妊娠期及产后合并可逆性后部白质脑病综合征的临床特点分析

Analysis of clinical features of pregnancy or postpartum combined with reversible posterior leukoencephalopathy syndrome

目的探讨妊娠期及产后合并可逆性后部白质脑病综合征(RPLS)的临床特点。方法对52例妊娠期或产后合并RPLS患者的临床资料进行回顾性分析。结果本组52例患者中,30例(57.7%)患者合并妊娠高血压疾病。32例(61.5%)患者首发症状为头痛,30例(57.7%)患者有癫痫发作,19例(36.5%)患者出现视物模糊,12例(23.1%)患者合并有意识障碍,3例(5.8%)患者有精神异常,7例(13.5%)患者有肢体麻木无力症状,9例(17.3%)患者查体有神经系统阳性体征。所有患者尿微量蛋白指标阳性,血清乳酸脱氢酶及尿酸指标均有不同程度升高。影像学检查示所有患者均有白质受累,以枕叶、顶叶受累为主,病灶多为对称性分布。经减轻脑水肿,控制血压,控制癫痫发作等对症处理,所有患者在治疗2~4周后痊愈出院,随访无复发。结论妊娠及产后合并RPLS常见于妊娠高血压疾病患者,对于妊娠期或产后出现头痛及癫痫发作的患者应及早行颅脑CT及MRI检查,以利及早诊断,及早治疗。

Objective To analyze the clinical features of pregnancy or postpartum combined with reversible posterior leukoencephalopathy syndrome （RPLS）. Methods The clinical data of 52 RPLS patients with pregnancy or postpartum were analyzed retrospectively. Results In this group of 52 patients, 30 cases （57.7%） were combined with hypertensive disorders in pregnancy. Thirty-two patients （61.5%） with initial symptom of headache. Thirty cases （57.7%） had seizures. Nineteen cases （36.5%） had blurred vision. Twelve cases （23. 1% ） had disturbance of consciousness. Three patients （5.8%） had mental disorders. Seven patients （13.5%） had limb numbness symptoms. Nine patients （ 17.3% ） had neurological positive signs. All patients with urinary microprotein markers were positive. Serum lactate dehydrogenase and uric acid were increased to varying degrees. Imaging studies showed that all patients had white matter involvement, occipital lobe and parietal lobe were mainly involved, and the lesions were mainly symmetry distribution. By reducing brain edema, blood pressure control, control of seizures and other treatment, all patients were cured after 2 to 4 weeks of treatment, and follow-up without recurrence. Conclusions Pregnancy and postpartum complicated with RPLS is common in patients with hypertensive disorders in pregnancy. For patients with headache and epileptic seizures during pregnancy or postpartum should be early detected by brain CT and MRI, in order to be early dagnosed and early treated.