妊娠相关性脑静脉及静脉窦血栓形成和可逆性后部白质脑病的磁共振鉴别

目的探讨MRI和MRV在妊娠相关性脑静脉及静脉窦血栓形成(CVST)和可逆性后部白质脑病综合征(RPLS)鉴别诊断中的价值。方法回顾性分析3例妊娠相关性CVST和6例重度子痫前期、子痫发生RPLS患者的影像学资料。所有患者均行MRI和DSA检查,其中7例患者行MRV检查。结果 3例CVST患者中,1例孤立性大脑上静脉前组血栓形成,MRI表现为相应部位T1WI低、等信号,T2WI、FLAIR等、稍高信号,DWI为等、高信号,ADC图为低、稍高信号;2例横窦血栓形成,表现为双侧枕叶皮质、皮质下白质片状T1WI低信号,T2WI、FLAIR高信号,DWI、ADC高信号,可不对称性地累及顶叶、小脑半球,MRV与DSA检查结果相符。6例RPLS患者MRI显示双侧顶、枕叶皮质、皮质下白质多发性、斑片状、对称性病变,部分严重患者大脑半球呈弥漫性、大片状受累,表现为T1WI低信号,T2WI、FLAIR高信号,DWI、ADC高信号;1例患者MRV检查示左侧横窦未显影,DSA检查示左侧横窦通畅。结论横窦血栓形成和RPLS患者MRI均显示血管源性脑水肿,两者脑水肿主要发生于双侧枕、顶叶,但前者范围较局限,后者范围更广泛,可累及基底节、额叶、颞叶。RPLS患者MRV检查可有假阳性,DSA是鉴别两者的重要检查方法。     

可逆性后部白质脑病综合征临床及影像学特点分析

目的 探讨可逆性后部白质脑病综合征(RPLS)的临床和影像学特点.方法 回顾性分析9例RPLS患者的临床及影像学资料.结果 9例患者临床表现以头痛、意识障碍、癫发作、视觉异常为主;头颅MRI检查有大脑半球后部白质为主的T1WI低信号,T2WI、Fair像呈高信号的病灶,且大多双侧对称.结论 头痛、意识及精神障碍、癫发作、视觉异常、是可逆性后部白质脑病综合征主要临床表现,影像学特征主要为大脑后部对称性、可逆性脑白质损害.     

可逆性后部白质脑病的临床与影像学特征

目的探讨可逆性后部白质脑病(reversible posterior leukoencephalopathy syndrome,RPLS)的临床及影像学特点。方法回顾性分析12例可逆性后部白质脑病患者的临床资料,总结其临床及影像学资料。结果本组女8例,男4例。子痫/先兆子痫6例,急性淋巴细胞白血病1例,肾病综合征2例,系统性红斑狼疮1例,再生障碍性贫血1例,原发性高血压病1例。12例患者均急性或亚急性起病,多以头晕头痛、视物模糊或意识障碍为首发症状。2例行腰穿检查,脑脊液细胞数正常、蛋白正常或轻度升高。11例患者行头颅MRI检查,病灶多以双侧枕、顶叶白质为主,部分可累及额颞叶;11例患者病灶均为等或长T1WI信号,长T2WI信号;5例行Flair检查均为高信号;4例DWI为低信号、ADC高信号,增强未见强化。经降压/对症支持治疗后,6例患者头颅MRI随访病灶明显改善或消失。10例患者症状改善或明显缓解。1例失访,1例随访死亡。结论 RPLS的原发病复杂多样,早期治疗临床症状及影像学表现多数可逆,预后良好。     

可逆性后部白质脑病综合征临床影像学特征

目的探讨可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)的临床和影像学特点。方法回顾性分析8例可逆性后部白质脑病综合征患者的发病原因、临床症状、影像学特征、治疗及预后。结果8例患者中,女5例,男3例;发病原因多样,系统性红斑狼疮2例,妊娠子痫2例,高血压病1例,真菌性脑炎1例,多发性骨髓瘤1例,肾移植1例;其中使用免疫抑制剂3例,化疗药物1例,使用抗真菌药物1例。以头痛、癫痫发作、视觉障碍、意识和精神障碍为主要临床症状。多数患者头颅MRI表现为双侧大脑后部白质对称性T1WI呈低或等信号,T2WI和FLAIR像呈高信号;经采取降压、脱水及对症等治疗2~3周后患者神经系统症状消失,MRI复查病灶完全或大部分消失。结论RPLS是以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,及时、准确的诊断和治疗可使其临床症状和影像学改变完全可逆。     

脑出血低场强MRI诊断分析

目的探讨脑出血低场强MRI诊断的应用价值。方法选取2011-01-2011-07我院诊治的40例脑出血患者,采用低场强MRI诊断,就其MRI表现及血肿内血红蛋白在低场强MRI中的信号变化等进行分析。结果 2例超急性期脑出血患者临床症状典型腰穿检查可有血性脑脊液;1例临床症状不典型,MRI扫描特性也不明显,进行Gd-DTPA增强扫描,结果显示血肿有轻度强化,同时进行CT检查,最终确诊为脑出血;7例急性期脑出血患者MRI扫描结果也无明显特征性,结合患者的临床症状,确诊为脑出血;亚急性期脑出血13例,T1WI和T2WI都表现为高信号,且具有特征性;17例慢性期出血患者,开始阶段T1WI和T2WI均表现为高信号。结论掌握脑出血MRI信号演变的典型规律,同时也要结合患者临床症状,可明确诊断。     

子癎前期、子癎患者并发可逆性后部白质脑病综合征的MRI表现及临床分析

目的探讨子癎前期、子癎并发可逆性后部白质脑病综合征(RPLS)的MRI表现及临床特点。方法回顾性分析17例子癎前期、子癎并发RPLS患者的临床资料。结果 17例RPLS均有高血压、头痛,14例恶心、呕吐;13例视力障碍;16例子癎发作;MRI检查大脑后部为主的白质水肿,特别是枕叶,T2WI、FLAIR呈高信号,DWI呈等信号或稍低信号,ADC图呈高信号。结论子癎前期、子癎易并发可逆性后部白质脑病综合征,视力障碍是RPLS的特征表现,MRI检查可明确诊断RPLS。     

Wernicke脑病的MRI诊断与临床

目的探讨Wernicke脑病(WE)的MRI特征及其诊断价值。方法回顾性分析20例经临床证实的WE患者的临床及MRI检查资料。结果 WE的MRI特征主要表现为对称性T1WI低信号、T2WI高信号,在FLAIR序列中呈明显高信号,在DWI上呈明显高信号,ADC上呈低信号。主要累及部位为乳头体,第三、四脑室及中脑导水管周围灰质。结论WE早期缺乏特征性临床表现,但具有典型的MRI表现,头颅MRI检查对于该病的早期诊断具有重要的临床价值。     

急性CO中毒患者MRI MRA表现

目的评价MRI、MRA对急性CO中毒的诊断及价值。方法回顾分析60例经临床确诊的急性CO中毒患者的头颅MRI、MRA资料。结果MRI异常表现为双侧苍白球、双侧侧脑室周围、脑干、脑叶为主的T1WI高信号、T2WI低信号;18.33%急性CO中毒患者伴发脑梗死,DWI为高信号,ADC为低信号。结论急性CO中毒的诊断主要依靠病史、临床表现和影像检查,头颅MRI、MRA对本病的诊断有一定的价值。     

急慢性肾衰竭合并可逆性后部白质脑病综合征（附二例病例报告）

目的 探讨急慢性肾衰竭合并可逆性后部脑白质综合征(RPLS)的原因、临床表现和病理特点.方法 回顾分析两例女性肾衰竭合并RPLS的临床资料并复习文献.结果 两例患者均出现意识障碍和高血压;病例1合并Goodpasture综合征,以癫痫为首发症状,病例2以头痛、视物障碍为首发症状.头颅CT检查显示多发低密度.颅MRI检查显示T2加权像、FLAIR像高信号,T1加权像等信号,弥散加权像为等信号和部分高信号.经降血压和停用细胞毒性药物治疗4 d和7 d后患者神经系统症状和体征完全恢复正常.结论 肾衰竭可引起RPLS.神经影像学检查对诊断RPLS具有重要地位.     

垂体卒中的临床与磁共振特征

目的:探讨垂体卒中的临床和MRI特征。方法:分析13例垂体卒中患者的临床和头MRI资料。结果:76.9%的患者卒中前无垂体瘤表现,84.6%的患者发病前无明显诱因。典型临床表现为头痛、呕吐及视力障碍等。MRI检查发现,瘤内出血8例,表现为T1WI等信号合并高信号,T2WI像为高信号;肿瘤内坏死3例,表现为T1WI低信号,T2WI高信号;出血合并坏死2例,表现为T1WI高低混杂信号,T2WI高信号。结论:垂体卒中临床表现多样,易漏诊误诊。MRI检查结合临床,对诊断和选择治疗方案有重要价值。     

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。     

可逆性后部白质脑病综合征临床及影像学特点分析（附六例报道）

目的 探讨可逆性后部白质脑病综合征的临床及影像学特点。 方法 收集无锡市人民医院神经内科自2007年12月至2010年8月诊治的6例可逆性后部白质脑病综合征患者的临床资料,回顾性分析其发病原因、临床症状、影像学特点、治疗及预后。 结果 6例患者中白血病1例,肾病综合征1例,肾移植1例,嗜铬细胞瘤1例,原发性高血压2例。患者临床表现多样,主要为痫性发作、头晕头痛、恶心呕吐、意识障碍、精神行为异常、视觉障碍等。头颅CT检查示4例脑白质低密度病灶,2例正常。头颅MRI检查主要表现为大脑半球后部白质病变,TIWI呈低或等信号,T2WI呈高信号,液体衰减反转恢复序列(FLAIR)呈高信号,弥散加权成像(DWI)呈低信号或等信号,表观弥散系数图(ADC)呈高信号。5例经对因及对症治疗临床症状迅速改善,影像学表现减轻或恢复正常;1例肾移植患者因拒绝停用环孢霉素A及骁悉而最终死亡。 结论 可逆性后部白质脑病综合征是一组依靠病史、临床特征及影像学特点而诊断的疾病,经积极治疗大多预后较好,但也有小部分患者由于种种原因而预后不良。     

可逆性后部白质脑病综合征57例临床分析并文献复习

目的 探讨可逆性后部白质脑病综合征(RPLS)的临床和影像学特征.方法 回顾性分析57例(我院3例,文献54例)RPLS患者的临床资料.结果 本组成人多见,女性比例偏高.继发于先兆子痫/子痫19例(33.3%),高血压病18例(31.6%),肾功不全10例(17.5%),其他原因为红斑狼疮、应用化疗药和细胞毒性药、血管炎、肾病综合征、急性肾小球肾炎.头痛、癫痫发作、意识障碍、视力障碍是RPLS常见四联征,54例伴急性血压升高.影像学表现为大脑后部对称性白质水肿,CT低密度灶,MRIT1低信号,T2和Flair像高信号.50例累及双侧顶枕叶,3例累及单侧枕叶,其他部位受累频率依次为额叶、颞叶、小脑、基底节区、脑干、丘脑、胼胝体.经过治疗,55例患者临床症状、影像学异常迅速恢复.结论 头痛、癫痫、意识障碍、视力障碍是RPLS主要临床表现,血压急性升高是RPLS的重要体征,影像学特征是大脑后部对称性白质水肿,大多数患者经治疗很快恢复.

Abstract：

Objective To investigate the clinical and imaging characteristics of posterior reversible encephalopathy syndrome (RPLS). Methods The clinical data of 57 patients with RPLS were analyzed retrospectively ( 3 patients from our hospital and 54 from reference). Results Among the 57 cases with RPLS,most patients' symptoms occurrenced at adults and females cases were more than males. 19 cases(33.3% ) were secondary to preeclampsia/eclampsia, 18 cases (31.6%) were secondary to hypertension, 10 cases( 17.5% ) were secondary to renal inadequacy,other reasons were lupus erythematosus, application of chemotherapeutics, cytotoxic drug, vasculitis, nephrotic syndrome and acute glomerulonephritis.The common tetrad are headache, epileptic attack, conscious disturbance and visual disorder. 54 cases were accompanied with acute hypertension. Radiologic findings showed edema predominantly in the posterior cerebral white matter bilaterally,low density in CT, low signal in MRIT1, High signal in T2 and Flair. The bilateral apical and occipital lobe was involved in 50 cases,lateral occipital lobe was involved in 3 cases, other parts are frontal lobe, temporal lobe, cerebellum, basal ganglia,brain stem, thalamus, callosum. The clinical manifestations and imaging lesions of 55 cases were both improved soon after treatment. Conclusions The main clinical manifestations of RPLS are headache, epileptic attack, conscious disturbance and visual disorder. The important physical sign of RPLS is acute hypertension. Radiologic characteristic is edema predominantly in the posterior cerebral white matter bilaterally, and most patients snap back after treatment.     

以可逆性皮层盲为主要表现的可逆性后部白质脑病综合征三例临床和影像学分析

目的探讨主要表现为皮层盲的可逆性后部白质脑病综合征的临床与影像学表现、早期诊断和治疗。方法回顾性分析主要表现为可逆性皮层盲的慢性肾功能衰竭患者1例、先兆子痫和子痫患者各1例的临床、腰椎穿刺和影像学资料。结果3例患者均出现急性双侧完全性皮层盲,伴有高血压、头痛,1例伴有癫痫发作。腰椎穿刺示轻度颅内压增高。头颅MRI示双侧枕叶皮层或皮层下对称性异常信号,T2WI、FLAIR为高信号,DWI为低或等信号,ADC为高信号,提示血管源性水肿。3例患者均诊断为可逆性后部白质脑病综合征,经控制血压、脱水降颅压等治疗,皮层盲在2天内均完全好转,2周后复查头MRI病灶完全消失。结论可逆性皮层盲是可逆性后部白质脑病综合征最为特征性的症状之一,是由于双侧枕叶皮层或皮层下血管源性水肿所致。     

Reversible bilateral pyramidal tract lesions after hypertensive crisis and cerebral seizures

This is a rare case of reversible high signal-intensity changes along the pyramidal tracts in a patient with reversible posterior leukoencephalopathy syndrome (RPLS). A 38-year-old man was admitted to hospital for loss of consciousness and generalized seizures. His systolic blood pressure was 220 mmHg. Neurological examination revealed bilateral pyramidal-tract signs, and paresis of the right arm. Initial MRI showed increased signal intensities on T2-weighted, FLAIR and diffusion-weighted imaging in the following regions: bilateral temporo-occipital white matter and cortex, dorsal parts of the lentiform nuclei, bilateral caudate nuclei and external capsule. High signal intensities were observed in the pyramidal tracts as well. On patient follow-up, MRI signal abnormalities and clinical symptoms were completely resolved after antihypertensive treatment.     

酷似中毒性脑病的可逆性后部白质脑病综合征:6例临床分析

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,为与中毒性脑病进行鉴别提供依据。方法回顾性分析6例RPLS患者的临床特点、影像学资料及治疗经过。结果 6例患者分别有大量饮酒史、海洛因吸食史、煤气中毒史、长期接触油漆涂料史、一氧化碳吸入史和有机溶剂接触史。临床主要表现为头痛、恶心、呕吐、癫痫发作以及血压升高。头部MRI主要表现为双侧颞叶、顶叶、额叶、侧脑室旁白质、小脑、脑干病灶,呈长T1、长T2信号,无强化。6例患者对症及去除病因治疗后临床表现及影像学表现均明显好转。结论 RPLS患者可以出现与中毒性脑病相似的临床及影像学特点,特别是当患者有毒物吸入史时,应根据该病相对特征性的临床、影像学及疗效尽早排除。     

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.     

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。     

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.     

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。