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。

Concurrent reversible posterior leukoencephalopathy syndrome during peri-operative period of renal transplantation in one case

BACKGROUND：Reversible posterior leukoencephalopathy syndrome is rarely reported, especial y concurrent during perioperative period of renal transplantation. Due to its clinical manifestations similar to uremia, transplant doctors are easy to ignore or not timely diagnosis reversible posterior leukoencephalopathy syndrome, thus impacting its treatment. 〈br〉 OBJECTIVE：To discuss the clinical manifestations, imaging features, treatment experience and prognosis of patients with reversible posterior leukoencephalopathy syndrome concurrent during perioperative period of renal transplantation, in order to improve the diagnostic rate and therapeutic effect. METHODS：We reviewed clinical data of one case of concurrent reversible posterior leukoencephalopathy syndrome during perioperative period of renal transplantation admitted at the General Hospital of Shenyang Military Region. RESULTS AND CONCLUSION：From the 3rd day postoperatively, the patient gradual y experienced abnormal blood pressure, blurred vision, headache, seizures, disturbance of consciousness and mental and behavioral abnormalities. Early head CT showed low density in the left frontal lobe and corona radiate;and further MRI re-examination showed flake-shaped T1 and long T2 signals in the bilateral frontal lobe, hippocampus, parietal occipital cortex, and brainstem, as wel as high signals on FLARI images at the corresponding parts. After active treatment, the clinical manifestations were improved. Retrospective analysis of clinical data of this case and review of relevant literature wil provide clinical data for the diagnosis and treatment of concurrent reversible posterior leukoencephalopathy syndrome during perioperative period of renal transplantation.