可逆性后部脑病综合征的临床、影像学特征及鉴别诊断分析

Clinical Features,Imaging Findings and Differential Diagnosis of Posterior Reversible Encephalopathy Syndrome

目的分析可逆性后部脑病综合征(PRES)的临床及影像学特征,提高临床对该病的诊断水平。方法回顾性分析遂宁市中心医院2010年1月—2014年7月收治的8例PRES患者的临床特征、脑脊液检查结果、脑电图检查结果、影像学检查结果以及患者治疗、预后情况,总结其鉴别诊断要点。结果 8例患者均有头痛、视物不清症状,4例患者出现恶心呕吐及肢体抽搐,3例患者出现意识和精神障碍。基础疾病:妊娠4例,高血压2例,肾上腺腺瘤1例,系统性红斑狼疮1例。2例患者颅脑CTA示双侧大脑中动脉、大脑后动脉及大脑前动脉血管分支节段性舒张或收缩。8例患者颅脑MRI示病变多数对称分布于双侧大脑后部白质区,部分皮质受累,T2WI及FLAIR均呈高信号,边界不清。8例患者经相关治疗后神经系统症状消失,MRI复查病灶大部分或完全消失。结论 PRES病因及临床表现多样,病程具有可逆性,确诊时应结合影像学检查以排除颅内其他疾病。

Objective To analyze the clinical features and imaging findings of posterior reversible encephalopathy syndrome（ PRES）, to improve the diagnostic ability of clinicians. Methods From January 2010 to July 2014 in Suining Central Hospital,a total of 8 patients with PRES were enrolled, and their clinical features, cerebrospinal fluid examination results,electroencephalogram examination results,imaging findings,treatment and prognosis were retrospectively analyzed,the key points of differential diagnosis were summarized. Results All of the 8 cases occurred headache and blurred vision,4 cases occurred nausea and vomiting,limb seizures,3 cases occurred consciousness and mental disorders. Basic diseases： 4 cases with pregnancy,2 cases with hypertension,1 case with adrenal adenoma,1 case with systemic lupus erythematosus. CTA findings： 2cases showed segmental relaxation or shrink of bilateral middle cerebral artery, posterior cerebral artery and anterior cerebral artery branches. MRI findings： 8 cases showed symmetric lesions in bilateral posterior white matter（ some of them occurred cortex damage）,T2 WI and FLAIR showed increased signal intensity,with fuzzy boundary. All of the 8 patients＇ neurological symptoms disappeared after symptomatic treatment,the lesions completely or mostly disappeared by reexamination of MRI. Conclusion The etiological factors and clinical features of PRES are various,but its process is reversible,and imaging findings should be referred to make a definite diagnosis of PRES.