可逆性后部白质脑病综合征1例

头痛剧烈伴恶心、呕吐,并出现进行性视力下降至无光感.查体: BP 212/127 mmHg,嗜睡,反应迟钝.双眼无光感,双视乳头水肿.余颅神经(-),四肢肌力肌张力正常,双侧腱反射正常存在,病理征未引出.头颅CT示:双侧枕叶可疑低密度,不除外静脉窦血栓,急行头颅MRV检查结果正常.脑脊液:压力280 mmHg,蛋白稍高,细胞学:轻微混合性炎性细胞反应,OB + ,余正常.请眼科会诊:双眼视乳头水肿.既往胆结石、胰腺炎病史,经治疗后好转.否认高血压、冠心病、糖尿病.吸烟30年,20支/d.家族史无特殊.     

可逆性后部白质脑病综合征2例

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,临床上不常见。现将所诊治的2例分析报道如下。例1,男,52岁,因间断头痛3天,伴抽搐2次于2009年5月6日入院。否认高血压、肾脏病。入院查体:血压120/70     

妊娠高血压综合征合并可逆性后部白质脑病综合征14例

可逆性后部白质脑病( reversible posterior leukoencephalopathy syndrome,RPLS)为血管自身调节功能障碍所致,病因很多,以高血压最为常见.妊娠及产后期合并妊娠高血压综合征者易发病.现总结我院14例妊娠高血压综合征合并RPLS住院患者临床及影像学特征如下.1 临床资料1.1 病例选择 2005年1月至2011年5月我院妊娠高血压综合征合并RPLS患者14例,年龄20～37岁,平均(26.0±4.9)岁.     

可逆性后部白质脑病

可逆性后部白质脑病(reversible posterior leukoencephalopath syndrome,RPLS)是一种少见的临床综合征.临床以迅速出现的头痛、精神异常、意识障碍、癫痫发作、视觉障碍等为主要表现.病因多样,脑高灌注及血管内皮损伤为其主要发病机制.影像学主要表现为双侧大脑半球后部脑白质弥漫性对称性水肿.脑血管源性水肿为其主要病理特征.故本病大多数是可逆的,经及时正确的治疗,临床症状及影像改变可以完全恢复.如治疗不及时,可造成神经细胞的不可逆性损害.探讨RPLS的病因、发病、临床表现、病理、影像学以及诊治等方面进展,旨在提高对RPLS的认识.     

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。     

可逆性后部白质脑病综合征误诊2例

1病例报道例1,男,44岁,因不能言语6 h为主诉于2010年6月6日入院。患者于6 h前无明显诱因出现不能言语,不伴肢体活动障碍,无头痛、头晕、恶心、呕吐,无肢体抽搐及意识障碍,既往有高血压病史,未正规药物治疗。入院体检:体温36.4℃,脉搏68次/min,呼吸18次/min,血压240/160 mm Hg,双肺呼吸音清,心率     

可逆性后部白质脑病综合征2例报告

目的分析可逆性后部白质脑病综合征(RPLS)患者的临床表现、影像学特征、病因,探讨诊断方法、治疗及愈后。方法2例RPLS患者均经头CT检查,其中1例做头磁共振成像(MR I)检查,内科治疗后症状好转。结果该病主要表现为抽搐、视觉异常、头痛、呕吐、意识障碍、精神症状;影像学主要表现为脑白质对称性弥漫性水肿,主要累及白质,灰质也可受累。头MR I检查T1低信号T2高信号,头CT为低密度灶,病变主要累及顶枕叶。结论抽搐、视觉异常、头痛、呕吐、意识障碍、精神症状者,结合影像学检查,并随着临床症状改善,水肿减退或消失者可诊断。     

可逆性后部白质脑病综合征10例分析

目的 探讨可逆性后部白质脑病综合征(RPLS)的临床表现和影像学特点.方法 回顾性分析10例RPLS患者的临床资料.结果 10例患者均为急性或亚急性起病,临床表现包括头痛、视觉障碍、意识障碍等.头颅MRI以双侧大脑半球后部白质为主的T1WI略低信号或等信号、T2WI、Flair高信号表现.结论 多种病因可引起RPLS,RPLS具有特征性的临床和影像学表现,早期诊断、及时治疗,临床症状、影像学表现可逆.     

可逆性后部白质脑病综合征1例分析

可逆性后部白质脑病综合征（reversible posterior leukoencephalopathy syndrome, RPLS）是一种具有潜在破坏性的神经疾病,最初的研究显示大脑半球后部白质病变是该综合征的显著特征,故Hinchey等^[1]将其命名为可逆性后部白质脑病综合征。现将我院诊断的1例病例报道如下。     

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     

Systemic lupus erythematosus complicated with reversible posterior encephalopathy syndrome: a case report

A 28-year-old female patient was hospitalized primarily because of “intermittent fever for 28 days aggravated by systemic rashes, oral ulcer, and edema in both eyelids for 5 days.” During treatment, convulsions and loss of consciousness occurred. Magnetic resonance imaging (MRI) of the head revealed an abnormal signal with shadows in the bilateral frontal, parietal, temporal, and occipital lobes; cerebellar hemispheres; and basal nodes, with high signal intensity on T2 weighted imaging (T2WI), on fluid-attenuated inversion-recovery, and of the apparent diffusion coefficient and low signal intensity on T1WI and diffusion weighted imaging. Therefore, the patient was diagnosed with systemic lupus erythematosus (SLE) with reversible posterior encephalopathy syndrome (RPES). Intravenous high-dose methylprednisolone and cyclophosphamide were administered for blood pressure control, which effectively controlled the disease. Therefore, when patients with SLE and hypertension or renal insufficiency or those receiving high-dose methylprednisolone or immunosuppressants suddenly present with neurologic abnormalities, a diagnosis of RPES must be considered, and head MRI is the first choice for diagnosis of this disease. In terms of treatment, the blood pressure should be quickly controlled, and the primary disease should be aggressively treated.     

Autoimmune encephalitis with posterior reversible encephalopathy syndrome: A case report

BACKGROUNDPosterior reversible encephalopathy syndrome (PRES) is a neuroimaging-based syndrome and is associated with multifocal vasogenic cerebral edema. Patients with PRES frequently demonstrate headache, seizure, encephalopathy, altered mental function, visual loss and so on. We here report a patient who showed persistent neurologic deficits after PRES and was ultimately diagnosed with autoimmune encephalitis (AE). CASE SUMMARYThis case exhibits a rare imaging manifestation of anti-casper 2 encephalitis which was initially well-matched with PRES and associated vasogenic edema. CONCLUSIONAE should be further considered when the etiology, clinical manifestations, and course of PRES are atypical.     

可逆性后脑白质脑病综合征的诊断和治疗

可逆性后脑白质脑病综合征(reversible posteriorleukoencephalopathy syndrome,RPLS)临床特征包括头痛、不同程度交替出现意识障碍、癫痫发作等;神经影像学表现为后脑白质受累,多位于顶枕部区域,特征表现为血管源性水肿。也有学者称之为“可逆性后脑综合征”(posterior reversible encephalopathysyndrome,PRES)、顶枕部脑病、可逆性脑白质综合征、可逆性后脑水肿综合征等。该病的临床和放射学改变可为完全可逆,故早期诊断治疗非常重要。病因RPLS是一种临床影像学综合征,与突发严重的急性血压升高有密切关系,其发病机制尚未完全明确。…     

Licorice consumption as a cause of posterior reversible encephalopathy syndrome: a case report

Introduction  

A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. At the time of presentation, her blood pressure was 219/100 mmHg, her arterial pH was 7.64 and her potassium level was 2.7 mM/l.     

肾移植围手术期并发可逆性后部白质脑病综合征1例

背景：可逆性后部白质脑病综合征临床少见,特别是继发于肾移植围手术期,国内外鲜有相关报道,因尿毒症患者临床表现与其有相似处,移植医生容易忽略或发现不及时,影响治疗。目的：讨论肾移植围手术期并发可逆性后部白质脑病综合征的临床表现、影像学特征、治疗经验及预后,以提高临床工作中的确诊率及治疗效果。方法：回顾近期在解放军沈阳军区总医院行同种肾移植围手术期并发可逆性后部白质脑部综合征的1例患者的临床资料。结果与结论：患者于移植后3d起逐渐出现异常血压升高、视物模糊、头痛、癫痫发作、意识障碍及精神行为异常等表现,早期头部CT示左侧放射冠、额叶低密度,进一步复查MRI示双侧额叶、海马、顶枕叶皮质下,脑干多发片状等T1、长T2信号,相应部位FLARI高信号。经积极治疗患者临床表现有明显好转。通过对此例患者的临床资料进行回顾性分析及相关文献复习,拟对以后在肾移植围手术期及移植后并发可逆性后部白质脑部综合征的诊断及治疗上提供临床资料。     

Oral cyclophosphamide-induced posterior reversible encephalopathy syndrome in a patient with ANCA-associated vasculitis: A case report

BACKGROUNDPosterior reversible encephalopathy syndrome (PRES) manifests many neurological symptoms with typical features on neuroimaging studies and has various risk factors. Cyclophosphamide is one of the therapeutic agents for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Cyclophosphamide as the sole cause of PRES has been reported in only a few cases. Herein, we report a unique case of early-onset oral cyclophosphamide-induced PRES in a patient with ANCA-associated vasculitis. CASE SUMMARYA 73-year-old man was transferred to our hospital for sepsis due to acute cholangitis. He had already received hemodialysis for two weeks due to septic acute kidney injury. His azotemia was not improved after sepsis resolved and perinuclear-ANCA was positive. Kidney biopsy showed crescentic glomerulonephritis. Alveolar hemorrhage was observed on bronchoscopy. He was initially treated with intravenous methylprednisolone and plasma exchange for one week. And then, two days after adding oral cyclophosphamide, the patient developed generalized tonic-clonic seizures. We diagnosed PRES by Brain magnetic resonance imaging (MRI) and electroencephalography. Seizures were controlled with fosphenytoin 750 mg. Cyclophosphamide was suspected to be the cause of PRES and withdrawal. His mentality was recovered after seven days and brain MRI showed normal state after two weeks. CONCLUSIONThe present case shows the possibility of PRES induction due to short-term use of oral cyclophosphamide therapy. Physicians should carefully monitor neurologic symptoms after oral cyclophosphamide administration in elderly patients with underlying diseases like sepsis, renal failure and ANCA-associated vasculitis.     

可逆性后部白质脑病综合征患者的观察与护理

总结7例可逆性后部白质脑病综合征患者的观察与护理。认为护理重点是密切观察病情,协助早期诊断;加强意识障碍、头痛、血压改变、视觉障碍、精神异常、癫痫发作和并发症的观察与护理。经治疗与护理,6例患者恢复到病前水平,1例患者症状、体征基本消失。