摘要
目的 探讨治疗中枢神经系统（CNS）白血病时微量硫酸长春新碱鞘内注射后导致神经系统损害的临床、影像及电生理特点。方法 收集11例确诊病例临床、MRI、肌电图（EMG）及神经传导等详细资料进行综合分析。结果 所有患者均有不同程度双下肢无力，除1例肌无力最轻者外均有不同程度感觉障碍及尿便障碍。行腰骶段MRI平扫结果8例均未见异常，其中2例行增强扫描亦未见异常。电生理检查结果双下肢异常10例：EMG表现为神经源性损害；运动神经传导部分神经未引出波形，能引出者复合肌肉动作电位（CMAP）波幅均明显降低（0．1～2．7mV），2例胫神经运动传导速度（MCV）轻度减慢；感觉传导速度（SCV）及感觉神经动作电位（SNAP）均正常。结论从电生理检查结果分析此组腰骶神经根损伤可能主要为轴索损害。患者病情相对较轻，病变部位相对局限于邻近给药部位，可能与注入长春新碱量较少有关。
Objective To investigate the clinical, MRI and neuroelectrophysilogical characteristics of nervous system damage caused by inadvertent administration of microcontent vincristine intratbecally. Methods The clinical, MRI, electromyogram （EMG） and nerve conduction data of the 11 cases were collected and analyzed. Results Lower limbs weakness were found in all 11 cases. Sensory disturbances, urinating and rectum dysfunction appeared in 10 cases except the one with the mildest muscle weakness. There were no remarkable changes in lumbosacral MRI screening for 8 cases, among them enhancement screening were performed for 2 cases, but with negative finding. Ten of the eleven cases were found possessing electrophysiological abnormalities in lower limbs. Needle EMG revealed neurogenic damage in muscles of the lower limbs. Compound muscle action potentials （CMAP） were not inducible for some nerves. For nerves with inducible CMAP, the amplitude of CMAPs was much decreased （0.1-2.7 mV）. Motor conduction velocity （MCV） of tibial nerve were slightly decreased in two cases. Sensory nerves conduction velocity （SCV） and sensory nerve action potential （SNAP） were within normal range for all patients. Conclusions The electrophysilogical findings implied pathologically axonal damage for these inadvertent administrations of microcontent vincristine intrathecally had caused lumbosacral radiculopathy. The clinical manifestations were relatively less severe and the lesions were localized in regions adjacent to the site of drug dilivery, these could be explained by the small amount of vincristine intrathecally administrated.
出处
《中国神经免疫学和神经病学杂志》
CAS
2009年第1期58-60,共3页
Chinese Journal of Neuroimmunology and Neurology
关键词
长春新碱
鞘内注射
腰骶神经根病
肌电图
神经传导
vincristine
intrathecal administration
lumbosacral radiculopathy
electromyogram （EMG）
nerve conduction
