可逆性后部白质脑病综合征的临床特征及MRI影像学分析

The clinical characteristics and MRI imaging analysis of reversible poste- rior leukoencephalopathy syndrome

目的探讨可逆性后部白质脑病综合征(RPLS)的MRI影像学特征及临床表现、早期诊断和治疗。方法分析8例RPLS患者的临床及影像学资料。结果主要临床表现为头晕、头痛、视物模糊、癫痫发作、恶心、呕吐、精神障碍和行为改变。MRI检查显示双侧大脑后部白质水肿,额叶、顶叶、颞叶、脑干、小脑、基底节区和大脑皮质亦可累及。MRI表现T1WI为略低或等信号,T2WI和FLAIR为高信号,DWI呈等或低信号,ADC图呈高信号。结论 RPLS的发病机制为急性脑白质血管源性水肿。绝大多数患者通过积极的治疗后,症状、体征和MRI表现可以完全恢复至病前水平。DWI和ADC图对早期明确诊断和指导治疗具有非常重要的意义。

Objective To study the MRI imaging features, clinical manifestations,early diagnosis and treatment of re versible posterior leukoencephalopathy syndrome（RPLS）. Methods The clinical and imaging features of 8 cases with RPLS were analyzed. Results The main clinical manifestations included headache,disturbance of vision, nausea, vomiting,epilepsy,conscious disturbance,psychiatric disorder and action abnormality.Neuroimaging test found that edema mainly appeared in the posterior cerebral white matter bilaterally, frontal lobe, parietal lobe, temporal lobe,brainstem, cerebellum and basal nucleus, and the grey matter could be also involved. Tile lesions showed hypointense or isosignal in T1WI,low signal in T2WI and FLAIR high signal. The lesion also demonstrated hyperintense in apparent diffusion coefficient（ADC） map and hypointense or isosignal in diffusion weighted magnetic resonance imaging（DWI）. Condu- sioll The pathophysiological mechanism of RPLS is acute vasogenic edema.The symptoms,signs and MRI features could fully recover in most of RPLS cases. DWI and ADC map may be crucial to the exact diagnosis and treatment in early stage