重度子（癎）前期或子（癎）合并可逆性后部白质脑病综合征临床及影像学分析

Clinical and radiological analyses of reversible posterior leukoencephalopathy syndromes in preeclampsia/eclampsia

目的 探讨重度子（癎）前期或子（癎）合并可逆性后部白质脑病综合征（RPLS）的临床及影像学特点,总结孕产妇及胎儿预后信息,为临床早期识别、早期治疗提供依据.方法 回顾性收集广州重症孕产妇救治中心2013年1月至2015年7月诊断为重度子（癎）前期或子（癎）合并RPLS孕产妇33例,分析其临床症状、头颅CT或MRI影像学及临床预后相关特点.结果 （1）临床症状：头痛23例,视物不清19例,（癎）性发作15例,意识状态改变12例,恶心呕吐3例,4例出现少见的胸闷气促.（2）影像学特点：33例患者急性期均行影像学检查,提示脑组织水肿,其中部位以累及枕叶最常见,有24例,顶叶13例,颞叶和基底节各9例,额叶6例,亦累及脑干等不常见部位4例,小脑2例.（3）预后：33例中32例产前孕妇均终止妊娠,其中31例行剖宫产,1例自然分娩,所有患者积极治疗后预后均良好,除1例合并狼疮性脑病死亡余均未遗留后遗症;胎儿预后,8例出现死胎,余25例胎儿情况良好.结论 重度子（癎）前期或子（癎）合并RPLS临床症状以头痛、（癎）性发作、视觉改变及意识状态改变多见,影像学以累及枕、顶叶多见,亦可累及其他部位,早期诊断,积极治疗通常预后良好.

Objective To investigate clinical and radiological characteristics of reversible posterior leukoencephalopathy syndromes（RPLS） in preeclampsia/eclampsia and to summarize prognosis of patients and fetus in order to provide the basis for early diagnosis and early treatment.Methods Clinical and radiological characteristics, and treatments and outcomes of 33 pregnant women with RPLS in preeclampsia/eclampsia were analyzed retrospectively.All patients were treated in Guangzhou Medical Center for Critical Pregnant Women during January 2013 and July 2015.Results Clinical symptoms ：23 of 33 patients were with headache, 19 cases with visual changes, 15 with seizures, and 12 cases with conscious or mental disorder besides 3 cases with nausea and vomiting, and 4 cases with chest tightness and shortness of breath symptoms.Imaging features： 33 cases were all checked with radiological examination in acute period, which suggests edema of white matter.It involved the most common parts of occipital lobe（24 cases）, 13 cases in the parietal lobe,9 cases in temporal lobe and basal ganglia,and 6 cases in frontal lobe.Moreover, the common parts involving the brain stem occurred in 4 cases, and 2 cases of cerebellum.Clinical outcomes： 33 cases of pregnant women in prenatal emergency termination of pregnancy include 31 cases of cesarean section, and 1 case of natural delivery.After active treatment, the prognosis was good, except 1 case complicated with systemic lupus erythematosus （SLE） died, the rest were good.Fetal prognosis ： stillbirths occurred in 8 cases, the rest were good.Conclusions The clinical presentations of RPLS in patients with eclampsia or preeclampsia are typical, including headache, epileptic seizures, visual changes, conscious, or mental disorder.The imaging features which involved the most common parts are occipital lobe and parietal lobe.The early diagnosis and timely intervention lead to a sound prognosis.