可逆性后部脑病综合征患者的临床表现及影像学分析

可逆性后部脑病综合征患者的临床表现及影像学分析

目的探讨可逆性后部脑病综合征常见临床表现及影像学特点。方法对我院2012年2月～2015年3月收治的15例可逆性后部脑病综合征患者临床表现及影像学资料，进行回顾性分析。结果15例患者中，男性患者3例，女性患者12例；急性起病12例，占80%，亚急性起病3例，占20%；高血压患者占14例，93.33%；妊娠子痫或子子痫前期患者10例，占66.67%；尿毒症患者4例，占26.67%；白血病化疗后患者1例，占6.67%。頭痛、视物模糊、癫痫发作患者各8例，占53.33%；意识状态改变及伴恶心、呕吐患者7例，占46.67%，其中有1例伴有尿失禁及肢体麻木局部神经功能损伤症状。影像学显示：累及枕叶及顶叶11例，占78.57%；累及额叶10例，占66.67%；累及基底节区8例，占53.33%；累及颞叶7例，占46.67%；另外，半卵圆中心、小脑、胼胝体、脑干均有累及。结论本病多急性或亚急性起病，成年人女性患者居多，常见临床表现为头痛、恶心、呕吐等颅高压症状及视物模糊、癫痫发作，严重者伴意识障碍，其头颅影像学提示颅内灰白质均可累及，多以枕、顶叶受累为主；因此对于急性起病，血压过高、子痫或先兆子痫、肾功能不全、化疗药物使用患者，临床表现为头痛、视物模糊、癫痫发作患者，应及时行头颅影像学检查，警惕可逆性后部脑病综合征可能。

Abstract：Objective To investigate common clinical manifestations and imaging features of posterior reversible encephalopathy syndrome.Methods A retrospective analysis was conducted on the clinical manifestations and imaging data of 15 cases of patients with posterior reversible encephalopathy syndrome admitted in our hospital from February 2012 to March 2015.Results Among 15 patients，there were 3 cases of male patients and 12 cases of female patients；12 cases of patients with acute onset （80%）and 3 cases of patients with sub-acute onset（20%）；14 cases of patients with hypertension（93.33%）；10 cases of patients with pregnant eclampsia or pre-eclampsia （66.67%）；4 cases of patients with uremia（26.67%）；one case of patient with leukemia after chemotherapy（6.67%）；8 cases of patients with headache，blurred vision，and epileptic seizure（53.33%）；7 cases of patients with altered mental status，accompanied by nausea and vomiting（46.67%），of which one case was accompanied by symptoms of local neurological damage including urinary incontinence and numbness of limb.According to imaging tests，11 cases of patients were involved with occipital and parietal lobes（78.57%）；10 cases were involved with frontal lobe （66.67%）；8 cases were involved with basal ganglia region（53.33%）；7 cases were involved with temporal lobe（46.67%）；in addition，the centrum semiovale，cerebellum，corpus callosum，and brainstem were all involved.Conclusion This disease often attacks after acute or sub-acute onset，mainly in adult female patients，with common clinical manifestations of intracranial hypertensive symptoms including headache，nausea and vomiting，blurred vision，and epileptic seizure，accompanied by disturbance of consciousness in severe cases.The head imaging test indicated involvement of intracranial gray matter and white matter，mainly in occipital and parietal lobes.Therefore，the head imaging examination should be timely conducted

on patients with acute onset，hyperpiesia，eclampsia or pre-eclampsia，renal insufficiency，patients received chemotherapy drugs，or those with clinical manifestations of headache，blurred vision，epileptic seizure in order to identify the possibility of posterior reversible encephalopathy syndromeKey words：Posterior reversible encephalopathy syndrome；Clinical manifestations；Imaging

可逆性后部脑病综合征（posterior reversible encephalopathy syndrome，PRES），由Hinchey等[1]于1996年报道，近年逐渐受到关注，该病是由多种病因引起的神经功能异常表现和可逆性后部白质损害为主要神经影像学表现的临床综合征。本文收集2012年2月～2015年3月贵阳医学院附属医院经治的临床及影像淡确诊的15例PRES患者的临床及影像学检查资料进行分析。

1 资料与方法

1.1一般资料本组病例共15例，男性患者3例，平均年龄（36.33±18.77）岁；女性患者12例，平均年龄（27.67±7.82）岁；其中，发病年龄16～53岁；妊娠子痫或子子痫前期患者10例；尿毒症患者4例；白血病化疗后患者1例。

1.2临床及影像学表现结果

1.2.1起病状态急性起病10例；亚急性起病5例。

1.2.2 15例患者的临床表现见表1。

1.2.3 15例患者的影像学病灶分布见表2。

1.3治疗及预后上述患者，经给予及时控制血压、脱水降颅压、抑制炎性水肿，控制抽搐及营养神经等对症治疗后，均恢复正常。

2 讨论

可逆性后部脑病综合征（posterior reversible encephalopathy syndrome，PRES），由Hinchey等[1]于1996年报道，是一种国外新提出的中枢神经影像学病名，该病是由多种病因引起的以头痛、恶心、痫性发作、视觉异常、昏迷或意识改变，轻偏瘫、偏盲、精神障碍或局灶性神经功能缺陷为主要临床表现[2]和可逆性后部白质损害为主要神经影像学表现的临床综合征，最初命名为可逆性后部白质脑病综合征（reversible posterior leuko-encephalopathy syndrome，RPLS）；后Casey等[3]研究了本病影像后指出，本病累及白质同时也累及灰质，因此命名为PRES。

2.1可逆性后部脑病综合征影像学表现本组患者头颅影像学提示病灶累及枕叶及顶叶11例，占78.57%；累及额叶10例，占66.67%；累及基底节区8例，占5

3.33%；累及颞叶7例，占46.67%；另外，半卵圆中心、小脑、胼胝体、脑干均有累及，这和Prout[4]报告相似。说明本病累及范围较广，本组病例常见累