脑后部可逆性脑病综合征六例并文献分析

目的 探讨脑后部可逆性脑病综合征(PRES)的临床及影像学表现,提高对PRES的认识.方法 6例PRES患者中4女2男,终末期肾病、肾移植、孕妇、系统性红斑狼疮、非霍奇金淋巴瘤及高血压患者各1例.6例行MRI多序列成像及增强检查.3例行CT平扫及增强检查.结果 6例PRES有不同诱因,以突发头痛、子痫或癫痫发作、意识障碍及视觉障碍为临床特点,及时正确治疗后症状1周左右消失,1例遗留视力模糊.CT及MRI显示6例多发病灶主要位于双侧顶枕叶皮质下白质内,额叶及颞叶后部各2例,左侧小脑1例,皮质受累2例,增强无强化.随访MRI显示病灶消失,1例遗留小梗死灶.结论 PRES是一种临床一影像综合征,常常是良性及可逆的,快速降压、去除诱因及支持治疗后症状缓解、病灶消失,治疗不当可发展为脑梗死.

Posterior reversible encephalopathy syndrome:report of six cases

Objecfive To investigate clinical features and imaging manifestation in patients with posterior reversible eneephalopathy syndrome (PRES) to improve its recognition.Methods Six patients with PRES were enrolled,four women with history of end-stage renal disease,kidney transplantation,eclampsia,or systemic lupus erythematosus (SLE) and two men with history of chemotherapy or hypertension.All of them underwent multi-serial MR imaging (T1 WI,T2 WI,FLAIR) and post-contrast T1 WI.Three cases also underwent CT scan and gadolinium enhancement. Results All the six cases of PRES had different inducing causes such as acute hypertension,preeclampsia or eclampsia, taking immunosuppressive agents or steroids.and their clinical symptoms were characterized by sudden occurrence of headache,eclampsia or seizure of epilepsy,altered melltal status,visual disturbances.Clinical symptoms were died out in about one week after prompt and appropriate treatments for high blood pressure.or removal of precipitating factors,or treatment for epileptic seizures or status epilepticus.MRI and CT scanning demonstrated multifocal subcortical white lesions in bilateral parieto-occipital lobes (six cases), bilateralfrontal lobes (two cases),bilateral post temporal lobes (two cases) and left cerebellum (one cases).and cortical involvement (two cases).All lesions appeared unenhanced with gadolinium enhancement. FoHow-up by MRI showed decreased abnormal signs and small infarct foci were left in the cortex-subeortex of one case.Conclusions PRES is a clinico-neuroradiologieal transient condition, usually benign and reversible in nature.Completely clinical and radiographic recovery Can be achieved with prompt antihypertensive treatment or removal of precipitating factors and supportive care,but delayed diagnosis and therapy Can result in cerebral infarct with neurological sequelae.