Kleinschmidt-DeMasters B K, Anderson C A, Rubinstein D
Department of Pathology, University of Colorado, Health Sciences Center, Denver 80262, USA.
J Neurol Sci. 1997 Jul;149(1):27-35. doi: 10.1016/s0022-510x(96)05333-6.
Clinicians occasionally receive radiographic reports noting pontine lesions in their patients who have undergone magnetic resonance imaging (MRI) for symptoms not referable to the pons. Based on these relatively isolated lesions, patients may receive the presumptive radiographic diagnosis of central pontine myelinolysis (CPM). Review of our MRI database from the last five years identified twelve such patients with hyperintense pontine lesions on T2-weighted scans which were out of proportion to supratentorial white matter disease processes and unexplained by the remainder of their radiographic studies. In an attempt to further clarify whether these findings were more consistent with CPM or some other process, we reviewed these patients' clinical records with particular attention to electrolyte disturbances, alcoholism, liver disease and hypertension. We also compared the MRI studies from these twelve patients with four MRI scans from patients with clinically diagnosed CPM and with eight post-mortem MRI scans on autopsy-proven asymptomatic CPM. By comparing pre- and post-mortem scans, five of the twelve unknown pontine lesions were felt to be too large to represent asymptomatic CPM. Five were thought to be incompatible with CPM based on shape and/or discohesiveness; one of these came to autopsy and showed cerebral and pontine ischemic rarefaction, not CPM. Only two of these twelve cases were felt to be asymptomatic or mildly symptomatic CPM, but have not come to autopsy. We conclude that pontine lesions found incidentally on MRI scans are a heterogeneous group, many of which are more consistent with pontine ischemic rarefaction than with asymptomatic CPM.
临床医生偶尔会收到影像学报告，报告中指出其患者在因与脑桥无关的症状接受磁共振成像（MRI）检查时发现了脑桥病变。基于这些相对孤立的病变，患者可能会被初步影像学诊断为中枢性脑桥髓鞘溶解症（CPM）。回顾我们过去五年的MRI数据库，发现了12例这样的患者，他们在T2加权扫描上显示脑桥病变呈高信号，与幕上白质疾病进程不成比例，且其影像学检查的其他部分无法解释。为了进一步明确这些发现与CPM或其他某种疾病过程是否更相符，我们查阅了这些患者的临床记录，特别关注了电解质紊乱、酒精中毒、肝脏疾病和高血压。我们还将这12例患者的MRI研究与4例临床诊断为CPM的患者的MRI扫描以及8例经尸检证实为无症状CPM的死后MRI扫描进行了比较。通过比较生前和死后扫描，12例不明脑桥病变中有5例被认为太大，不可能代表无症状CPM。5例基于形状和/或不连续性被认为与CPM不符；其中1例进行了尸检，显示为脑桥和脑缺血性稀疏，而非CPM。这12例病例中只有2例被认为是无症状或轻度症状性CPM，但尚未进行尸检。我们得出结论，MRI扫描偶然发现的脑桥病变是一个异质性群体，其中许多与脑桥缺血性稀疏比与无症状CPM更相符。
