儿童难治性颞叶癫痫的手术治疗

Objective To study the preoperative evaluation, surgical treatment strategies, and factors associated with seizure outcome of refractory temporal lobe epilepsy (TLE) in children.Methods Of a series of 21 children with refractory TLE, who were treated surgically during the period from July 2007 to February 2009, nineteen were followed up and their clinical data were retrospectively reviewed. Most patients had complex partial seizure, seizure aura such as abdominal discomfort, and automatism such as smacking lips and swallowing. MRI scanning demonstrated abnormal signal at temporal lobe in 15 cases. Six patients had abnormal results in PET scaning. Scalp EEG monitoring demonstrated local epilepsy discharge in 7 cases, and multiple locals in 12. Fifteen patients underwent surgery for removal of one side pretemporal lobe and amygdalohippocampus, and 4 had still partial cortex of the frontal lobe resection. Results The follow- up period ranged from 12 to 30 months. The seizure outcome according to Engel outcome scale were Ⅰ grade in 13 cases, Ⅱ in 3, Ⅲ 1 and Ⅳ in 2.Neuropsychological outcome: Two patients improved significantly. Postoperative pathology results included the brain cortex dysplasia and mesial temporal lobe sclerosis. Conclusions Most of the children who had temporal lobe surgery for intractable TLE had good seizure contral. The procedure is safe, with a low complication rate. A concordant localization of epileptogenic zone from seizure manifestation, EEG and neuroimaging studies may predict a favorable seizure outcome. Early surgical intervention may improve the neuropsychological scale.     

儿童难治性颞叶癫痫的手术治疗

Objective To study the preoperative evaluation, surgical treatment strategies, and factors associated with seizure outcome of refractory temporal lobe epilepsy (TLE) in children.Methods Of a series of 21 children with refractory TLE, who were treated surgically during the period from July 2007 to February 2009, nineteen were followed up and their clinical data were retrospectively reviewed. Most patients had complex partial seizure, seizure aura such as abdominal discomfort, and automatism such as smacking lips and swallowing. MRI scanning demonstrated abnormal signal at temporal lobe in 15 cases. Six patients had abnormal results in PET scaning. Scalp EEG monitoring demonstrated local epilepsy discharge in 7 cases, and multiple locals in 12. Fifteen patients underwent surgery for removal of one side pretemporal lobe and amygdalohippocampus, and 4 had still partial cortex of the frontal lobe resection. Results The follow- up period ranged from 12 to 30 months. The seizure outcome according to Engel outcome scale were Ⅰ grade in 13 cases, Ⅱ in 3, Ⅲ 1 and Ⅳ in 2.Neuropsychological outcome: Two patients improved significantly. Postoperative pathology results included the brain cortex dysplasia and mesial temporal lobe sclerosis. Conclusions Most of the children who had temporal lobe surgery for intractable TLE had good seizure contral. The procedure is safe, with a low complication rate. A concordant localization of epileptogenic zone from seizure manifestation, EEG and neuroimaging studies may predict a favorable seizure outcome. Early surgical intervention may improve the neuropsychological scale.     

Effects of low-frequency repetitive transcranial magnetic stimulation on electroencephalogram and seizure frequency in 15 patients with temporal lobe epilepsy following dipole source localization*★

BACKGROUND： Low-frequency repetitive transcranial magnetic stimulation （rTMS） has been shown to significantly reduce epileptiform discharges and control clinical seizures in intractable epilepsy patients. The location of epileptic foci and magnetic stimulation sites remain uncertain. The effects of rTMS on electroencephalogram and seizure remain unclear in epileptic patients following dipole source localization. OBJECTIVE： To investigate the effects of low-frequency rTMS on electroencephalogram and seizure in temporal lobe epilepsy patients after dipole source localization. DESIGN, TIME AND SETTING： The randomized, controlled study was performed at the outpatient clinic Department of Neurology, Hospital Affiliated to North Sichuan Medical College from December 2003 to February 2007. PARTICIPANTS： A total of 30 temporal lobe epilepsy patients, comprising 19 males and 11 females, aged 1749 years, presented with epileptiform discharges and were enrolled for this study. Disease course ranged between 1-6 years, with 1-5 seizures per month. Imaging examinations revealed 11 patients with structural changes in the brain. The patients were randomly and equally assigned into drug treatment and transcranial magnetic stimulation （TMS） groups. METHODS： Patients in the drug treatment group were orally treated with carbamazepine. Patients in the TMS group received oral carbamazepine treatment of and TMS. A Maglite-r25 magnetic stimulator （Dantec Dynamics, Denmark） was used to stimulate epileptic foci in the temporal lobe following electroencephalogram dipole localization （1 Hz, 90% threshold intensity, at a stimulation frequency of 500 times, once a day, for 7 days）. MAIN OUTCOME MEASURES： At 30 days after TMS, seizure frequency and rate of epileptiform discharges were observed in patients from both groups. Therapeutic safety was investigated during treatment. RESULTS： Within 30 days of treatment, there were no significant differences in seizure frequency between the TMS group （1.5 ± 0.3） seiz     

中枢神经系统感染后继发难治性癫痫的病灶切除治疗

Previous studies have focused on medial temporal lobe epilepsy secondary to central nervous system infections. Several large-sample analyses of multi-lobe injuries or complications of medial temporal lobe epilepsy have been reported. The present study selected 29 patients (10 males and 19 females with a mean age of 18 years) with refractory epilepsy secondary to central nervous system infections (meningitis in 8, encephalitis in 21) from Beijing Functional Neurosurgical Institute from May 2006 to August 2008. All patients underwent computer tomography or magnetic resonance imaging, as well as electroencephalogram examinations; cortical electrodes were embedded in 11 patients. In addition, 13 (45%) patients underwent anterior temporal lobectomy, and 16 (56%) underwent extratemporal corcticectomy. Results showed that 18 (62%) patients obtained favorable outcomes following surgical treatment, including 80% with temporal lobe epilepsy and 50% with extratemporal epilepsy. Central nervous system infection was not a contraindication for epilepsy treatment, and identification of epileptic foci proved to be crucial. In addition, a young age at infection, as well as prolonged latent period from time of infection to initial afebrile seizure, were 2 predictive factors for all patients. Cortical electrodes significantly increased the detection rate of epileptic foci, but did not improve prognosis of foci excision.     

Approximate entropy and support vector machines for electroencephalogram signal classification*****

The automatic detection and identification of electroencephalogram waves play an important role in the prediction, diagnosis and treatment of epileptic seizures. In this study, a nonlinear dynamics index–approximate entropy and a support vector machine that has strong generalization ability were applied to classify electroencephalogram signals at epileptic interictal and ictal periods. Our aim was to verify whether approximate entropy waves can be effectively applied to the automatic real-time detection of epilepsy in the electroencephalogram, and to explore its generalization ability as a classifier trained using a nonlinear dynamics index. Four patients presenting with partial epileptic seizures were included in this study. They were all diagnosed with neocortex localized epilepsy and epileptic foci were clearly observed by electroencephalogram. The electroencephalogram data form the four involved patients were segmented and the characteristic values of each segment, that is, the approximate entropy, were extracted. The support vector machine classifier was constructed with the approximate entropy extracted from one epileptic case, and then electroencephalogram waves of the other three cases were classified, reaching a 93.33% accuracy rate. Our findings suggest that the use of approximate entropy allows the automatic real-time detection of electroencephalogram data in epileptic cases. The combination of approximate entropy and support vector machines shows good generalization ability for the classification of electroencephalogram signals for epilepsy.     

Brain areas activated by uncertain reward-based decision-making in healthy volunteers

Reward-based decision-making has been found to activate several brain areas, including the ven- trolateral prefronta~ lobe, orbitofrontal cortex, anterior cingulate cortex, ventral striatum, and mesolimbic dopaminergic system. In this study, we observed brain areas activated under three de- grees of uncertainty in a reward-based decision-making task （certain, risky, and ambiguous）. The tasks were presented using a brain function audiovisual stimulation system. We conducted brain scans of 15 healthy volunteers using a 3.0T magnetic resonance scanner. We used SPM8 to ana- lyze the location and intensity of activation during the reward-based decision-making task, with re- spect to the three conditions. We found that the orbitofrontal cortex was activated in the certain reward condition, while the prefrontal cortex, precentral gyrus, occipital visual cortex, inferior parietal lobe, cerebellar posterior lobe, middle temporal gyrus, inferior temporal gyrus, limbic lobe, and midbrain were activated during the ＇risk＇ condition. The prefrontal cortex, temporal pole, inferior temporal gyrus, occipital visual cortex, and cerebellar posterior lobe were activated during am- biguous decision-making. The ventrolateral prefrontal lobe, frontal pole of the prefrontal lobe, orbi- tofrontal cortex, precentral gyrus, inferior temporal gyrus, fusiform gyrus, supramarginal gyrus, infe- rior parietal Iobule, and cerebellar posterior lobe exhibited greater activation in the ＇risk＇ than in the ＇certain＇ condition （P 〈 0.05）. The frontal pole and dorsolateral region of the prefrontal lobe, as well as the cerebellar posterior lobe, showed significantly greater activation in the ＇ambiguous＇ condition compared to the ＇risk＇ condition （P 〈 0.05）. The prefrontal lobe, occipital lobe, parietal lobe, temporal lobe, limbic lobe, midbrain, and posterior lobe of the cerebellum were activated during deci- sion-making about uncertain rewards. Thus, we observed different levels and regions of activation for different types of reward processing during decision-making. Specifically, when the degree of reward uncertainty increased, the number of activated brain areas increased, including greater ac- tivation of brain areas associated with loss.     

Value of long-term electroencephalogram in diagnosing epilepsy

BACKGROUND: Routine electroencephalogram (EEG) usually cannot accurately reflect the discharge of epileptic patients due to the short examination, and long-term EEG can make up the shortcoming. OBJECTIVE: To comparatively analyze the long-term EEG of epileptic and non-epileptic patients, and investigate the values of long-term EEG in the diagnosis and differential diagnosis of epilepsy. DESIGN: A case-controlled study. SETTING: Ningjin County People's Hospital. PARTICIPANTS: Totally 122 patients with epilepsy (epilepsy group) were selected from the EEG room of Ningjin County People's Hospital from January 2000 to December 2006, including 76 males and 44 females, 7 months to 78 years of age, the disease course ranged from 7 days to 7.5 years, and they all according with the standards for epilepsy set by the International Association for Epilepsy in 1997. Meanwhile, 118 patients with non-epileptic paroxysmal diseases were selected as the control group, including 71 males and 47 females, 2.5–87 years of age, the disease course ranged from 3 days to 7.5 years. Informed contents were obtained from all the subjects. METHODS: OXFORD GATE WAY 2000 16-lead portable EEG recorder was used for 24-hour electroencephalographic procedure. The patients could move normally during the monitoring, their activities, sleeping conditions, time and manifestations of seizures were recorded in details. In the next day, EEG at wake was recorded for 10 minutes, followed by 3-minute hyperventilation and open/close eye induction test, the phases of non-rapid eye movement (Ⅰ–Ⅳ) and rapid eye movement were performed using EEG at sleep according to the international EEG standard. The abnormal rates of EEG epileptic discharge at wake and sleep at different sites were calculated. MAIN OUTCOME MEASURES: Abnormal rate of long-term EEG at wake and sleep in both groups; Epileptic discharge at different sleeping phases in both groups; Abnormal rates of EEG epileptic discharge at wake and sleep at different sites in the epilepsy group. RESULTS: All the 122 patients with epilepsy and 118 patients with paroxysmal diseases were involved in the final analysis of results. ① Comparison of abnormal rate of long-term EEG at wake and sleep: In the epilepsy group, the abnormal rate of EEG at wake was obviously lower than that at sleep (68%, 91%, P < 0.01). In the control group, the abnormal rate of EEG at wake and sleep had no obvious difference (P > 0.05). ② Results of epileptic discharge at different sleeping phases: In the epilepsy group, the epileptic discharge occurred at Ⅰ–Ⅱ phases of sleep cycle in 88.1%, and at Ⅲ–Ⅳ in 11.9%; In the control group, the epileptic discharge occurred at Ⅰ–Ⅱ phases of sleep cycle in 91.7%, and at Ⅲ–Ⅳ phases in 8.3% (1/12). ③ Comparison of the abnormal rates of EEG epileptic discharge at wake and sleep at different sites in the epilepsy group: The abnormal rates of epileptic discharge at frontal lobe and temporal lobe at sleep were obviously higher than those at wake (21.3%, 24.6%; 10.7%, 11.7%, P < 0.01), while there were no obvious differences at wake and sleep at occipital lobe, parietal lobe (P > 0.05). CONCLUSION: Long-term EEG has great importance in the diagnosis and differential diagnosis of epilepsy, especially that it increases the detective rate of discharge by several cycles of sleep derivation. This method also provides important reference for the allocation of epileptic focus.     

可逆性后部白质脑病的CT及MRI影像学表现

可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)是一种临床神经影像综合征,近年国内外对本病的报道逐渐增多.RPLS病变主要累及后部脑区,病程上经过治疗后一般具有可逆性,如治疗不及时脑部病变可演变为不可逆损伤.本文对6例经临床及影像学证实的RPLS患者的影像学资料进行回顾性分析,期望对临床诊治该病有所帮助.     

中央变异型可逆性后部白质脑病综合征1例报告

正可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)是一组多种原因引起的临床-放射学综合征,随着磁共振在神经影像学中的应用,越来越多的RPLS的变异类型被发现和认识。现将我院收治的1例中央变异型可逆性后部白质脑病综合征报道如下。     

同心圆硬化12例临床及影像学分析

目的 探讨同心圆硬化的临床表现、影像学特征及其诊断价值.方法 回顾12例同心圆硬化患者(门诊2例,住院10例)的临床表现、实验室检查结果、影像学特点及病理结果,并对患者进行随访.结果 12例患者(男4例,女8例)发病年龄8～54岁(平均36.8岁),多以淡漠少语、反应迟钝起病(7例),病程中其他临床表现以智能减退(10例)、肢体活动障碍(8例)、大小便失禁(7例)、肌力减退(7例)、锥体束征阳性(6例)较多见.8例患者行脑脊液髓鞘碱性蛋白检查,其中7例增高.6例行脑活体组织检查,均可见分层脱髓鞘改变,有炎性细胞浸润.病灶数量1例为单发,11例为多发.4例患者行头颅CT检查,病灶均呈低密度影,增强后无强化.MRI检查均可见圆或类圆形影像,增强扫描8例可见环状或半环状强化,易被误诊为脑肿瘤;3例呈同心圆样强化.结论 同心圆硬化常亚急性或慢性起病,首发症状多为认知功能障碍,易被误诊,头颅MRI有特征表现,有诊断价值,激素治疗有效,预后良好,呈良性临床过程.

Abstract：

Objective To explore the clinical features, imaging and their diagnosis vaule of Baló's concentric sclerosis (BCS). Methods The clinical manifestation, laboratory examination, neuroimaging characteristics, pathology and follow-up of 12 (2 outpatients and 10 inpatients) cases of BCS were analyzed retrospectively. Results The onset age of 12 patients (male 4, female 8) ranged from 8 to 54 years old (mean 36.8 years). Unconcerned and slowness response were common in the disease onset (7 cases).Other symptoms and signs such as hypophrenia ( 10 cases), limitation of limb or hand movement (8 cases),urinary and fecal incontinence (7 cases), hypo-myodynamia (7 cases), positive pyramidal sign (6 cases)were not rare in course of disease. Eight cases underwent the examination of cerebrospinal fluid myelin basic protein, which increased in 7 cases. Demyelinating change and perivascular inflammatory infiltration were shown in 6 brain biopsies. The involvements of multi-lesions were found in 11 cases. Four patients underwent CT scanning and all the cases showed with hypodense lesions and couldn' t be enhanced. On MRI, all cases appeared round or round-like in shape. Enhanced lesions showed ring-like or half-ting-like shape (8 cases) and concentric ring (3 cases). It's easy to be misdiagnosed as brain tumor (8 cases).Conclusions BCS is a kind of demyelinating disease of subacute or chronic onset accompanied with cognitive disorder being the most common initiating symptoms. It's prone to be misdiagnosed. Diagnosis depends on MRI and corticosteroid treatment is effective. BCS has a good prognosis and presents with benign clinical course.     

Reversible posterior leukoencephalopathy syndrome: experience in 3 cases]

We report 3 cases with reversible posterior leukoencephalopathy syndrome (RPLS) accompanied by eclampsia or hypertensive encephalopathy. RPLS may develop in patients who have eclampsia or hypertensive encephalopathy or who are immunosuppressed. The findings on neuroimaging are characteristic of subcortical edema without infarction. A 27-year-old primigravida developed eclampsia at 37 weeks of gestation. MRI was performed 4 hours after the onset. The FLAIR sequence delineated extensive hyperintense lesions in the temporal and occipital lobe bilaterally. MR angiography(MRA) performed 6 days after the onset of symptoms clearly demonstrated intracranial vasospasm. Follow up MRI and MRA were performed 3 weeks after the onset. The MRI showed slight residual hyperintensity in the occipital lobe. The MRA showed the disappearance of the vasospasm. A 39-year-old woman on the 8th postpartum day presented with thunderclap headache, which led to a search for SAH. She visited our hospital, whose high arterial blood pressure (220/110 mmHg) was observed. Both CT and MRA were normal. MRI revealed abnormalities in the parieto-occipital regions bilaterally. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. A 38-year-old woman on the 11th postpartum day suddenly developed vertigo, visual disturbance and generalized convulsion. MRI was performed 7 days after the onset. The FLAIR sequence delineated extensive hyperintense lesions in the occipital lobe bilaterally. MRA clearly demonstrated diffuse intracranial vasospasm. MRA performed 3 weeks after the onset showed the disappearance of the vasospasm. In conclusion, our experience suggests that the MRI and MRA noninvasively provide valuable findings which are complementary in the diagnosis and follow-up examination of a brain edema and vasospasm in RPLS.     

可逆性后部白质脑病综合征

可逆性后部白质脑病综合征(RPLS)是一组由多种原因引起的以神经系统异常为主要表现的综合征,临床表现以迅速进展的颅高压症状、癫发作、视觉障碍、意识障碍、精神异常为特征,神经影像学上显示以双侧大脑后部白质为主的水肿区,经及时有效治疗后临床表现和神经影像学改变可以完全恢复,一般不遗留有神经系统后遗症。核磁共振新技术的发展,突出显示了血管源性水肿的特点,有助于RPLS的正确诊断。     

可逆性后部白质脑病综合征的临床及影像学特点

目的探讨可逆性后部白质脑病综合征(RPLS)的临床及影像学特点。方法回顾性分析16例RPLS患者的临床资料。结果患者均为急性起病,其中继发于高血压脑病7例,妊娠子痫9例。患者均出现血压明显升高,其中出现头痛9例,意识障碍9例,癫痫发作13例,视力模糊6例。16例患者MRI均表现为双侧枕叶和/或额、颞、顶叶对称或不对称的T1低信号,T2高信号;其中累及顶叶13例(81.3%),枕叶12例(75.0%),额叶9例(56.3%),颞叶5例(31.3%),小脑4例(25.0%)。弥散加权成像(DWI)显示等/低信号14例,异常高信号2例。所有患者经对症治疗均痊愈。结论 RPLS以血压升高、头痛、视觉异常、意识障碍、癫痫发作为主要临床表现。MRI表现双侧枕叶和/或额、颞、顶叶对称或不对称的T1低信号,T2高信号,经治疗预后良好。     

Four cases of reversible posterior leukoencephalopathy syndrome

We reported four children cases with reversible posterior leukoencephalopathy syndrome (RPLS). Magnetic resonance imaging (MRI) of the brain demonstrated reversible multiple cortical and subcortical lesions predominant in the occipital region. All patients presented with neurological symptoms associated with hypertension, such as headache, seizures and visual disturbances, which were successfully treated with antihypertensive therapy. Although RPLS is rare in childhood, characteristic lesions on MRI in the hypertensive children should be recognized as manifestations of RPLS. Subsequent clinical management should focus on the treatment of the hypertension and/or its underlying causes.     

Occipital Lobe Seizures as the Major Clinical Manifestation of Reversible Posterior Leukoencephalopathy Syndrome: Magnetic Resonance Imaging Findings

Summary: Purpose: Reversible posterior leukoencephalopathy syndrome (RPLS) is an increasingly recognized brain disorder most commonly associated with malignant hypertension, toxemia of pregnancy, or the use of immunosuppressive agents. When associated with acute hypertension, RPLS typically occurs concurrently with the fulminant clinical syndrome of hypertensive encephalopathy. We describe occipital lobe seizures, in the setting of only moderate elevations of blood pressure, as the major clinical manifestation of RPLS.
Methods: Two patients from the Dent Neurologic Institute are presented with clinical and magnetic resonance imaging(MRI) correlation.
Results: New onset secondarily generalized occipital seizures were noted, with MRI findings consistent with RPLS. Both of the patients had chronic renal failure and a moderate acute exacerbation of chronic hypertension. Other features of hypertensive encephalopathy were lacking, such as headache, nausea, papilledema, and an altered sensorium. Magnetic resonance imaging (MRI) showed edematous lesions primarily involving the posterior supratentorial white matter and corticomedullary junction, consistent with RPLS. With lowered blood pressure, the MRI lesions resolved and the patients became seizure-free without requiring chronic anticonvulsant therapy.
Conclusions: Occipital seizures may represent the only major neurologic manifestation of RPLS due to acute hypertension, especially in patients with renal failure. Other evidence of hypertensive encephalopathy, such as cerebral signs and symptoms, need not be present. Blood pressure elevations may be only moderate. Early recognition of this readily treatable cause of occipital seizures may obviate the need for extensive, invasive investigations. Despite the impressive lesions on MRI, prompt treatment of this disorder carries a favorable prognosis.     

12例可逆性后部白质脑病综合征的临床特点

目的探讨可逆性后部白质脑病综合征(RPLS)的临床特点。方法回顾性分析2015-06—2016-09于河南省人民医院诊治的12例可逆性后部白质脑病综合征患者的临床特征、影像学特点、实验室检查并复习相关文献。结果临床特征:本组女11例,男1例。子痫10例,合并血小板减少7例;原发性高血压2例。10例出现癫痫发作,7例出现头痛,6例视物障碍。影像学特点:病灶大多为对称性,主要位于双侧大脑后部白质,少数位于额顶叶、基底节区、胼胝体、小脑及其他部位。在CT呈低密度影,MRI呈长T_1、长T_2,FLAIR呈高信号,DWI大部分呈低信号,ADC大部分呈高信号。4例复查后病灶完全恢复,呈完全可逆性。实验室检查:LDH升高11例,其中血小板减少伴白细胞升高、肌酸激酶升高7例。结论 RPLS是一种女性好发,以头痛、癫痫发作、视觉障碍、意识障碍为主要表现,影像学表现为可逆的血管源性水肿的神经系统疾病,血小板减少可能为其病因之一,经积极治疗,大部分预后良好。     

可逆性后部白质脑病二例临床分析

目的探讨可逆性后部白质脑病综合征(RPLS)的病因、临床表现、影像学特征、诊断及治疗。方法分析2例可逆性后部白质脑病综合征患者的临床资料。结果2例患者均急性起病,以头痛、频繁癫发作为首发症状;均发病于产褥期前后,均有血压升高、头晕、视物模糊等症状。1例烦躁、计算、近记忆力下降;另1例恶心、呕吐;头部CT检查2例均显示对称分布于枕、顶、额、颞叶沟回状低密度灶,其中1例广泛脑白质水肿;MRI检查2例均显示对称分布于枕、顶、额、颞叶回状或沟回弥漫片状长T2、长T1信号、Flair像示皮层下弓状纤维形高信号病灶,以脑白质为主、皮质亦见受累。经治疗2例患者的临床症状约1周消失,复查影像学恢复正常。结论头痛、视觉障碍和癫发作是RPLS主要临床表现,影像学特征主要为大脑后部白质对称性CT呈低密度灶、MRI呈长T1、长T2信号。经过正确的治疗,患者的症状、体征及神经影像学改变均可很快好转并可以完全恢复。     

可逆性后部白质脑病综合征的临床及影像学特点

目的 探讨可逆性后部白质脑病综合征（PRES）的临床和影像学特点。方法 回顾性分析7例PRES患者临床及影像学资料。结果 本组继发于妊娠高血压综合征3例，肾功能衰竭3例，高血压1例。临床表现：7例均有头痛及视物模糊，伴有癫痫发作6例，恶心、呕吐4例，轻偏瘫、共济失调各1例。6例行头颅CT检查，3例枕叶低密度影，其中2例广泛脑白质水肿；1例多发小血肿；2例未发现异常。7例MRI检查显示枕叶均受累，同时伴小脑受累3例，脑干2例，额顶叶皮质下白质2例，尾状核、丘脑各1例。在脑叶呈脑回样、在其他部位呈斑片样异常信号；T1WI呈略低或等信号，T2WI和Fair像呈高信号。2例增强扫描1例无强化，1例呈脑回样、斑片样和环状强化。4例DWI扫描，2例呈略高信号，1例呈低信号，1例未见异常。结论 头痛、视觉障碍和癫痫发作是PRES主要临床表现，影像学特征主要为大脑后部白质对称性长T1、长T2信号。     

可逆性后部白质脑病综合征的临床和影像学特征(附2例报告)

目的探讨可逆性后部白质脑病综合征(RPLS)的临床及影像学特点。方法回顾性分析2例RPLS患者的临床资料。结果 2例均为急性起病,例1为产后2 d出现持续高血压,以癫疒间发作、意识障碍为主要症状;例2遭雷击后出现以声音嘶哑、共济失调为主要症状。颅脑MRI检查急性期均显示以大脑后部为主的异常信号,恢复期异常信号可明显减少或消失。结论 RPLS临床表现为脑病的症状,急性期MRI的脑白质异常是可逆的。     

可逆性后部白质脑病综合征合并HELLP综合征的临床分析

目的分析可逆性后部白质脑病综合征(PRIS)合并HELLP综合征患者的临床特征,提高对该病的认识。方法回顾性分析我院诊治1例及国内文献报道4例.PRLS合并HELLP综合征的临床表现、实验室及影像学检查、治疗和转归。结果5例患者中出现严重高血压4例,头痛5例,癫痫发作5例,视觉异常5例,意识障碍5例,精神障碍2例,局灶性神经系统定位体征3例,肢体水肿1例。实验室检查均提示有溶血、肝酶升高、血小板减少。5例患者头部cT或MRI检查均显示双侧顶枕叶白质为主的对称性异常,部分累及额叶、颞叶,病灶在cT为低密度灶,MRI为长T_1长T_2信号灶。结论 RPLS同时合并HELLP综合征是妊高征患者罕见的并发症,充分认识其临床和影像学特点,有助于及时诊断和治疗。