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[一例中暑后迟发性脑病的临床与病理报告]

[A clinical and pathological report of delayed encephalopathy after heat stroke].

作者信息

Lu A J, Cheng M, Dong C X, Guo H W, Cao B Z, Hu H Q

机构信息

WeiFang Medical University, Weifang 261053, China Department of Neurology, the 960th Hospital of PLA, Jinan 250031, China.

Department of Neurology, the 960th Hospital of PLA, Jinan 250031, China.

出版信息

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2021 Jun 20;39(6):450-452. doi: 10.3760/cma.j.cn121094-20200413-00183.

Abstract

To explore the clinical manifestations, dynamic neuroimaging changes and brain histopathologic characteristics of a patient with delayed encephalopathy after heat stroke. In October 2019, the clinical manifestations, electroencephalogram, cerebrospinal fluid, imaging changes and brain histopathological characteristics of a patient with brain damage caused by heat stroke were retrospectively analyzed. The patient was a 40-year-old male who suddenly appeared dizziness, unconscious, high fever when working in the high temperature environment. The EEG showed diffuse slow wave activity. Early CT was normal, and abnormal signals gradually appeared in the basal ganglia region of the thalamus after a few days. In the late, the MRI found a large area of abnormal signals under the cerebral cortex, and white matter was involved. Pathological examination of brain biopsy showed that cortical neuron loss, loose white matter changes, and significant demyelination changes, while no inflammatory cell infiltration was observed in subarachnoid space, meninges, and dermal white matter. Imaging examination dynamic changes of the delayed encephalopathy is important in the heat stroke, and the main pathological manifestation is demyelination.

摘要

探讨热射病后迟发性脑病患者的临床表现、动态神经影像学变化及脑病理组织学特征。2019年10月,回顾性分析1例热射病致脑损伤患者的临床表现、脑电图、脑脊液、影像学变化及脑病理组织学特征。患者为40岁男性,在高温环境下工作时突然出现头晕、昏迷、高热。脑电图显示弥漫性慢波活动。早期CT正常,数天后丘脑基底节区逐渐出现异常信号。后期MRI发现大脑皮质下大面积异常信号,累及白质。脑活检病理检查显示皮质神经元丢失、白质疏松改变及明显脱髓鞘改变,而蛛网膜下腔、脑膜及皮髓质未见炎性细胞浸润。热射病后迟发性脑病的影像学检查动态变化具有重要意义,主要病理表现为脱髓鞘。

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