【摘要】 目的分析子痫前期-子痫并发可逆性后部白质脑病综合症的临床表现、影像学特征及治疗后改变。方法回顾性分析子痫前期-子痫合并可逆性后部白质脑病综合症患者9例的临床表现、影像学表现及随访结果。结果 9例均为急性、亚急性发病,收缩压/舒张压短期内平均升高42/37mmHg,主要表现为突发性癫痫发作7例(78%)、意识障碍9例(100%)、视力障碍8例(89%),伴有不同程度头痛、恶心、呕吐等颅高压症状及精神行为异常。影像学改变呈多发片状、斑片状局部水肿灶对称性分布6例(67%),非对称性分布3例(33%),病变累及顶叶白质区8例(89%)、枕叶白质区9例(100%)、皮层下白质9例(100%)及大脑皮层6例(67%),部分病例累及额叶5例(56%)、颞叶2例(22%)、小脑白质1例(11%)、基底节区1例(11%)及脑干2例(22%),病变区继发出血1例(11%),急性梗塞灶1例(11%)。5例MRV检查未见脑静脉及静脉窦阻塞,4例MRA检查颅内动脉未见狭窄。治疗1-2周后复查MRI:6例(67%)患者颅内病灶消失,3例(33%)病灶明显吸收、缓解。结论根据子痫前期-子痫患者突发血压升高、癫痫发作、视力障碍、颅高压症状及精神行为异常,结合影像学病灶特征性分部部位及血管源性水肿性质可明确诊断,T1WI可发现出血、DWI有助于发现梗塞等继发性改变。治疗及时,病变可完全逆转,预后良好。更多还原

【Abstract】 Objective To analyze the Clinical features,specific characteristics of magnetic resonance image(MRI) and prognosis of preeclampsia-eclampsia patients with reversible posterior leukoencephalopahy syndrome(RPLS).Methods The Clinical features,MRI manifestations and following results were retrospectively analyzed in 9 cases of RPLS.Results 9 cases of RPLS developed acutely or subacutely with average increasing blood pressure 42/37mmHg.Petients mostly presented epilepsia(7 cases,78%),confusion mental status(9 cases,100%),visual disturbances(8 cases,89%),accompanied with different degrees of headache,nausea,the symptom of intracranial hypertension and altered mental status.The most common abnormality on neuroimaging was multiple edema distributing symmetrically(6 cases,67%) or non-symmetrically(33 cases,33%),involving parietal lobes 8 cases(89%),occipital lobes 9 cases(100%),subcortical white matter 9 cases(100%) and cortex 6 cases(67%).Part patients involved frontal lobes 5 cases(56%),temporal lobes 2 cases(22%),cerebellum white matter 1 case(11%),basal ganglia 1 case(11%) and brain stem 2 cases(22%).Lension with secondary haemorrhage 1 case accompanied with acute infarction.5 cases undertaken MRV examinations showed normal with brain weins and 4 cases undertaken MRA didn’t show narrow.All patients reexamined MRI,The lesions disappeared completely in 6 cases(67%) and 3 cases(33%) absorbed obviously.Conclusion According to the patients with preeclampsia-eclampsia who developed suddenly increased blood pressure,epilepsia,visual disturbances,symptom of intracranial hypertension and confusion mental status,combining with neuroimaging which presenting characteristic lesion distribution and vesogenic edema,we can make clear diagnosis.The prognosis for preeclampsia-eclampsia with RPLS is usually quite nice as long as the treatment is prompt.更多还原