Shoji M, Kimura T, Ota K, Ohta M, Sato K, Yamamoto T, Funyu T, Mori T, Tateyama M, Abe K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai.
Intern Med. 1996 May;35(5):427-31. doi: 10.2169/internalmedicine.35.427.
Hypoxic encephalopathy and osmotic demyelination are independent clinical entities. We describe a rare case with these two complications as demonstrated by magnetic resonance imaging (MRI). A 58-year-old woman had adrenal crises twice a decade due to Sheehan syndrome. At the second crisis, hyponatremia was remarkable with consciousness disturbance which was rapidly corrected by intravenous administration of glucocorticoid and hypertonic saline. The maneuver improved consciousness disturbance, but resulted in hypokalemic ventricular fibrillation with circulatory failure. After the normalization of the circulation, however, her consciousness level deteriorated again. Repeated brain MRI revealed acute and chronic phases of cortical laminar necrosis and central pontine myelinolysis.
缺氧性脑病和渗透性脱髓鞘是独立的临床实体。我们描述了一例罕见病例，磁共振成像（MRI）显示存在这两种并发症。一名58岁女性因席汉综合征十年内发生两次肾上腺危象。在第二次危象时，低钠血症显著并伴有意识障碍，静脉注射糖皮质激素和高渗盐水后迅速得到纠正。这一措施改善了意识障碍，但导致低钾性室颤和循环衰竭。然而，循环恢复正常后，她的意识水平再次恶化。重复进行脑部MRI检查发现了皮质层状坏死和脑桥中央髓鞘溶解的急性期和慢性期。
