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Case No. 150
0000-00-00~0000-00-00
출제자 : 관리자
Hit : 325
| Period | 0000-00-00~0000-00-00 |
|---|---|
| Diagnosis | |
| Clinical information | 29세 남자. 내원 5일전부터 nausea, vomiting, dizziness있어 local에서 medication 하였으나 증상 호전없었으며, 내원 3일전부터 horizontal diplopia, gait imbalance, confused mental status, memory impairment 양상 보임.환자는 내원 4개월전부터 수입된 과일을 살충하는 작업을 하고 있었음. 과거병력이나 medication history없음 |
| Discussion | Methyl bromide intoxication * 영상소견 T2WI & FLAIR에서 inferior olives, dorsal midbrain and pons, periaqueductal region, cerebellar dentate nucleus, splenium of corpus callosum에 bilateral symmetrical high signal intensity가 있으며 splenium of corpus callosum병변은 cytotoxic edema소견을 보임. 환자는 특별한 치료없이 conservative treatment만 하였으며 1주일후 추적검사한 MR 소견(사진없음)상 호전된 소견을 보였음. * Review Methyl bromide (MB) gas is a colorless gas most commonly used as an insecticidal fumigant; it also has application as a refrigerant, solvent, methylating agent, and component in fire extinguishers. Most toxic exposures occur from inhalation and is associated with encephalopathy and neuropathy. MB intoxication might belong to the category of “energy deprivation syndromes” (EDSs), which are disorders of diverse etiology (toxic, genetic, nutritional) that disrupt enzymes involved in metabolic pathways responsible for the generation of energy. In addition to MB intoxication, toxic EDSs also result from metronidazole induced encephalopathy and patient who had smoked heroin. Nutritional and genetic EDSs are Wernicke encephalopathy, Leigh disease, and maple syrup urine disease. 지금까지 보고된 영상 소견은 특징적인 위치에 bilateral symmetrical T2 hyperintensity와 병변의 reversibility이다. 침범 위치는 inferior olives, dorsal midbrain and pons, periaqueductal region, cerebellar dentate nucleus, splenium of corpus callosum, posterior putamen, subthalamic nuclei, globus pallidus이다. * Reference 1. Howard L. Geyer, Herbert H. Schaumburg, Steven Herskovitz. Methyl bromide intoxication causes reversible symmetric brainstem and cerebellar MRI lesions. Neurology 2005;64:1279-1281 2. K Kang, YM Song, KD Jo, JK Roh. Diffuse lesion in the splenium of the corpus callosum in patients with methyl bromide poisoning. J Neurol Neurosurg Psychiatry 2006;77:703-704 |
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