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。

GESTATION-RELATED REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME： CLINICAL ANALYSIS OF NINE CASES

Objective To investigate the clinical and imaging characteristics of gestation-related reversible posterior leu- koencephalopathy syndrome （RPLS） and improve the diagnosis and treatment of this condition. Methods The etiology,clinical manifestations, MRI features, treatment and prognosis of nine patients with gestation-related RPLS were analyzed retrospectively. Results Of the nine cases, seven developed pre-eclampsia, and two with normal gestation fell ill with RPLS three to four days af- ter delivery. Their main manifestations were headaches,spasm, visual disorder, or conscious disturbance. Elevated blood pressure and LDH level were noted in all the nine patients at the onset. The characteristic changes of MRI were symmetric loci of occipitopa- rietal lobe, low T1WI signal and high signal were noted in T2WI images and Flair image. All the patients recovered completely without any sequela in nervous system after a prompt and effective therapy. Conclusion RPLS may occur during pregnancy and childbirth. The clinical features are headache, spasm, visual disorder and conscious disturbance, the MRT characteristics are sym- metrical low T1WI signal and high T2WI signal and high Flair signal on bilateral posterior white matters of cerebrum. An in-time diagnosis and treatment will make the disease reversible.