PDF(Pubmed)
Abstract：
A patient in her 50s presented with altered mental status and shortness of breath at 4600 m elevation. After descent to the base of the mountain, the patient became comatose. She was found to have bilateral pulmonary infiltrates and a serum sodium of 102 mEq/L. She was rapidly corrected to 131 mEq/L in 1 day. Initial MRI showed intensities in bilateral hippocampi, temporal cortex and insula. A repeat MRI 17 days post injury showed worsened intensities in the bilateral occipital lobes. On admission to acute rehabilitation, the patient presented with blindness, agitation, hallucinations and an inability to follow commands. Midway through her rehabilitation course, antioxidant supplementations were started with significant improvement in function. Rapid correction of hyponatraemia may cause central pontine myelinolysis or extrapontine myelinolysis (EPM). In some cases of hypoxic brain injury, delayed post-hypoxic leucoencephalopathy (DPHL) may occur. Treatment options for both disorders are generally supportive. This report represents the only documented interdisciplinary approach to treatment of a patient with DPHL and EPM. Antioxidant supplementation may be beneficial as a treatment option for both EPM and DPHL.
摘要：
50多岁的患者在海拔4600m时表现出精神状态改变和呼吸急促。下降到山脚后，病人昏迷了.发现她有双侧肺浸润，血清钠为102mEq/L。她在1天内迅速校正至131mEq/L。初始MRI显示双侧海马强度，颞叶皮层和脑岛。受伤后17天重复MRI显示双侧枕叶强度恶化。接受急性康复治疗后，病人出现失明，激动,幻觉和无法服从命令。在她康复课程的中途，抗氧化剂补充开始显着改善功能。快速纠正低钠血症可能会导致脑桥中央髓鞘溶解或脑桥外髓鞘溶解（EPM）。在某些缺氧性脑损伤的情况下，可能发生迟发性缺氧后白质脑病(DPHL).两种疾病的治疗选择通常是支持性的。该报告代表了DPHL和EPM患者治疗的唯一记录的跨学科方法。抗氧化剂补充作为EPM和DPHL的治疗选择可能是有益的。
