妊娠相关可逆性脑后部白质病变综合征临床分析

Clinical analysis of pregnancy-related reversible posterior leukoencephalopathy syndrome

目的探讨妊娠相关可逆性脑后部白质病变综合征(RPLS)的临床特点。方法收集2012-01—2017-01在郑州大学第二附属医院产科病房和神经内科收治的18例妊娠期及产后合并PRLS临床资料,进行回顾性分析。结果 13例(72.22%)首发症状是头痛,伴恶心、呕吐;11例(61.11%)癫痫抽搐,其中9例多次发作,2例呈持续抽搐状态,3例首发;11例(61.11%)意识障碍,其中1例首发;10例(55.56%)视觉障碍,1例首发,8例合并头痛;1例(5.56%)精神异常。实验室指标:14例贫血,18例低蛋白血症,17例尿蛋白阳性,18例血清乳酸脱氢酶和尿酸异常。影像学:均有脑白质受累,5例皮质受累,其中枕叶18例,顶叶16例,额叶12例,颞叶9例,基底节区5例,胼胝体压部4例,小脑半球2例。经积极治疗,18例均痊愈出院,随诊6～12个月,均无癫痫复发,复查颅脑MRI,较前减轻或恢复正常。结论早发现,早诊治对疾病的预后至关重要,提高临床医师和影像医师的认识,可减少并发症的发生。

Objective To explore the clinical features of pregnancy-related reversible posterior cerebral leukodystrophy syndrome(RPLS).Methods The clinical data of 18 cases with PRLS during pregnancy and postpartum in the Second Affiliated Hospital of Zhengzhou University from January 2012 to January 2017 were collected for retrospective analysis.Results The first symptom of 13 cases(72.22%)was headache,nausea and vomiting.11 cases(61.11%)had seizures,including 9 cases with multiple seizures,2 with persistent convulsions and 3 with first episode.11 cases(61.11%)had consciousness disorder,one of which was the first one.There were 10 cases(55.56%)with visual impairment,1 case with the first episode and 8 cases with headache.1 case(5.56%)had mental disorder.Conclusion Early diagnosis and treatment is very important to the prognosis of the disease.