中国神经免疫学和神经病学杂志
中國神經免疫學和神經病學雜誌
중국신경면역학화신경병학잡지
CHINESE JOURNAL OF NEUROIMMUNOLOGY AND
2014年
6期
410-413
,共4页
可逆性后部白质脑病综合征%临床特点%影像学改变
可逆性後部白質腦病綜閤徵%臨床特點%影像學改變
가역성후부백질뇌병종합정%림상특점%영상학개변
posterior reversible encephalopathy syndrome%clinical feature%radiological change
目的:探讨可逆性后部白质脑病综合征(PRES )的临床特点和影像学改变。方法回顾性分析12例PRES患者的临床和影像学资料。结果原发病为慢性酒精中毒1例,系统性红斑狼疮伴特发性血小板减少性紫癜1例,余10例均与妊娠相关,其中7例原发病为妊娠高血压综合征(妊高征)。临床主要表现为癫痫发作(9例)、视力障碍(5例)、意识障碍(9例)、头痛(7例)、恶心呕吐(3例);10例患者存在肾功能损害。颅脑C T 及M R检查示病灶累及顶枕叶(10例)、额叶(3例)、基底节(3例)、小脑(2例)和脑干(2例),M RI均呈长T1长T2信号,T2 flair高信号,DWI等信号(7例)或略高信号(1例);颅脑CT 呈低密度(8例)或等密度(2例);边界欠清。经积极对因对症治疗,本组患者症状在中位数4d(QL3.25d,QU5d)后几乎完全缓解,影像学表现在中位数9 d(QL 7.25 d ,QU 10.75 d)后得到完全或大部分恢复。结论 PRES以癫痫发作、视力障碍、意识障碍、头痛、恶心呕吐为主要临床表现,影像学改变以可逆的、多分布于后循环供血区的皮层下脑白质血管源性水肿为特点, MRI呈T1低信号、T2及T2 flair高信号,DWI等/略高信号,CT呈低/等密度。积极治疗后多数患者症状可完全缓解,影像学表现可完全或大部分恢复。
目的:探討可逆性後部白質腦病綜閤徵(PRES )的臨床特點和影像學改變。方法迴顧性分析12例PRES患者的臨床和影像學資料。結果原髮病為慢性酒精中毒1例,繫統性紅斑狼瘡伴特髮性血小闆減少性紫癜1例,餘10例均與妊娠相關,其中7例原髮病為妊娠高血壓綜閤徵(妊高徵)。臨床主要錶現為癲癇髮作(9例)、視力障礙(5例)、意識障礙(9例)、頭痛(7例)、噁心嘔吐(3例);10例患者存在腎功能損害。顱腦C T 及M R檢查示病竈纍及頂枕葉(10例)、額葉(3例)、基底節(3例)、小腦(2例)和腦榦(2例),M RI均呈長T1長T2信號,T2 flair高信號,DWI等信號(7例)或略高信號(1例);顱腦CT 呈低密度(8例)或等密度(2例);邊界欠清。經積極對因對癥治療,本組患者癥狀在中位數4d(QL3.25d,QU5d)後幾乎完全緩解,影像學錶現在中位數9 d(QL 7.25 d ,QU 10.75 d)後得到完全或大部分恢複。結論 PRES以癲癇髮作、視力障礙、意識障礙、頭痛、噁心嘔吐為主要臨床錶現,影像學改變以可逆的、多分佈于後循環供血區的皮層下腦白質血管源性水腫為特點, MRI呈T1低信號、T2及T2 flair高信號,DWI等/略高信號,CT呈低/等密度。積極治療後多數患者癥狀可完全緩解,影像學錶現可完全或大部分恢複。
목적:탐토가역성후부백질뇌병종합정(PRES )적림상특점화영상학개변。방법회고성분석12례PRES환자적림상화영상학자료。결과원발병위만성주정중독1례,계통성홍반랑창반특발성혈소판감소성자전1례,여10례균여임신상관,기중7례원발병위임신고혈압종합정(임고정)。림상주요표현위전간발작(9례)、시력장애(5례)、의식장애(9례)、두통(7례)、악심구토(3례);10례환자존재신공능손해。로뇌C T 급M R검사시병조루급정침협(10례)、액협(3례)、기저절(3례)、소뇌(2례)화뇌간(2례),M RI균정장T1장T2신호,T2 flair고신호,DWI등신호(7례)혹략고신호(1례);로뇌CT 정저밀도(8례)혹등밀도(2례);변계흠청。경적겁대인대증치료,본조환자증상재중위수4d(QL3.25d,QU5d)후궤호완전완해,영상학표현재중위수9 d(QL 7.25 d ,QU 10.75 d)후득도완전혹대부분회복。결론 PRES이전간발작、시력장애、의식장애、두통、악심구토위주요림상표현,영상학개변이가역적、다분포우후순배공혈구적피층하뇌백질혈관원성수종위특점, MRI정T1저신호、T2급T2 flair고신호,DWI등/략고신호,CT정저/등밀도。적겁치료후다수환자증상가완전완해,영상학표현가완전혹대부분회복。
Objective To explore the clinical features and radiological changes of posterior reversible encephalopathy syndrome (PRES ) . Methods The clinical and radiological data of 12 PRES patients were analyzed retrospectively .Results The primary disease in this group was chronic alcoholism for 1 case ,systemic lupus erythematosus (SLE ) with idiopathic thrombocytopenic purpura (ITP ) for one case and related to pregnancy for others which included edema‐hypertension‐proteinuria syndrome (EHP) for 7 cases .The primary clinical features included seizure (9 cases) ,blurred vision (5 cases) ,consciousness disorders (9 cases) ,headache (7 cases) ,vomiting (3 cases) and renal impairment in 10 cases .The radiological lesions of all cases involved parietal and occipital lobes (10 cases) ,frontal lobe (3 cases) ,basal ganglia (3 cases) ,cerebellum (2 cases) , brainstem (2 cases) which appeared as low signal in T1WI ,high signal in T2WI and T2 flair ,equisignal (7 cases) /higher (1 cases) signal in DWI on MRI scan ,and isodensity (8 cases) /hypodensity (2 cases) on CT scan .All patients in our study achieved clinical recovery in 4 (QL 3.25 ;QU 5) days and radiological recovery in 9 (QL 7.25 ;QU 10.75) days by timely therapy . Conclusions The main clinical manifestations of PRES are seizure ,blurred vision ,consciousness disorders ,headache and vomiting .The imaging findings are subcortical reversible edema in the posterior areas of the brain ,which shows low signal in T1WI ,high signal in T2WI and T2 flair ,equisignal or higher signal in DWI on MRI scan ,and isodensity/hypodensity on CT scan .Almost all patients presented reversible clinical symptoms and radiological recovery after correct therapy .