可逆性后部白质脑病综合征影像学与临床分析

Imaging and clinical diagnosis of reversible posterior leukoencephalopathy syndrome

目的探讨可逆性后部自质脑病综合征（RPLS）影像学与临床特点。方法回顾性分析2004年6月至2007年10月6例RPLS患者的影像学及临床资料。结果6例均行MRI及CT检查，4例双侧对称性枕叶白质受累，4例双侧额顶叶皮质下白质广泛受累，1例同时累及中脑和丘脑，1例累及尾状核头部；病灶形态不规则，表现为皮质及皮质下白质脑回样异常信号，2例妊娠高血压综合征磁共振静脉造影显示未发现静脉窦血栓形成。所有患者均给予积极治疗原发病、控制血压、控制癜痫发作、脱水减轻脑水肿及对症支持治疗。5例患者症状基本消失，1例遗留右侧肢体轻偏瘫。无一例死亡。绪论只要结合临床病史，特别是具有高血压、子痫及肾功能不全的患者出现典型的临床四联征，影像学为后部脑白质损害为主的表现，RPLS的诊断并不困难。

Objective To investigate the imaging and clinical characteristics of reversible posterior leukoencephalopathy syndrome （RPLS）. Method The imaging and clinical data of 6 patients with RPLS were analyzed retrospectively. Results CT and MRI examination in 6 patients revealed symmetry white matter lesions of occipital lobe in 4 patients, widely white matter edema of fronto-parietal subcortical white matter in 4 patients, meseneephal and thalamencephal involved in 1 patient, caudate nucleus involved in 1 patient. Venous sinus thrombosis was not found in 2 patients of pregnancy-induced hypertension syndrome with magnetic resonance intravenous angiography.AU patients were given active treatment,including controlling blood pressure and seizure disorder,dehydration and supporting therapy.The symptom of 5 patients disappeared. One patient left with hemiparesis of right body.Nobody died. Conclusion Diagnosis of RPLS isn＇t difficult as long as clinical history,imaging characteristics and clinical tetrad in the patients of hypertension,eelamptism or renal inadequacy is combined to consider.