可逆性后部白质脑病综合征29例分析

目的 :探讨可逆性后部白质脑病综合征的临床特点。方法 :分析 2 9例可逆性后部白质脑病综合征的临床资料。结果 :2 9例可逆性后部白质脑病综合征中 ,病因为高血压脑病 8例 ,子痫 3例 ,肺部感染伴高血压病 5例 ,使用免疫抑制剂 7例 ,肺癌术后使用化疗药物 3例 ,鼻咽癌放疗 3例。主要临床表现 :嗜睡与昏睡、视力障碍、癫痫发作、记忆力与注意力下降、共济失调、偏瘫。神经影像学以可逆性白质异常病变为特征 ,多数位于半球后部白质。结论 :可逆性后部白质脑病综合征并非所有患者的主要病变位于后部白质 ,部分患者的主要病变位于侧脑室旁、小脑白质与脑干 ,故可改名为可逆性白质脑病综合征较为合适 ,经过正确的治疗 ,患者的症状、体征及神经影像学改变可恢复到病前的水平     

产后子痫并可逆性后部白质脑病综合征2例报告并文献复习

目的探讨产后子痫并可逆性后部白质脑病综合征（RPLS）发生的临床特征及诊治。方法回顾性分析广西柳州医学高等专科学校第一附属医院收治的2例产后子痫并可逆性后部白质脑病综合征患者的诊治经过,并复习相关文献。结果产后子痫并可逆性后部白质脑病综合征临床上少见,易漏诊,确诊依赖头颅MRI检查。结论产后子痫可并发可逆性后部白质脑病综合征,诊断治疗及时,一般预后良好。     

可逆性后部白质脑病综合征的急救与护理

可逆性后部白质脑病综合征(RPLES)又可称逆性大脑后部脑病综合征和可逆性后部脑水肿综合征[1]。主要表现头痛、癫痫发作、视觉障碍、意识障碍以及精神异常。神经影像学主要表现为可逆性大脑后部白质损害。由于本病的临床和影像学改变的可逆性,及时确诊、迅速控制血压或停用引起     

产后可逆性后部白质脑病综合征三例报告

目的提高产后可逆性后部白质脑病综合征的早期诊断水平。方法回顾性分析3例产后可逆性后部白质脑病综合征的临床资料。结果 3例均在剖宫产术后6~8 d发作癫痫,并伴头痛、意识障碍及视力障碍等表现。头颅MRI检查表现为对称的局灶脑水肿,主要位于顶叶、枕叶及额叶,确诊为产后可逆性后部白质脑病综合征。经积极降压、镇静、降颅压及抗癫痫治疗,均在数周完全恢复。结论产后出现头痛、高血压、意识障碍、视觉改变和癫痫发作时,应警惕可逆性后部白质脑病综合征,及时行头颅MR I检查确诊。     

儿童急性淋巴细胞白血病治疗过程中发生可逆性后部白质脑病综合征的抢救与护理

可逆性后部白质脑病综合征 （reversible posterior leukoen- cephalopathy syndrome, RPLS） 是一组最近才被认识的独特的临床综合征，是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内高压症状、癫痫发作、视觉障碍、意识障碍、精神异常为特征，影像学主要表现为可逆性大脑后部白质损害，常显示以双侧大脑后部白质为主的水肿区，     

可逆性后部白质脑病综合征5例分析

可逆性后部白质脑病(RPLS)是一组以头痛、痫性发作、视觉异常、意识和精神障碍为主要临床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,现将我院2007-01-2010-01确诊的5例分析如下。     

可逆性后部脑病综合征的临床及影像学特征

可逆性后部脑病综合征(PRES)主要表现为头痛、意识障碍、抽搐及视力下降,神经影像学表现为可逆性大脑后部白质损害[1],病情严重时可导致患者昏迷或死亡.早期诊断、及时正确的治疗可使大多数患者的症状、体征及头颅神经影像学病灶消失.回顾性分析本院收治的8例确诊PRES患者的临床和影像学特点,旨在提高对本病的认识.     

儿童急性淋巴细胞白血病治疗过程中发生可逆性后部白质脑病综合征的抢救与护理

可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)是一组最近才被认识的独特的临床综合征,是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内高压症状、癫痫发作、视觉障碍、意识障碍、精神异常为特征,影像学主要表现为可逆性大脑后部白质损害,常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.     

可逆性脑后部白质脑病变综合征3例分析

目的探讨可逆性脑后部白质病变综合征（RPLS）的病因、临床表现,影像学特征及治疗。方法分析3例可逆性脑后部白质病变综合征患者的临床资料并复习文献。结果 3例中,均有视力障碍,头部MRI显示大脑半球脑白质长T1长T2信号。经治疗患者的临床表现和影像学均很快好转。结论可逆性脑后部白质病变综合征是一种预后良好的疾病,结合病史和MRI特征可以早期诊断。     

妊娠合并可逆性后部脑病综合征二例

可逆性后部脑病综合征是一种临床影像学综合征,其症状及体征并无特异性,神经影像学表现为可逆性大脑后部白质损害。本报道中2例患者均有妊娠高血压疾病,前者为产后抽搐,后者为产前抽搐,抽搐均持续时间较长,频繁发作,前者伴有视力模糊,后者伴有恶心呕吐,经积极治疗后,症状均短期完全缓解。     

妊娠相关可逆性后部白质脑病综合征9例临床分析

目的探讨妊娠相关可逆性后部白质脑病综合征（RPLS）的临床和影像学特点,以提高临床诊疗水平。方法回顾性分析9例妊娠相关RPLS病人的病因、临床特点、影像学特征、治疗及预后。结果 9例RPLS病人中7例并发子痫-子痫前期,2例孕产期正常而分别在产后3、4d突然发病。主要表现为头痛、抽搐、视力障碍、意识障碍。9例发病时均有血压升高及乳酸脱氢酶（LDH）水平升高。其影像学特征性改变为异常的对称性的枕顶叶病灶,MRI检查T1WI为低信号,T2WI及Flair像为高信号。经及时有效治疗后完全恢复,未遗留神经系统后遗症。结论 RPLS可发生在孕产期,临床特点为头痛、抽搐、视力障碍、意识障碍等,影像学特征主要为大脑后部白质对称性T1WI低信号、T2WI及Flair高信号,及时诊治病情可逆。     

可逆性后部白质脑病综合征患者临床表现与磁共振影像学特点分析

目的分析可逆性后部白质脑病综合征(RPLS)患者的临床表现及磁共振(MRI)影像学特点。方法回顾性分析115例RPLS患者的临床及影像学资料。结果115例RPLS患者表现为血压升高(89.56%)、痫性发作(74.78%)、头痛(59.13%)、视觉障碍(32.17%)、神经系统体征(20.00%)和意识改变(15.65%),其中101例(87.83%)患者头颅MRI异常,累及枕叶(71.29%)、顶叶(59.40%)、额叶(49.50%)、颞叶(38.26%)、侧室脑旁(1.98%)、脑干(3.96%)、小脑(3.96%)、皮质(3.96%)、丘脑(0.99%)、基底节区(0.99%),病灶为等或低T1WI信号,高T2WI信号,等或低DWI信号,高ADC及FLAIR信号。治疗后随访3~60月,81例预后良好,21例预后不良,5例死亡。预后不良组头痛发生率、住院期间mRS评分≥3分及并发症比例高于预后良好组(P<0.05)。结论RPLS的MRI表现具有特征性,结合临床表现可作出正确判断,及时治疗,改善预后。     

可逆性后部白质脑病综合征的临床和MR特点分析

目的:探讨可逆性后部白质脑病综合征(RPLS)的临床和MR特点。材料与方法:回顾性分析27例可逆性后部白质脑病综合征患者的病因、临床表现及MR影像资料。结果:27例患者中男8例,女19例。病因多种多样,妊娠高血压综合征及先兆子痫11例,继发性高血压3例,原发性高血压2例,系统性红斑狼疮1例,肾功能不全3例,肾病综合征1例,环孢霉素治疗后1例,癌症化疗后3例,鼻咽癌放疗1例,多发性动脉炎1例。主要临床表现为头痛、癫痫发作、视觉障碍和精神异常。大多数患者头颅MRI平扫表现为双侧大脑后部白质T1WI呈低或等信号,T2WI及FLAIR像呈高信号,DWI呈等或稍高信号,ADC图呈高信号,病灶双侧对称或不对称;予以积极对症治疗后患者临床症状及MR所见病灶均明显好转。结论:RPLS的病程具有可逆性,提高对该综合征的临床及MR特点的认识,对于RPLS的早期正确诊断、治疗以及疗效评价具有重要的临床意义。     

Reversible posterior leukoencephalopathy syndrome

Reversible posterior leukoencephalopathy syndrome (RPLS) is a neurological disorder characterized by signs of posterior cerebral edema upon radiographic examination. RPLS has been strongly associated with abrupt and significant elevations in blood pressure or the administration of immunosuppressive drugs. Here, we report a case of RPLS occurring in a 30-year-old-mother with a presumed amniotic fluid embolism subsequent to delivery by cesarean section. On the fifth day after the initial successful resuscitation from the cardiorespiratory collapse, she manifested generalized seizure activity and abnormal radiological findings, which were found to be consistent with RPLS. Through our experience, we have suggested that RPLS might occur more easily at lower blood pressures than has been previously recognized. It is important to consider the lower limit at which blood pressure is controlled, especially if accompanied with fever.     

53例诺卡菌感染病例临床特征分析

目的 探讨诺卡菌感染的临床表现、实验室检查、影像学特点及诊断、治疗、预后. 方法 检索1998-2013年国内医学数据库所报道的53例诺卡菌感染病例的相关文献并对其进行回顾性分析.以既往患病的诺卡菌病例为研究组,既往体健的诺卡菌病例为对照组,对比分析两组的临床表现,影像学特征及治疗转归情况. 结果 53例诺卡菌病例中,31例存在基础疾病.研究组与对照组临床表现除凹陷性水肿差异有统计学意义(2=4.442, P0.05),其他无统计学意义.药敏试验结果提示菌株对复方磺胺甲恶唑-甲氧苄啶(TMP-SMX)、阿米卡星、米诺环素等敏感.两组病例间死亡率的比较差异有统计学意义(2=4.576,P0.05). 结论 诺卡菌感染部位多见于肺,其临床特点无明显异质性,预后存在明显异质性,复方磺胺甲恶唑仍然是治疗诺卡菌感染的首选药物,临床上对于可疑病例应及早进行相关病原学检查.     

Reversible posterior leukoencephalopathy syndrome accompanying eclampsia: correct diagnosis using preoperative MRI

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by clinical symptoms such as seizures, visual disturbance, and altered mental status. It also presents abnormal findings on computed tomography (CT) and magnetic resonance imaging (MRI) indicating cerebral edema in the white matter of the occipital, temporal, and parietal lobes. Both the clinical symptoms and abnormal imaging findings can be reversed by controlling blood pressure or treating the underlying condition including infection. This report describes a patient with RPLS that occurred secondary to eclampsia. A 26-year-old female, gravida 0 para 0, developed weakness and pain in her upper and lower extremities and gait disturbance during the 34th week of pregnancy, and severe pregnancy-induced hypertension near the end of the 37th week. On the first day of the 38th week, she developed constricted visual fields and complained of visual illusions. MRI revealed a high-signal-intensity area in the right occipital lobe. Immediately after MRI, the patient had a 10-sec tonic convulsion. Diagnosed with eclampsia, she underwent emergency cesarean section. MRI on the 2nd postoperative day showed that the high-signal-intensity area was slightly improved. Her visual illusions were diminished by the 4th postoperative day, and almost all subjective symptoms disappeared by the 7th postoperative day. The patient was discharged at 12th postoperative day. We recommend MRI not only for symptomatic patients with suspected RPLS, but also for asymptomatic patients with severe pregnancy-induced hypertension. If findings such as cerebral edema are observed on MRI, immediate delivery should be considered before eclamptic seizures or exacerbation of neurological symptoms.     

肺淀粉样变的影像诊断

肺淀粉样变是呼吸系统的少见病之一,因临床和X线上缺乏特异性表现而易误诊。本文报告一例,并搜集得国内报导的另11例,结合文献温习,就本病的影像学表现及诊断问题作一些探讨。     

肺泡蛋白沉着症早期诊断体会

目的对9例确诊肺泡蛋白沉着症（PAP）病人进行分析，探讨PAP的早期诊断体会。方法对9例经纤维支气管镜肺泡灌洗液（BALF）病理检查证实的PAP病人进行回顾性分析，仔细观察BALF治疗前后PAP病人临床表现及影像学特征性变化。结果9例病人均有进行性加重的活动性呼吸困难，高分辨率CT检查示双肺弥漫分布毛玻璃样淡薄影，有地图样表现，小叶间隔增厚，呈斑片状影，有碎石路样表现。结论进行性加重的活动性呼吸困难、慢性呼吸衰竭、比较特征性影像学表现与BALF的PAS阳性染色是早期诊断本病的关键。     

Posterior reversible encephalopathy syndrome in the emergency department: A single center retrospective study

IntroductionPosterior Reversible Encephalopathy Syndrome (PRES) and the related term Reversible Posterior Leukoencephalopathy Syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. These symptoms may include headache, altered mental status, visual changes, and seizures. PRES is a rare condition and remains a challenging diagnosis to make in the emergency department. Data on risk factors and clinical presentation are limited, and there is no recent literature-supported diagnostic criteria. Our primary objective was to identify initial symptoms, clinical presentation, and risk factors that should guide the emergency clinician to consider a diagnosis of PRES. A secondary objective was to identify associations between risk factors and the outcomes of mortality and ICU admissions.MethodsThis was a retrospective, observational study that evaluated patients seen in the Emergency Department (ED) in an urban tertiary care center with the diagnosis of PRES or RPLS from 1/1/2008 to 1/1/2018. The Health System’s Electronic Medical Record was used to collect data. Search criteria included any patient diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) or Reversible Posterior Leukoencephalopathy Syndrome (RPLS), and excluded patients under 18 years of age, transfer patients, or patients that were not evaluated in our emergency department.ResultsWe identified 98 patients based on our initial search criteria. After a chart review, 27 patients met our predefined eligibility criteria. In patients with confirmed diagnosis of PRES, the majority were female (70%) and 37% were either on an immunomodulator or undergoing chemotherapy at the time of presentation. 67% of patients presented with altered mental status, 41% had a focal neurologic deficit, and 37% had a witnessed seizure prior to diagnosis. Headache (48%), nausea (33%), and vision changes (30%) were the next most common reported symptoms. The majority of patients were hypertensive at time of presentation (82%) and many had a past medical history of hypertension (78%); twelve were given anti-hypertensive medications. 33% of the patients were admitted to the ICU and 26% died. There were no statistical associations found between documented ED interventions and the outcome of mortality.ConclusionPRES is difficult to identify and diagnose in the emergency department. Significant risk factors such as female gender, hypertension, and those currently undergoing active immunotherapy/chemotherapy are associated with PRES. Common presenting complaints and exam findings include headache, altered mental status, and neurologic deficits. Emergency providers should consider PRES in patients presenting with altered mental status with significant risk factors, especially with neurologic deficits for which stroke has been ruled out.     

牵牛花综合征的超声诊断

目的探讨超声检查对牵牛花综合征的诊断及鉴别诊断价值，并与其他常用影像学方法进行比较。方法对6例牵牛花综合征的超声等影像学资料进行回顾性分析。结果A／B超检查示玻璃体腔无回声区向后极部延伸至视乳头处并突向肌锥底部，玻璃体腔后部呈倒置的瓶颈状回声图像，可见视网膜脱离带状回声；A超显示玻璃体腔与瓶颈部一致的无回声区均为平静的基线。结论超声检查在牵牛花综合征的诊断及鉴别诊断中具有传统眼底检查所不具有的整体性，其安全性明显优于其他影像学方法，是正确诊断牵牛花综合征的十分有参考价值的影像学手段。