剖宫产术-硬脊膜刺破后头痛-可逆性后部白质脑病综合征

Reversible posterior leukoencephalopathy syndrome （RPLS） in a postpartum woman after postdural puncture headache following combined-spinal epidural anesthesia

可逆性后部白质脑病综合症（reversible posterior leukoencephalopathy syndrome，RPLS）是一少见的具有多种临床表现的综合征，临床症状包括头痛、高血压、意识障碍、视觉改变和癫痫发作。此文报道1例剖宫产术后发生的RPLS。患者28岁，女性，因“停经40“周，慢性高血压合并妊娠”入院。剖宫产术后出现头痛、高血压、癫痫发作及双眼右侧视野偏盲，经脑部核磁检查确诊为RPLS，予镇静、降压、脱水及解痉治疗2周后症状完全缓解，复查脑部磁共振（MRI）结果正常出院。该病确诊的主要依据是MRI具有特征性改变：双侧大脑半球后部枕叶和顶叶白质异常信号。此病多数预后良好，经积极降压和抗癫痫治疗病情迅速好转，故称“可逆件”。佃县巾．可能因诊断延迟只或治疗不当而发毕“不可逆”的脑损伤如脑水肿、脑梗塞甚至脑疝死亡。

Reversible posterior leukoencephalopathy syndrome （RPLS） is a rare clinical syndrome, which is manifested clinically by headache, seizure, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. We present a case of postpartu women who developed RPLS after combined-spinal epidural anesthesia which was complicated by a postdural puncture headache. The patient was treated with magnesium sulfate, midazolam, mannitol and carbamazepine for seizure control and prophylaxis. Blood pressure was controlled with labetolol and nicardipine. The patient was discharged home two weeks later with no neurologic deficit, and repeated magnetic resonance imaging （MRI） showd normal. Cerebral MRI served as a diagnostic method for RPLS. The hallmark feature is bilateral symmetrical vasogenic edema in the territories of the posterior cerebral circulation （occipital and posterior parietal lobes）. If promptly recognized and treated, symptoms and neuroradiographic changes are reversible when blood pressure is controlled. However, if the diagnosis is delayed or unrecognized, cerebral ischemia and infarction can occur, which might result in permanent brain injury or death.