可逆性后部白质脑病综合征临床分析并文献复习

Clinical Analysis Review of Reference of Reversible Posterior Leukoen Cephalopa Syndrome

目的探讨可逆性后部白质脑病综合征(RPLS)的临床和影像学特征。方法回顾性分析62例RPLS患者的临床资料。结果本组成人多见,女性比例偏高。继发于先兆子痫/子痫21例(33.9%),高血压病19例(30.8%),肾功能不全11例(17.7%),其他原因为红斑狼疮、应用化疗药物、细胞毒性药物、血管炎、肾病综合征、急性肾小球肾炎、肾动脉狭窄、输血。头痛、癫痫发作、意识障碍、视力障碍是RPLS常见四联症,59例伴急性血压增高。影像学表现为大脑后部对称性白质水肿,CT低密度灶,MRI长T1低信号,短T2高信号,Flair像高信号。57例累及双侧顶枕叶,5例累及单侧枕叶,其他部位受累频率从高依次为:额叶、颞叶、小脑、基底核区、脑干、丘脑、胼胝体。经过降压、抗癫痫、减轻脑水肿对因、对症治疗,60例患者临床症状、影像学及临床症状异常迅速恢复。结论头痛、癫痫发作、意识障碍、视力障碍是RPLS主要临床表现,血压急性升高是RPLS的重要体征,影像学特征是大脑后部对称性白质水肿。大多数患者经治疗迅速恢复。

Objective To investigatethe clinical and imaging characteristics of posterior reversibl encephahalopathy syndrome（RPLS）.Methods The clinical data of 61 patients with RPLS were analyzed retospecitively （5 patients from our hospital and 57 from referenece）.Results Among the 62 cases with RPLS,most patients,symptoms occurrenced at adults and femals cases were more than males 21 cases （33.9%） were secondry to preeclamp sia/eclamp sia,,19例（30.8%）were secondry to hypertension,,11例（17.7%） were secondry to renal inadequacy,other reasons were lupus erythematosus,application of chemotherapeutics,cytotoxious disurbance and visual disorder 57cases were accompanied with acute hypertension Radiologic findings showed edema predom intantly in posterior cerbral white matter bilaterally,low density in CT,low signal in MRI T1,high signal in T2 and Flair,The bilateral apical and occipital lobe was invo;ved in 53 cases,lateral occipital lobe was involved in 5cases,other parts are frontal lobe,temporl lobe,cerebellum,basal gangia,brain stem,thalamus.callosum.The clinical manifestions and imaging lesions of 60 cases were both improved soon after treament.Conclusion The main clinical manifestions of RPLSare headache,epieptic attack,conscious disturbance and visual disorder.Tacute hypertension Radiologic charateristic is edema pedom inantly in the posterior cerebral white matter bilaterally,and mist patients snap back after treatment.