可逆性后部白质脑病综合征的发病机制

可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)是一种临床影像学疾病实体,主要以迅速进展的血压增高、头痛、呕吐、意识障碍、痢性发作为特征,神经影像学显示为双侧大脑半球对称性白质可逆性水肿(尤其是在大脑后部),通过及时和正确的治疗,临床症状和神经影像学改变可完全恢复.有关RPLS发病机制的两大假说--脑血管痉挛学说和脑血管过度灌注学说一直存在争论,目前多数学者仍然认同后者是造成脑水肿的主要原因.文章从RPLS的病因学、病理学和影像学特征阐述了其发病机制以及近年来对上述两大假说的新观点.

Pathogenesis in reversible posterior leukoencephalopathy syndrome

Reversible posterior leukoencephalopathy syndrome (RPLS) is a cliniconeuroradiological entity mainly characterized by the rapidly progressive increase in blood pressure, headache, vomiting, conscious disturbance and seizure. Neuroimaging showed symmetrical reversible white matter edema in bilateral cerebral hemispheres, particularly in posterior brain.Clinical symptoms and neuroimaging changes can be recovered completely with timely and correct treatment. The two major hypotheses about the pathogenesis of RPLS-cerebral vasospasm and cerebrovascular hyperperfusion-have been in dispute. At preseut, most researchers still agree that the latter is the main cause of cerebral edema. This article expounds the new viewpoints of its pathogenesis and the above two major hypotheses in recent years from the characterizations of etiology, pathology and imaging of RPLS.