儿童可逆性后部脑病综合征2例报告并文献复习

Posterior reversible encephalopathy syndrome in children:a report of 2 cases and literature review

目的提高对儿童可逆性后部脑病综合征(RPES)的认识。方法回顾性分析首都儿科研究所收治的2例可逆性后部脑病综合征患儿的临床资料,并结合文献进行分析。结果2例患儿原发病分别为系统性红斑狼疮和肾病综合征,均在病程中突然出现头痛、视觉异常、意识障碍、高血压和抽搐等症状。头颅MRI显示双侧大脑顶、颞、枕叶皮层或皮层下片状长T1/T2信号。经过及时降血压和对症治疗后,短期内症状很快缓解,2～3周内影像学异常完全消失。结论RPES的发病机制是多方面的,急剧增高的血压可能是发生RPES的主要原因之一,及时有效的降压治疗可使病情在短期内逆转。

Objective To improve recognition of posterior reversible encephalopathy syndrome（PRES） in children.Methods Two children with PRES admitted to children＇s hospital were included.Clinical data were retrospectively studied and related literatures were reviewed.Results The primary diseases of the two patients are systemic lupus erythematosus and nephritic syndrome,respectively.They all developed an acute onset of headache,visual changes,consciousness disturbance,hypertension and seizures.Cranial MRI showed bilateral parietal,temporal and occipital cortical or subcortical lesions with hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging.Clinical symptoms resolved soon and radiographic recovery occurred within 14 to 21 days with prompt anti-hypertension treatment and supportive care.Among the mechanisms which might contribute to the development of PRES,acute elevated blood pressure seems to be the most important factors in these two cases.Prompt anti-hypertension treatment usually can reverse the PRES lesion.Conclusions It is important to improve cognition of PRES in children.Delayed treatment can cause permanent neurological impairment.Doctors should be alert to this syndrome.Early diagnosis and prompt treatment are very important.