可逆性后部白质脑病综合征的临床和MR特点分析

Clinical and MR features of reversible posterior leukoencephalopathy syndrome were analyzed

目的:探讨可逆性后部白质脑病综合征(RPLS)的临床和MR特点。材料与方法:回顾性分析27例可逆性后部白质脑病综合征患者的病因、临床表现及MR影像资料。结果:27例患者中男8例,女19例。病因多种多样,妊娠高血压综合征及先兆子痫11例,继发性高血压3例,原发性高血压2例,系统性红斑狼疮1例,肾功能不全3例,肾病综合征1例,环孢霉素治疗后1例,癌症化疗后3例,鼻咽癌放疗1例,多发性动脉炎1例。主要临床表现为头痛、癫痫发作、视觉障碍和精神异常。大多数患者头颅MRI平扫表现为双侧大脑后部白质T1WI呈低或等信号,T2WI及FLAIR像呈高信号,DWI呈等或稍高信号,ADC图呈高信号,病灶双侧对称或不对称;予以积极对症治疗后患者临床症状及MR所见病灶均明显好转。结论:RPLS的病程具有可逆性,提高对该综合征的临床及MR特点的认识,对于RPLS的早期正确诊断、治疗以及疗效评价具有重要的临床意义。

Purpose： To study the reversible posterior leukoencephalopathy syndrome（ RPLS） clinical and MR features. Materials and Methods： a retrospective analysis of 27 patients with reversible posterior leukoencephalopathy syndrome of etiology,clinical manifestation and MR imaging data. Results： In 27 cases,8 cases of male,female 19 cases.Causes are diverse,pregnancy- induced hypertension syndrome and preeclampsia in 11 cases,secondary hypertension in 3cases,2 cases with essential hypertension（ eh）,systemic lupus erythematosus（ sle） in 1 case,renal insufficiency in 3 cases,1 case with nephrotic syndrome,cyclosporine in 1 case after treatment,cancer after chemotherapy（ 3 cases）,nasopharyngeal carcinoma radiotherapy in 1 case,multiple arteritis in 1 case. Major clinical manifestations are headache,seizures,visual impairment and mental disorder. Most of the patients with cranial MRI scan performance for both sides at the back of the brain white matter T1 WI was low or equal signal,T2 WI and FLAIR like show high signal,DWI is egual or slightly high signal,the ADC figure shows high signal,lesions bilaterally symmetrical or asymmetrical; Be positive in patients with symptomatic treatment after clinical treatment and MR images were significantly improved. Conclusion： the clinical course of RPLS is reversible,and improve the understanding of the clinical and MR features of the syndrome,the RPLS early correct diagnosis,treatment and curative effect evaluation has important clinical significance.