酒癮相關性之中央橋腦髓鞘溶解症：病例報告

中央橋腦髓鞘溶解症是一種發生在中央橋腦的去髓鞘病變的疾病，它並沒有侵犯到神經軸突。此疾病的致病機轉及發生率仍不清楚。根據文獻記載，此疾病最常發生在慢性酒癮者身上，另外，因為快速矯正低血鈉症而造成者居次。在臨床上的表現包括意識不清、嗜睡、腦部功能損壞、吞嚥困難、口齒不清、四肢無力、步態不穩、深部肌腱反射下降、低血壓以及癲癎發作。治療方法包括了支持性療法、攝取足夠的營養以及完善的復健計畫。本病例報告是一位47歲男性，有糖尿病、高血壓及長期酗酒的習慣。病人於入院前突然發生打嗝、口齒不清、步態不穩合併兩側下肢無力以及輕微嗆到的情形，在入院前一天進而有意識上的改變。神經學檢查發現牛眼徵候陽性、嚴重的構音困難合併輕微的失語症、兩側深部肌腱反射下降、合併軀體及步態不穩。經腦部磁振造影的檢查，在TZ加權影像中，發現在中央橋腦區有訊號增強的情形。希望藉由此病例報告，對臨床同仁於診斷及處理此類疾病時，能有所助益。

關鍵字

中央橋腦髓鞘溶解症；步態不穩

並列摘要

Central pontine myelinolysis (CPM) characterizes demyelinolysis of the central basal pons without involving the nerve axon. The etiology and incidence are unclear. According to previous reports, CPM occurs most often in chronic alcoholism, followed by hyponatremia due to rapid correction of electrolyte imbalance. Clinical manifestations of CPM include consciousness disturbance, lethargy, impaired brain function, dysphasia, dysarthria, four limbs weakness, ataxia, decreased deep tendon reflex, hypotension and seizure. The treatment of CPM includes supportive management with enough nutrition intake and rehabilitation programs. Our case report is a 47 year old male with the history of diabetics mellitus, hypertension and chronic alcoholism. He suffered from hiccup, slurred speech, ataxia of bilateral lower extremities, weakness and a tendency to choke on water, accompanied by consciousness disturbance. The neurological examination showed positive Bull’s eye signs, severe dysarthria with mild aphasia, decreased bilateral deep tendon reflex and ataxia. In a series of brain MRI images, the T2- weighted images showed hyperdensity signals in the central pons. Due to easy approach of MRI study while suspicion, CPM should not be misdiagnosed. This case report seeks to provide a guide to pertinent treatment of CPM.

並列關鍵字

Central pontine myelinolysis ； ataxic gait

國際替代計量

酒癮相關性之中央橋腦髓鞘溶解症：病例報告

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