可复性后部脑病综合征的MR影像分析

目的探讨可复性后部脑病综合征(PRES)的MRI特点。材料与方法回顾性分析16例临床和影像学诊断的PRES患者的MR影像资料,全部患者行常规MRI平扫和DWI检查,5例同时行MRV检查,11例患者对症治疗后行MRI复查。结果病变多发,16例患者MRI平扫共检出73个病灶,多位于皮层下白质,表现为T1WI稍低、T2WI稍高信号,于T2-FLAIR上呈高信号。最常累及顶、枕叶(88.5%),其次为额叶(61.3%),小脑半球(31.3%),颞叶(30.1/%),基底节(28.7%),脑干(17.3%)。1例患者伴有脑内多发出血灶。除出血灶外,余病变于DWI上呈等或稍高信号,多数于ADC图上呈高信号;仅于胼胝体压部发现一病变于ADC图上呈低信号。5例颅脑MRV检查均未见确切异常。经治疗后11例患者行MRI复查,显示病变数目较前明显减少,残余病灶ADC值[(0.937±0.086)×10–3mm2/s]较前次检查[(1.036±0.186)×10–3mm2/s]减低(P=0.005),更接近正常脑组织ADC值[(0.832±0.078)×10–3mm2/s]。结论 PRES的颅脑MRI表现较具有特征性,DWI及MRV检查对该病的诊断及鉴别诊断具有重要意义,MRI复查对PRES疗效评价具有重要价值。     

后脑可逆性脑病综合征的护理对策

目的探讨后脑可逆性脑病综合征患者的护理对策。方法回顾性分析3例后脑可逆性脑病综合征患者的临床资料和治疗、护理措施。结果3例患者经过治疗和护理2周后均好转出院,随访未见复发或加重。结论后脑可逆性脑病综合征是以血压升高、头痛、痫性发作、视力损害为主要表现的临床综合征。在护理上注意病情观察,加强对症护理、心理护理、健康教育等,有利于促进患者康复。     

Posterior reversible encephalopathy syndrome postpartum

Preeclampsia (PE) should be considered in women with headache who are in gestational week 20 or more, are in labor, or have recently given birth. Early diagnosis is essential to arrest disease progression and further prognosis in PE.     

Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care

PURPOSE: To describe the signs, symptoms, causative factors, and treatment for posterior reversible encephalopathy syndrome (PRES), an emerging clinical neuroradiologic entity which may be encountered by nurse practitioners in almost any clinical setting. DATA SOURCES: Extensive review of worldwide literature, including peer-reviewed medical specialty journals, supplemented by an actual case study. Currently, a paucity of information exists in the nursing literature. CONCLUSIONS: PRES occurs as a result of disordered cerebral circulatory autoregulation and/or endothelial dysfunction, usually as a result of acute, intermittent hypertension. Clinical manifestations include mental status change, headache, visual disturbance, and seizures. Characteristic abnormalities in the posterior cerebral white matter, seen best on diffusion-weighted magnetic resonance imaging, confirm the presence of the syndrome. PRES has been documented worldwide among a diverse patient population, yet many clinicians are still unfamiliar with this diagnosis. IMPLICATIONS FOR PRACTICE: PRES is a clinical-radiographic diagnosis that requires close collaboration between the clinician and interpreting radiologist. Rapid identification and appropriate diagnostics are essential, as prompt treatment usually results in reversal of symptoms; permanent neurologic injury or death can occur with treatment delay.     

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.     

Posterior reversible encephalopathy syndrome (PRES) in critically ill obstetric patients

Objective To describe clinical, neuroradiological and evolutionary findings in obstetric patients with posterior reversible encephalopathy syndrome (PRES).Design Retrospective case series.Setting University intensive care unit (ICU).Patients Four critically ill patients. Two patients experienced PRES in late postpartum without the classical pre-eclamptic signs. All patients showed impairment of consciousness and epileptic seizures; two of them presented cortical blindness and headache, too. True status epilepticus (SE) occurred in two cases. In all patients MRI showed the typical feature of gray-white matter edema, mainly localized to the temporo-parieto-occipital areas.Interventions Normalization of high blood pressure (BP) and treatment of seizures. Two patients with SE and severe impairment of consciousness were treated with an intravenous valproate (ivVPA) bolus followed by continuous infusion.Measurements and results In three cases, neurological and MRI abnormalities completely resolved in about a week. Another patient died due to subarachnoid hemorrhage.Conclusion Posterior reversible encephalopathy syndrome is a well described clinical and neuroradiological syndrome characterized by headache, altered mental status, cortical blindness and seizures, and a diagnostic MRI picture; usually reversible, PRES can sometimes result in death or in irreversible neurological deficits, thus requiring early diagnosis and prompt treatment. PRES can have various etiologies, but pregnancy and postpartum more frequently lead to this condition. Treatment of seizures deserves special attention since the anti-epileptic drugs currently used in SE management may worsen vigilance as well as autonomic functions. Extensive research is needed to assess the role of ivVPA in this condition.     

Methotrexate-induced posterior reversible encephalopathy syndrome

WHAT IS KNOWN AND OBJECTIVE: Posterior reversible encephalopathy syndrome (PRES) is described clinically as an acute neurologic deterioration characterized by headache, change in mental status and seizures. Although the mechanism(s) for this syndrome is not fully understood, PRES results from vasogenic edema in areas of the brain supplied by the posterior circulation. Methotrexate (MTX)-induced neurotoxicity is a well-known complication of therapy in the paediatric population but is uncommon in adults. DETAILS OF THE CASE: We describe a 55-year-old woman with an acute presentation of PRES caused by intrathecal MTX given as part of a treatment regimen for diffuse large B-cell type lymphoma. Both clinical symptoms and radiographic abnormalities resolved 5 days after cessation of treatment. WHAT IS NEW AND CONCLUSION: We describe what we believe to be the first report of intrathecal MTX-induced PRES in an adult. Clinicians should include MTX-induced PRES in the differential diagnosis of acute neurologic changes in patients receiving this medication. The incidence of MTX-induced neurotoxicity may be under recognized in adults.     

非典型可逆性后部脑病综合征一例并相关文献学习

患者,男,33岁,急性起病,病程较短,既往有高血压病史,最高血压180/120 mmHg,平时未口服降压药物,主要表现为头晕、头闷,无视物旋转,无耳鸣及听力下降,与转头及体位变化无关,症状持续存在。查体:无神经系统阳性体征,动态血压监测血压波动于140~178/90~120 mmHg。生化检查:高血脂(甘油三酯2.15 mmol/L)、血同型半胱氨酸高(34μmol/L)、尿酸略高(489μmol/L)。影像学表现:头颅CT:左侧额叶斑片状低密度影,CT值约为15 HU,边缘稍模糊(图1A、1B)。头颅MRI:左侧额叶斑片状长T1、长T2信号影,FLAIR示高信号,扩散加权成像(diffusion weighted imaging,DWI)呈等信号,表观扩散系数(apparent diffusioncoefficients,ADC)图呈高信号,磁敏感加权成像呈高信号。     

可逆性后部脑病综合征的CT及MRI表现

目的 探讨可逆性后部脑病综合征(PRES)的CT和MRI表现。方法 回顾性分析12例PRES患者的临床和影像学资料,所有患者均接受MR平扫,包括常规T2W、T1W、FLAIR序列扫描、DWI,4例接受磁共振静脉血流成像(MRV),3例接受MR增强扫描;3例接受CT扫描。9例治疗后复查MRI。对病灶分布部位及受累几率的比较采用四格表Fisher确切概率法。结果 12例患者均有突发性血压升高病史,其中子痫前期10例,高血压病2例。病灶主要累及双侧顶枕叶白质区,与基底节区、颞叶、额叶、脑干、小脑和胼胝体受累几率比较差异均有统计学意义(P均<0.05)。病变CT表现为白质区多发斑片状低密度,MRI呈对称性长T1长T2信号,FLAIR呈高信号,DWI等信号,ADC图呈高信号10例,ADC等信号2例。临床治疗1~2周后9例复查MRI示脑白质区病灶可完全恢复,基底节疗效常不佳。结论 PRES的MRI典型征象是双侧顶枕叶白质区多发对称性血管源性水肿,FLAIR序列和T2WI是显示病灶的最佳序列,DWI和MRV有鉴别意义。     

Blood transfusion‐induced posterior reversible encephalopathy syndrome presenting severe brain atrophy: A report of two cases

Several cases of posterior reversible encephalopathy syndrome (PRES) after blood transfusion have been reported, but the long‐term prognosis is unknown. Here, we report two cases of blood transfusion‐associated PRES with severe brain atrophy at 1 year after onset. We report the case with a discussion of pathological mechanisms.     

高血压合并可逆性后部脑病综合征的临床及影像学表现分析

目的 探讨高血压合并可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)的临床特征及影像学表现.方法 回顾性分析14例高血压合并PRES患者的临床和影像学资料,其中原发性高血压病9例,妊娠高血压病5例.结果 14例患者中急性起病11例,亚急性起病3例:首发症状为头痛9例,头晕2例,癫痫2例,视物不清1例;头颅MRI显示病变多集中于后循环供血区(原发性高血压患者有部分病灶在前循环供血区),表现为病灶T1WI呈等或略低信号,T2WI和液体衰减反转恢复序列呈高信号,弥散加权成像呈等或低信号,表观弥散系数呈高信号;经颅多普勒超声和颈部血管超声结果示5例妊娠高血压病患者未见异常,9例原发性高血压病患者中颅内血管狭窄5例,脑动脉粥样硬化2例;5例妊娠高血压病患者治疗1～2周临床症状基本消失,未遗留明显后遗症;9例原发性高血压病患者中7例治疗2～4周后临床症状逐渐好转,未遗留明显后遗症,2例合并新发脑梗死,其中1例遗留肢体偏瘫,1例遗留视物模糊.结论 原发性高血压病与妊娠高血压病所致PRES的发病机制、影像学改变和转归有所不同,临床应针对其特点进行诊治.     

脑后部可逆性脑病综合征与MELAS的磁共振特征对照研究

目的对脑后部可逆性脑病综合征(PRES)的磁共振特征进行分析并与线粒体脑肌病伴高乳酸血症和卒中样发作综合征(MELAS)进行对照,以进行诊断与鉴别诊断。方法收集21例PRES和6例MELAS患者,所有患者均行磁共振检查,回顾性分析和比较它们在MRI上的影像特征(发病部位,信号强度,功能成像特点等)。结果 21例PRES病灶主要位于皮质下白质区,13例同时累及皮质;6例MELAS病灶位于皮质及皮质下白质。DWI上,19例PRES患者病变表现为稍低信号;MELAS综合症患者,急性期病变为高信号,缓解期为等信号。2例PRES表现为局部脑血流量(CBF)减低;2例MELAS局部CBF轻度增高。结论详细的磁共振检查和分析有助于PRES和MELAS的鉴别。     

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.     

Posterior reversible encephalopathy syndrome concurrent with human herpesvirus-6B encephalitis after allogeneic hematopoietic stem cell transplantation

Posterior reversible encephalopathy syndrome (PRES) and human herpesvirus (HHV)-6 encephalitis are both serious neurological complications post hematopoietic stem cell transplantation. Although infection is one of the important causes of PRES, only few cases have reported the relation between PRES and viral infection. Herein, we report the first adult case of PRES concurrent with HHV-6 encephalitis after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. This case suggests that HHV-6 reactivation is associated with the pathogenesis of PRES. Also, PRES and HHV-6 encephalitis cause similar symptoms, and switching the immunosuppressant from calcineurin inhibitor to prednisolone for treating PRES may worsen HHV-6 encephalitis. Therefore, we should pay attention to the complication of HHV-6 encephalitis even after PRES is diagnosed.     

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.     

Posterior reversible encephalopathy syndrome in intensive care medicine

Background Posterior reversible encephalopathy syndrome (PRES) is a well-recognized clinico-neuroradiological transient condition. Early recognition is of paramount importance for prompt control of blood pressure or removal of precipitating factors and treatment of epileptic seizures or status epilepticus. Delay in the diagnosis and treatment may in fact results in death or in irreversible neurological sequelae. Discussion PRES is characterized by headache, altered mental status, seizures, and visual disturbances and is associated with a number of different causes, most commonly acute hypertension, preeclampsia/eclampsia, and immunosuppressive agents. Clinical symptoms and neuroradiological findings are typically indistinguishable among the cases of PRES, regardless of underlying cause. Magnetic resonance studies typically show edema involving the white matter of cerebral posterior regions, especially parieto-occipital lobes but frontal and temporal lobes, and other encephalic structures may be involved. Conclusions Intensivists and other physicians involved in the evaluation of patients with presumed PRES must be aware of the clinical spectrum of the associated conditions, the diagnostic modalities, and the correct treatment.     

Asymmetric posterior reversible encephalopathy syndrome in patient with hyperplastic anterior choroidal artery

We describe a case of asymmetric PRES due to the presence of hyperplastic anterior choroidal artery (AChA) in a man affected by sever hypertension. Posterior reversible encephalopathy syndrome (PRES) has become synonymous with a unique pattern of brain vasogenic edema and predominates in the parietal and occipital regions, accompanied by clinical neurological alterations. Sever hypertension is a risk factor that exceeds the limits of brain autoregulation, leading to breakthrough brain edema. In our knowledge this is the first case reported in literature, in which a similar vascular abnormality is linked to a PRES syndrome.