酷似中毒性脑病的可逆性后部白质脑病综合征:6例临床分析

Reversible posterior leukoencephalopathy syndrome mimicking toxic encephalopathy: a clinical analysis of 6 cases

目的探讨可逆性后部白质脑病综合征(RPLS)的临床及影像学特点,为与中毒性脑病进行鉴别提供依据。方法回顾性分析6例RPLS患者的临床特点、影像学资料及治疗经过。结果 6例患者分别有大量饮酒史、海洛因吸食史、煤气中毒史、长期接触油漆涂料史、一氧化碳吸入史和有机溶剂接触史。临床主要表现为头痛、恶心、呕吐、癫痫发作以及血压升高。头部MRI主要表现为双侧颞叶、顶叶、额叶、侧脑室旁白质、小脑、脑干病灶,呈长T1、长T2信号,无强化。6例患者对症及去除病因治疗后临床表现及影像学表现均明显好转。结论 RPLS患者可以出现与中毒性脑病相似的临床及影像学特点,特别是当患者有毒物吸入史时,应根据该病相对特征性的临床、影像学及疗效尽早排除。

Objective To investigate the clinical and radiological characteristics of reversible posterior leukoencephalopathy syndrome（ RPLS） and to provide a reference for the differentiation between RPLS and toxic encephalopathy. Methods A retrospective analysis was performed on the clinical characteristics,imaging data,and treatment of 6 patients with RPLS. Results The 6 patients had histories of drinking,taking heroin,gas poisoning,long-term exposure to paint coatings,inhaling carbon monoxide,and exposure to organic solvent. The clinical manifestations mainly included headache,nausea,vomiting,seizures,and hypertension. Head MRI showed lesions in both temporal lobes,parietal lobe,frontal lobe,periventricular white matter,cerebellum,and brainstem,and the signals were long T1 and long T2 with no enhancement. After symptomatic treatment and treatment for removing the cause of disease,the 6 cases showed significant improvements in both clinical manifestations and imaging findings. Conclusions Patients with RPLS may manifest clinical and imaging features similar to those of toxic encephalopathy,especially when patients have histories of inhaling poisonous substances. The disease should be excluded as early as possible based on its clinical and radiological characteristics as well as the treatment outcome.