10.3760/cma.j.issn.1001-9391.2019.02.011.
Characteristics of clinical, MRI and electroencephalogram after trimethyltin chloride (TMT) poisoning. The clinical manifestations, MRI, EEG, treatment and prognosis of 16 patients with TMT poisoning were analyzed retrospectively. Among the 16 cases of TMT poisoning, 6 cases were severe poisoning, 4 cases were moderate poisoning, and 6 cases were mild poisoning. All patients had dizziness, headache, general fatigue, loss of appetite, nausea, vomiting and other general clinical symptoms. Six patients with severe poisoning had psychobehavioral abnormalities, including 4 patients with mania, delirium, ataxia, epileptic seizures. Glasgow was 15 points in mild and moderate poisoning. Of the 6 cases of severe poisoning, 4 cases of Glasgow were 9~11 points, and 2 cases of Glasgow were 13 points. 2 patients with severe poisoning had abnormal MRI in head, and the total abnormal rate was 12.50%. Toxic encephalopathy was considered in 1 case with abnormal signal of corpus callosum pressure, and patchy ischemic foci of left cerebral foot and mild cerebral atrophy in 1 case. The total abnormal rate of EEG was 56.25%. The abnormal rate of electroencephalogram in severe poisoning was 83.33%. There were 2 cases of severe abnormal electroencephalogram, 2 cases of moderate abnormal electroencephalogram and 1 case of slight abnormal electroencephalogram. Twelve patients were recovered and discharged from hospital. 4 cases of severe poisoning are still getting better, and there are still cerebellar ataxia symptoms such as dizziness and unstable walking. In clinical work, attention should be paid to the identification of patients with mild and moderate TMT poisoning, and attention should be paid to the patients with severe TMT poisoning manifested by disturbance of consciousness. The positive rate of MRI test in TMT poisoning is low, and the lesion is nonspecific. Electroencephalogram test has a high positive rate in TMT poisoning, which can well reflect the degree of illness. Attention should be paid to the prevention and treatment of neurodegeneration caused by TMT poisoning.
三甲基氯化锡（TMT）中毒后的临床、MRI及脑电图特征。回顾性分析16例TMT中毒患者的临床表现、MRI、脑电图、治疗及预后。16例TMT中毒患者中，重度中毒6例，中度中毒4例，轻度中毒6例。所有患者均有头晕、头痛、全身乏力、食欲不振、恶心、呕吐等一般临床症状。6例重度中毒患者有精神行为异常，其中4例有躁狂、谵妄、共济失调、癫痫发作。轻度和中度中毒患者格拉斯哥评分为15分。6例重度中毒患者中，4例格拉斯哥评分为9～11分，2例格拉斯哥评分为13分。2例重度中毒患者头部MRI异常，总异常率为12.50%。1例胼胝体压部信号异常考虑为中毒性脑病，1例左侧脑桥脚斑片状缺血灶及轻度脑萎缩。脑电图总异常率为56.25%。重度中毒患者脑电图异常率为83.33%。脑电图重度异常2例，中度异常2例，轻度异常1例。12例患者康复出院。4例重度中毒患者仍在好转，仍有头晕、行走不稳等小脑共济失调症状。临床工作中，应注意TMT轻度和中度中毒患者的鉴别，对意识障碍表现的重度TMT中毒患者应予以关注。TMT中毒MRI检查阳性率低，病变无特异性。脑电图检查在TMT中毒中阳性率高，能较好反映病情程度。应重视TMT中毒所致神经变性的防治。
