麻辣火锅与脱髓鞘脑病.DOCVIP

临床医学论文-麻辣火锅与脱髓鞘脑病 　　　　　　　　作者：桂德超　耿同超　焦劲松　张秀海 【关键词】? 脱髓鞘脑病 　　【摘要】? 目的? 报告2例食用麻辣火锅后发生的脱髓鞘脑病，并探讨其可能发病机制。方法? 记录、分析2例患者的临床表现，实验室辅助检查资料及治疗经过。结果? 2例患者均为急性发病，主要表现为中枢神经系统受累症状、体征；在大脑皮质下白质，颅脑核磁共振成像（MRI）T1和T2加权像显示多发点、片状异常信号影，马根维显（Gd-DTPA）静注T1显示增强效应；皮质类固醇激素治疗显效；4年后随诊无复发。结论? 食用麻辣火锅后发生的脱髓鞘脑病可能与激活自身免疫反应或某些物质对髓鞘的毒性作用有关。??? 　　【关键词】? 麻辣火锅；脱髓鞘脑病 　　【Abstract】? Objective? To report two patients with demyelinating encephalopathy after having peppery spicy chafing dish,and study the possible mechanism of it.Methods? Clinic manifestations,laboratory and assistant examination data,treatment of two cases were described.Other neurologic diseases were excluded.Results?Both were acute onset,systems and signs indicated that central nervous system were mainly involved.MRI showed multiple macula areas of abnormal signal intensity in T1 and T2-weighted images in white matter under subcotex,enhancing after gadolinium injected intravenously in the T1weighted sequences.Both patients recovered rapidly after treatment with steroid.There has been no relapse during the follow-up of 4 years.Conclusion? Demyelinating encephalopathy duo to peppery spicy chafing dishes may be related with self-immunological response and some matter toxic to the myelin. 　　【Key words】? peppery spicy chafing dish;demyelinating autoimmune disease,CNS 　　在临床工作中，脱髓鞘脑病并不少见，如自身免疫性和血管炎性疾病、工农业毒物和药物不良反应等多种因素均可以引起［1］。但是，因食用麻辣火锅引起的脱髓鞘脑病，目前国内外尚未见有文献报道。现将我们收治的2例分析报告如下。 　　1? 临床资料 　　例1，患者，女，28岁，公司会计。患者主因视力急剧减退，伴头痛1周入院。1周前，晚餐食用麻辣火锅，当时即感全身热灼不适，第2天晨起后，自觉视环境发暗如阴天，视物不清，头胀痛，行走时左腿力弱。5天后因视物模糊、视力急剧下降，拟诊球后视神经炎住本院眼科。颅脑MRI检查，双侧额叶、颞叶、顶叶均见散在不规则T1低信号，T2高信号，注射增强剂，显示不同程度强化，视交叉可见异常强化信号（图1a,b）。会诊后转住神经科。神经系统查体：双眼眼前20cm处见指动，正常眼底，未见其他肯定阳性体征。脑脊液压力正常，常规无特殊。生化检查：蛋白53mg/dl,IgG 32.5mg/dl（正常0.5mg/dl）,IgA 5.47mg/dl（正常0.4mg/dl）,IgM 1.91mg/dl（正常0.1mg/dl）,电泳见寡克隆区带，墨汁和抗酸染色、细菌培养、梅毒抗体、抗核抗体等无阳性发现，埃柯病毒、巨细胞病毒、麻疹病毒、风疹病毒、水痘带状疱疹和单纯疱疹病毒抗体等均阴性。视觉诱发电位（VEP）双侧无波形，脑干电测听（BSR）右侧无反应，体干诱发电位（SSEP）正常。脑电图（EEG）各导联散在低到中波幅4~7c/s波，报告轻度异常。神经电生理学检查未见肯定神经源性损害，运动诱发电位正常范围。颈椎MRI未见异常。诊断考虑脱髓鞘脑病。大剂量甲基强的松龙冲击