可逆性后部白质脑病综合征五例并文献复习

Clinical analysis and review of reference of 5 cases of reversible posterior leukoencephalopathy syndrome

目的探讨可逆性后部白质脑病综合征的临床特点和影像学特征。方法回顾性分析我院2010年10月至2014年9月收治的5例可逆性后部白质脑病综合征患者的发病原因、临床症状、影像学特征、治疗及顶后。结果5例患者中，合并的基础疾病为系统性红斑狼疮2例，子痫1例，肾病综合征1例，肾功能不全1例。主要临床表现为癫痫发作、头痛、视物模糊及意识障碍。头颅MRI为大脑半球后部白质为主的T1WI低信号，T2WI、T2-F1Mr像呈高信号病灶，DWI大多呈等信号或稍低信号，表观弥散系数呈高信号，部分病例DWI和ADC均呈高信号且双侧对称。经降血压及适当处置后患者临床症状得到有效缓解，病灶消失，近、中期预后良好，随访期内未见疾病复发。结论可逆性后部白质脑病综合征具有特征性的临床及影像学改变，对此类患者及时诊治，一般预后良好。

Objective To explore clinical and imaging characteristics of reversible posterior leukoencephalopathy syndrome （RPLS）. Methods The clinical data of 5 patients with RPLS who were hospitalized in the People＇s Hospital of Jinhu County from October 2010 to September 2014 were analyzed retrospectively, including disease causes, clinical symptoms, imaging features, treatment and diagnosis. Results Among 5 cases,2 cases were secondary to systemic lupus erythematosus, 1 case was secondary to preeclampsia/ eclampsia, 1 case was secondary to nephrotic syndrome, and 1 case was secondary to renal insufficiency. The main clinical symptoms were epileptic attack, headache, visual disorder and conscious disturbanc. Magnetic resonance examination showed that lesions were hypointense on T1 weighted and hyperintense on T2 weighted and fluid-attenuated inversion recovery（FLAIR） images,iso-and slight hypointense On Diffusion-weighted image （DWI） in most of cases in th eposterior cerebral white matter bilaterally, but the lesions were hyperintense on DWI and ADC bilaterally in some of the cases. After blood pressure was treated, the clinical symptoms were relieved and the focus was disappear. The recent and mid-term prognosis was good. No recurrence occurred during follow-up. Conclusion Reversible posterior leukoencephalopathy syndrome is characterized of clinical and imaging changes, with good prognosis if timely diagnosis and treatment is conducted.