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。

Clinical features of 12 patients with reversible posterior leukoencephalopathy syndrome

Objective To analyze the clinical features of reversible posterior leukoencephalopathy syndrome(RPLS).Methods Clinical data including the clinical presentation,laboratory finding and imaging features of twelve patients diagnosed of RPLS by People's Hospital of Henan Province from June 2015 to September 2016 were analyzed.Results Eleven cases of female and one case of male were identified.Ten cases presented with eclampsia,seven of which combined a low level blood platelet.Seizure(10/12),headache(7/12)and visual disturbance(6/12)were observed.Radiological imaging showed symmetrical lesions in posterior brain matter,low density on brain CT and vasogenic edema on MRI,with fronto-parietal lobe,basal ganglia region,callosum,cerebellum involved accasionally.Reexamination after treatment showed completely remission in four cases.Elevated level of LDH was detected in 11/12 cases,7 of which accompanied by reduced platelet level,elevated white blood cell and creatine kinase(CK).Conclusion RPLS is a central nervous system disease featured by headache,seizure,blurred vision and consciousness disturbance.Brain MRI shows vasogenic edema.Lower level of platelet is a possible cause of the disease.Positive treatment is correlated with a better prognosis.