中央变异型可逆性后部脑病综合征一例

One case of central-variant posterior reversible encephalopathy syndrome

目的 探讨中央变异型可逆性后部脑病综合征(PRES)患者的特点。方法分析1例以头晕为主要症状的中央变异型PRES患者的临床及影像学资料。结果本例患者临床症状轻微且无神经系统定位体征,以严重高血压伴肾功能异常为特点,磁共振(MRI)示脑干、丘脑、小脑等多发异常信号伴微出血,DWI等信号ADC高信号提示血管源性水肿,降压治疗后症状消失、病变明显减少,最终诊断为中央变异型PRES。结论不同于经典型PRES(以顶枕叶为主),中央变异型PRES主要累及脑干和基底神经核,临床少见。提高对中央变异型PRES的认识,对疑似患者进行详细的病史询问、结合ADC和DWI综合分析信号特点(血管源性水肿),对早期诊断、避免额外侵入性检查和正确治疗至关重要。

Objective To investigate the features of central-variant posterior reversible encephalopathy syndrome(PRES).Method Describe and analyze the clinical data of 1 case of central-variant PRES with dizziness as the main symptom.Results The most prominent feature of this patient was the extremely high blood pressure and renal dysfunction,with only mild clinical symptoms and without any neurologic sign.Brain MRI showed diffuse brain edema over the brainstem,bilateral thalami,and cerebellar hemispheres with microbleeds.The normal DWI findings and high ADC values were consistent with vasogenic edema.His symptoms completely resolved and the lesions improved dramatically after antihypertensive therapy.Conclusion central-variant PRES predominantly involving the brainstem and basal ganglia and relatively sparing the parieto-occipital lobe is rare.Greater awareness of central-variant PRES—taking history detailedly and recognizing vasogenic changes on neuroimaging-is important to establish the diagnosis and avoid additional invasive testing and potentially harmful therapy.