可逆性后部白质脑病综合征8例临床分析

Clinical analysis of 8 patients with reversible posterior leukoencephalopathy syndrome

目的探讨可逆性后部白质脑病综合征(RPLS)临床和影像学特点。方法回顾性分析8例RPLS患者临床及影像学资料。结果本组患者继发于高血压2例,子痫2例,产褥期子痫1例,血栓性血小板减少性紫癜1例,肺性脑病1例,颅咽管瘤1例。临床表现:6例出现头晕,4例出现癫发作,3例出现头痛,2例出现视物模糊,恶心、呕吐、精神异常、脑疝、左侧轻偏瘫各1例。6例无神经系统定位体征。影像学检查颅脑CT检查1例脑干低密度影,4例出现枕叶低密度影(其中2例广泛脑白质水肿),1例未发现异常。7例颅脑MRI检查(T1、T2、FLAIR),6例均有枕叶受累,3例同时累及额颞叶,1例累及脑干和小脑,1例累及尾状核头和丘脑,在脑叶呈脑回样,在其他部位呈斑片样异常信号;T1WI呈略低或等信号,T2WI呈高信号,FLAIR像显示皮质和皮质下白质明显高信号。结论头晕、头痛、视觉障碍和癫发作是RPLS主要临床表现,影像学特征主要为大脑后部白质对称性长T1、长T2信号。

Objective To investigate the clinical and imaging characteristics of reversible posterior leukoencephalopathy syndrome（RPLS）. Methods The clinical and imaging data of 8 patients with RPLS were analyzed retrospectively. Results Among the 8 cases was with RPLS,2 cases were secondary to hypertension, 2 cases were secondary to eclampsid, 1 case was secondary to puerperal, 1 case was secondary to thrombotic thrombocytopenic purpura, 1 case was secondary to pulmorary encepha- topathy, 1 case was secondary to craniopharyngioma . The clinical characteristics were that 6 cases presented with vertigo,4 ca- ses with epilepsy,3 cases with headache,2 cases with disturbance of vision, 1 case with nausea and vomitting, 1 case with men- tol disorders , 1 case with brain hernia, 1 case with hemiparesis. Cranial CT examination in 6 cases revealed occipital low density lesions in 4 cases, widely white matter edema in 2 cases,and no lesion in 1 case. Brain MRI showed that the occipital lobe was involved in 7 cases,frontal-temporal in 3 cases, brain stem and cerebellar in 1 case, caudate nucleus in 1 case, thalamus in 1 case. The lesion showed gyrus-tike abnominal signals in lobes and patchy abnormal signals in the other areas. The lesion showed low or iso-signal in TiWI,high signal in T2WI and FLAIR. Conclusion The vertigo,headache,disturbance of vision and epi- lepsy are the principal clinical symptoms in RPLS. The imaging features of RPLS are symmetrical long T1 and T2 signals on the bilateral posterior white matters of cerebrum.