摘要
目的分析围生期可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)的临床、影像特征与预后,提高诊治水平。方法对30例围生期RPLS进行回顾性分析。结果所有患者均急性起病,产前发病8例,产后发病22例(发生于阴道分娩后20例,其中发生于产后48 h后16例)。产前发病6例(75%)具有子痫前期,而产后发病者仅1例(4.5%)具有子痫前期。首发症状以头痛为主。主要表现为头痛23例(76.7%)、抽搐22例(73.3%)、视觉异常19例(63.3%)、意识障碍8例(26.7%)。影像表现为双侧对称性可逆件以大脑后部皮质下白质为主的病变,包括枕叶27例(90%)、顶叶23例(76.7%)、颞叶10例(33.3%)、额叶7例(23.3%)等。MR弥散成像显示血管源性脑水肿。治疗以降血压和控制癫痫为主,所有患者的临床症状和影像改变在l d～6个月内明显改善或消退,其中25例(83.3%)在2周内缓解。结论围生期RPLS具有特征性的临床和影像表现,好发于产后,特别是产后48 h后,且发病前多无子痫前期。MR弥散成像有助于鉴别病灶性质。治疗及时,病灶完全可逆,预后良好。
Objective To analyze the clinical and neuroimaging characteristics and prognosis of peripartum reversible posterior leukoencephalopathy syndrome （RPLS）. Methods Thirty cases with peripartum RPLS were retrospectively reviewed. Results All patients developed acutely, 8 cases（36.4%） in the antepartum period and 22 cases（63.6%） in the postpartum period among which 20 cases（90.9%） developed after vaginal delivery, 16 cases（72.7%） presented more than 48 hours after delivery. Six cases（75% ） of the antepartum RPLS had pre-eclamptic signs while only 1 case（4.5%） of the postpartum RPLS had pre-eclamptic signs. Headache was the initial manifestation of the patients. The major clinical characteristics were headache （23 cases,76.7%）, seizures （22 cases, 73.3%）,visual disturbances （19 cases, 63.3%）, altered mental status （8 cases, 26.7%）. The most common abnormality on neuroimaging was edema predominantly involving the cortex and subcortical white matter in the posterior portions of the cerebral hemispheres,including the occipital lobes （27 cases, 90%） , parietal lobes （23 cases, 76.7%）, temporal lobes （10 cases, 33.3%） and frontal lobe （7 cases, 23.3%）. MR diffusion-weighted imaging revealed vasogenic edema rather than cytotoxic edema. The treatments included aggressive blood pressure control and anticonvulsants. The clinical symptoms and the lesions on neuroimaging improved or resolved from 1 day to 6 months,among which 25 cases（83.3%） of the patients resolved within 2 weeks. Conclusion Peripartum RPLS is a clinical entity with characterized clinical manifestation and neuroradiological findings, which favored the postpartum period （especially over 48 hours after delivery） and most without pre-eclamptic signs. MR diffusion-weighted imaging and ADC mapping contribute to differentiate vasogenic edema from cytotoxic edema. The prognosis for peripartum RPLS is usually quite good as long as the diagnosis is made properly and the blood pressure and seizures were w
出处
《河北医科大学学报》
CAS
2010年第4期380-383,390,共5页
Journal of Hebei Medical University
关键词
脑病变
疾病特征
预后
brain disease
disease attributes
prognosis
