围产期脑后部可逆性脑病综合征的临床影像分析

Neuroimaging characteristics of patients with peripartum reversible posterior encephalopathy syndrome

目的：分析研究围产期脑后部可逆性脑病综合征的影像特征,提高诊治水平。方法：回顾性分析我院30例围产期脑后部可逆性脑病综合征患者的临床及影像学资料。结果：所有患者均急性起病,8例产前发病,22例产后发病（其中20例发生于自然阴道分娩后,2例为剖宫产术后发病）;16例发生于产后48h后。产前发病者6例具有子痫前期表现,而产后发病者仅1例具有子痫前期表现。首发症状以头痛为主,主要表现头痛（23例）、抽搐（22例）、视觉异常（19例）、意识障碍（8例）。影像表现为双侧对称性可逆性以大脑后部皮质下白质为主的病变,包括枕叶（27例）、顶叶（23例）、颞叶（10例）、额叶（7例）等。MR扩散成像显示血管源性脑水肿。治疗以降血压和控制癫痫为主,所有患者的临床症状和影像改变在1天～6个月有明显改善或消退,其中25例在2周内缓解。结论：围产期脑后部可逆性脑病综合征具有特征性的临床和影像表现,好发于产后,特别是产后48h后,且发病前多无子痫前期;MR扩散成像有助于鉴别病灶性质;治疗及时病灶完全可逆,预后良好。

Objective：To analyze the neuroimaging characteristics of patients with peripartum reversible posterior encephalopathy syndrome （RPES）.Methods：Thirty cases with peripartum RPES were retrospectively reviewed.Results：The disease in all patients developed acutly,8 cases in the antepartum period and 22 in the postpartum period （among which 20 developed after vaginal delivery,16 presented more than 48h after delivery）.Six cases of the antepartum RPES had preeclamptic signs while only 1 of the postpartum RPLS had preeclamptic signs.The major clinical characteristics were headache （23 cases）,seizures （22 cases）,visual disturbances （19 cases）,and altered mental status （8 cases）.The most common abnormality on neuroimaging was edema predominantly involving the cortex and subcortical white matter in the posterior portions of the cerebral hemispheres,including the occipital lobes （27 cases）,parietal lobes （23 cases）,temporal lobes （10 cases） and frontal lobes （7 cases）.MR diffusion-weighted imaging revealed vasogenic edema rather than cytotoxic edema.The treatments included aggressive blood pressure control and anticonvulsants.The clinical symptoms and the lesions on neuroimaging improved or resolved from 1 day to 6 months,among which 25 cases resolved within 2 weeks.Conclusion：Peripartum RPES is a clinical entity with characterized clinical manifestation and neuroradiological findings,which favors the postpartum period （especially over 48 hours after delivery） and most without preeclamptic signs.MR diffusion-weighted imaging contributes to the differentiation of vasogenic edema from cytotoxic edema.The prognosis for peripartum RPES is usually quite good as long as the diagnosis is made properly and the blood pressure and seizures are well controlled.