急慢性肾衰竭合并可逆性后部白质脑病综合征(附二例病例报告)

Reversible Posterior Leukoencephalopathy Syndrome with Acute and Chronic Renal Failure

目的探讨急慢性肾衰竭合并可逆性后部脑白质综合征(RPLS)的原因、临床表现和病理特点。方法回顾分析两例女性肾衰竭合并RPLS的临床资料并复习文献。结果两例患者均出现意识障碍和高血压;病例1合并Goodpasture综合征,以癫痫为首发症状,病例2以头痛、视物障碍为首发症状。头颅CT检查显示多发低密度。颅MRI检查显示T2加权像、FLAIR像高信号,T1加权像等信号,弥散加权像为等信号和部分高信号。经降血压和停用细胞毒性药物治疗4 d和7 d后患者神经系统症状和体征完全恢复正常。结论肾衰竭可引起RPLS。神经影像学检查对诊断RPLS具有重要地位。

Objective To retrospectively identify reversible posterior leukoencephalopathy syndrome （RPLS） patient with acute and chronic renal failure with clinical presentation and neuroimaging and pathology. Methods To analyze and review clinical information of two female patients with RPLS. Results Both of them had conscious disturbance and hypertension. Case 1 with Goodpasture syndrome had seizures and Case 2 with chronic renal failure had visual abnormalities and headaches. CT scan showed the multiple low density lesion. MRI demonstrated hyperintense lesion on T2 weighting image and FLAIR imaging. Diffusion weighted image （DWI） showed the part of high or normal signal lesions. The patients recovered well after treated with anti-hytertensive drugs and stopping using of cytoxic drug. Conclusions Acute and chronic renal failure could induce RPLS. Neuroimage may be very important in diagnosis of RPLS.