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目的 分析放射性脑病的致病因素、诊断、鉴别诊断以及治疗措施。方法 回顾性分析 17例放射性脑病的临床资料。结果 17例患者发病潜伏期为 3个月～ 4年 ,潜伏期与放射量无明显相关 ,患者主要表现为头晕、头痛、精神症状、记忆力减退、无力和抽搐。脑部影像学检查显示相应照射部位坏死水肿 ,部分病灶有不规则强化 ,病变范围可超出照射范围。治疗后 1例症状完全缓解 ,7例明显好转 ,另 7例病情平稳 ,2例死亡。结论 高剂量照射是直接致病因素 ,血管损伤可造成广泛持久的脑损害 ,自由基损伤和免疫因素可能参与致病。治疗以激素为主 ,辅以神经营养药、改善脑循环药以及高压氧等。预防是关键。
Objective To analyze the etiological factors, diagnosis, differential diagnosis and treatment of radiation encephalopathy. Methods Retrospective analysis of 17 cases of radiation encephalopathy clinical data. Results The incubation period of 17 patients was from 3 months to 4 years. There was no significant correlation between latency and radiation dose. The patients showed dizziness, headache, mental symptoms, memory loss, weakness and convulsions. Cerebral imaging examination showed necrosis and edema at the corresponding irradiation site. Some of the lesions showed irregular enhancement, and the extent of the lesions could exceed the irradiation range. After treatment, one patient had complete remission of symptoms, 7 patients improved significantly, and 7 patients remained stable and 2 patients died. Conclusion High-dose irradiation is a direct risk factor. Vascular injury can cause extensive and permanent brain damage. Free radical damage and immune factors may be involved in pathogenicity. Treatment of hormone-based, supplemented by neurotrophic drugs, improve cerebral circulation drugs and hyperbaric oxygen. Prevention is the key.