可逆性后部脑病综合征8例临床分析

Clinical Analysis of 8 Patients with Posterior Reversible Encephalopathy Syndrome

目的探讨可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)的临床特点及影像学特征。方法对2009年10月—2012年10月经临床、影像学检查确诊的8例PRES的临床资料进行回顾性分析。结果 8例PRES中均伴有基础疾病;以头痛、癫痫发作、视觉异常、意识和精神障碍为主要临床症状,血压急剧升高或波动性升高是其主要诱发因素。头颅MRI表现多为双侧大脑后部白质对称性T1WI低或等信号,T2WI和FLAIR高信号,DWI等信号或略高信号病变。给予降压、脱水及对症治疗1～2周后神经系统症状消失,MRI复查病灶完全或大部分消失。结论 PRES是以可逆性后部白质损害为主要神经影像学表现的临床综合征,及时、准确的诊断和治疗可使病情迅速缓解。

Objective To explore the clinical and imaging features of posterior reversible encephalopathy syndrome （PRES）. Methods Clinical data of 8 patients with PRES diagnosed by clinical and imaging examination during October 2009 and October 2012 were retrospectively analyzed. Results Eight patients with PRES were all associated with some basic diseases. The clinical features of these diseases were headache, seizure disorder, disordered vision un- consciousness and mental disorders. The sharp or undulatory rising of blood pressure was the main causative factor. Magnetic resonance imaging （MRI） of head mainly showed symmetrical abnormalities in the bilateral posterior white matter regions of brain with low or equal signal on T1WI, high signal on T2WI and FLAIR images, and isointensity or a little higher signal on DWI. After treatment with antihypertensive agents, dehydration therapy and heteropathy for 1 - 2 weeks, the patients＇ neurological deficits were almost resolved, and initial lesions disappeared completely or almost completely in all patients by the follow-up MRI. Conclusion PRES is a clinical syndrome with main neuroimaging features of reversible white matter damage in posterior brain. Diagnosis and treatment as quickly as possible may result in reversible resolution of its clinical symptoms and neuroradiological lesions.