Neurology:极限屏气潜水后减压病相关的白质病变

2018-12-07 zyx整理 神经科病例撷英拾粹

39岁男性,在极限屏气潜水后出现短暂的表达性失语和头痛。患者进行了大约30次屏气潜水,每次约2分钟,30米深,共持续5小时,在水面上间隔时间短。 脑MRI(图A-C)可见左侧额叶白质病变,无弥散受限,强化或占位效应。

39岁男性,在极限屏气潜水后出现短暂的表达性失语和头痛。患者进行了大约30次屏气潜水,每次约2分钟,30米深,共持续5小时,在水面上间隔时间短。 脑MRI(图A-C)可见左侧额叶白质病变,无弥散受限,强化或占位效应。

在1个月的随访中,患者经过3次高压氧治疗后,保持无症状,病变几乎完全消退(图D)。

反复屏气潜水后血液和组织中的氮积聚会引起内皮细胞功能障碍以及血脑屏障的破坏,随后出现微血管通透性升高和血管源性水肿。


(图:A:初始FLAIR可见左侧额叶皮质下高信号线样病变,皮质下U形纤维不受累;B-C:DWI上病变呈稍高信号,对应ADC亦为高信号,不提示弥散受限;D:1个月复查FLAIR可见病灶几乎完全消退)

原始出处:Guerreiro C1, Teixeira A2, Marques T2, et al. Mystery Case: White matter lesion related to decompression sickness following extreme breath-hold diving. Neurology. 2018 Oct 30;91(18):847-848.  

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    2019-02-27 yinhl1978
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