司艳红++++++丁长青+++++++孙惠芳++++++张玉娜++++++赵辉

[摘要] 目的 分析CO中毒性脑病的临床及影像学表现特征。 方法 回顾性分析我院2016年1月～2017年6月临床确诊的25例CO中毒性脑病的临床及影像学资料。所有患者均有2次及以上CT和（或）MRI检查资料。 结果CO中毒性脑病临床表现主要包括头痛、智能及认知功能障碍、精神症状、锥体外系功能障碍、肢体功能障碍、昏迷等。本组CT及MRI表现：单纯基底节受累（n=12），单纯脑皮层受累（n=1），基底节和脑白质同时受累（n=4），基底节区及脑皮层同时受累（n=5），基底节区、脑皮层和脑白质同时受累（n=3）。伴发病变：伴急性大面积出血性脑梗死1例，伴急性中耳乳突炎8例。本组MRI在显示病变范围及损伤程度方面较CT更为直观准确，影像学随访还较好地评价病变治疗后变化及转归。 结论 CO中毒性脑病表现为以急性痴呆为特征的一系列神经精神症状及体征，其影像学尤其是MRI表现具有一定特征性，CT及MRI在该病的诊断、鉴别诊断及预后评价中具有重要价值。

[关键词] 一氧化碳中毒；脑病；螺旋CT；磁共振成像

[中图分类号] R749 [文献标识码] A [文章编号] 1673-9701（2017）31-0029-06

[Abstract] Objective To analyze the clinical and imaging characteristics of carbon monoxide poisoning encephalopathy. Methods The clinical and imaging data of 25 cases of carbon monoxide poisoning encephalopathy diagnosed in our hospital from January 2016 to June 2017 were retrospectively analyzed. All patients had CT and/or MRI data for 2 or more than 2 times. Results Clinical manifestations included headache， intelligence and cognitive dysfunction， psychiatric symptoms， extrapyramidal dysfunction， limb dysfunction， and coma. The CT and MRI manifestation included simple basal ganglia involvement（n=12）， simple cerebral cortex involvement（n=1）， basal ganglia combined with white matter involvement（n=4）， basal ganglia and cerebral cortex involvement（n=5） and basal ganglia and cerebral cortex， white matter involvement（n=3）. There was 1 case of acute large area hemorrhagic cerebral infarction， and 8 cases of acute middle ear mastoiditis. MRI of this group was more intuitive and accurate than CT in showing the range of lesions and the degree of damage. The follow-up imaging also assessed changes and outcome of disease after treatment. Conclusion Carbon monoxide poisoning encephalopathy manifested as a series of neuropsychiatric symptoms and signs characterized by acute dementia. The imaging feature， especially MRI feature， has a certain characteristic. CT and MRI have important value in the diagnosis， differential diagnosis and prognosis of the disease.

[Key words] Carbon monoxide poisoning； Encephalopathy； Spiral CT； Magnetic resonance imaging

一氧化碳（carbonmonoxide，CO）中毒是临床上较为常见的窒息性中毒，为发病率及死亡率最高的中毒性疾病。CO中毒在我国被列入国家法定职业病目录，非职业性急性CO中毒秋冬及早春季节好发，主要见于室内燃煤取暖中毒。CO中毒若得不到及时诊治，重者可致死亡，存活者多遗留以痴呆、精神和锥体外系症状为主要表现的系列神经精神症狀及体征[1]。随着CT及MRI成像设备的渐趋普及，其在CO中毒性脑病的诊断、随访及预后评估中的作用越来越受到重视。……