可逆性后部脑病综合征四例的临床和影像学特征分析  

Clinical and imaging characteristic analysis of 4 cases of reversible posterior encephalopathy syndrome

作　　者：杨昂[1] 张雪林[1] 

机构地区：[1]南方医科大学南方医院影像中心,广州510515

出　　处：《中华神经科杂志》2007年第8期530-532,共3页Chinese Journal of Neurology

摘　　要：目的探讨可逆性后部脑病综合征(RPES)的临床特征和 MRI 表现。方法回顾性分析4例经临床诊断 RPES 的临床和 MRI 资料。结果 4例患者均有血压升高,神经症状有剧烈头痛(2例)、烦躁不安(3例)、视觉模糊(2例)、近期记忆力减退(1例)、癫癎发作(2例);MRI 上病灶主要对称性分布于顶叶后部及枕叶(4例),表现为 T_2加权像及压水像高信号,T_1加权像低信号,2例主要累及皮质,1例表现皮质及皮质下白质同时受累,1例主要累及白质。4例复查时病灶明显消散。结论 RPES 的 MRI 表现较为有特征性,病灶多对称性分布于大脑后部,累及皮质或皮质下白质,为可逆性病灶;结合临床血压升高和某些后部脑结构受累所致神经症状等特点有助于该综合征的早期鉴别诊断。Objective To investigate clinical and MRI features of the reversible posterior encephalopathy syndrome （RPES）. Methods Clinical and MRI materials of 4 RPES cases confirmed by integrated clinical diagnosis were retrospectively analyzed. Results All the cases presented with a rise of blood pressure. The neural symptom include severe headache （2 cases ）, dysphoria （3 cases ）, blur of vision （2 cases）, impairment of impermanent memory （1 case）, seizure （2 cases）. In MRI, the lesions mainly systematically located in posterior parietal lobe and occipital lobe in all cases, or randomly located in frontal lobe （2 cases）. Lesions demonstrated high signal on T2 weighed and water-suppressed sequences in MRI. The lesions dominantly located in cortex in 2 cases, in both cortex and subcortical white matter in 1 case and in subcortical white matter in 1 case. Four cases resolved their lesions when re-examined. Conclusions RPES represents such characteristic MRI findings as symmetrical distribution of reversible lesions in posterior brain with involvement of cortex or subcortical white matter. When combined with hypertension and neural symptoms caused by involvement of posterior brain structure, it is helpful for early differential diagnosis of this syndrome.

关 键 词：脑疾病 头痛 烦躁 记忆障碍 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学]