CAJ | 학술논문

可逆性后部白质脑病综合症(reversible posterior leukoencephalopathy syndrome,RPLS)是一少见的具有多种临床表现的综合征,临床症状包括头痛、高血压、意识障碍、视觉改变和癫痫发作.此文报道1例剖宫产术后发生的RPLS.患者28岁,女性,因"停经40+6周,慢性高血压合并妊娠"入院.剖宫产术后出现头痛、高血压、癫痫发作及双眼右侧视野偏盲,经脑部核磁检查确诊为RPLS,予镇静、降压、脱水及解痉治疗2周后症状完全缓解,复查脑部磁共振(MRI)结果正常出院.该病确诊的主要依据是MRI具有特征性改变:双侧大脑半球后部枕叶和顶叶白质异常信号.此病多数预后良好,经积极降压和抗癫痫治疗病情迅速好转,故称"可逆性".但是也可能因诊断延迟或治疗不当而发生"不可逆"的脑损伤如脑水肿、脑梗塞甚至脑疝死亡.
가역성후부백질뇌병종합증(reversible posterior leukoencephalopathy syndrome,RPLS)시일소견적구유다충림상표현적종합정,림상증상포괄두통、고혈압、의식장애、시각개변화전간발작.차문보도1례부궁산술후발생적RPLS.환자28세,녀성,인"정경40+6주,만성고혈압합병임신"입원.부궁산술후출현두통、고혈압、전간발작급쌍안우측시야편맹,경뇌부핵자검사학진위RPLS,여진정、강압、탈수급해경치료2주후증상완전완해,복사뇌부자공진(MRI)결과 정상출원.해병학진적주요의거시MRI구유특정성개변:쌍측대뇌반구후부침협화정협백질이상신호.차병다수예후량호,경적겁강압화항전간치료병정신속호전,고칭"가역성".단시야가능인진단연지혹치료불당이발생"불가역"적뇌손상여뇌수종、뇌경새심지뇌산사망.
Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical syndrome, which is manifested clinically by headache, seizure, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. We present a case of postpartu women who developed RPLS after combined -spinal epidural anesthesia which was complicated by a postdural puncture headache. The patient was treated with magnesium sulfate, midazolam, mannitol and carbamazepine for seizure control and prophylaxis. Blood pressure was controlled with labetolol and nicardipine. The patient was discharged home two weeks later with no neurologic deficit, and repeated magnetic resonance imaging (MRI) showd normal. Cerebral MRI served as a diagnostic method for RPLS. The hallmark feature is bilateral symmetrical vasogenic edema in the territories of the posterior cerebral circulation (occipital and posterior parietal lobes). If promptly recognized and treated, symptoms and neuroradiographic changes are reversible when blood pressure is controlled. However, if the diagnosis is delayed or unrecognized, cerebral ischemia and infarction can occur, which might result in permanent brain injury or death.