酷似颅内静脉窦血栓形成的产后可逆性后部脑病综合征四例临床分析  

Clinical analysis of four cases of postpartum posterior reversible encephalopathy syndrome which mimics cerebral venous sinus thrombosis

作　　者：文延斌[1] 阳柏凤[1] 杨晓苏[1] 刘卫平[1] 冯莉[1] 李静[1] 

机构地区：[1]中南大学湘雅医院神经内科,长沙410008

出　　处：《中华神经科杂志》2014年第3期177-181,共5页Chinese Journal of Neurology

摘　　要：目的 探讨产后可逆性后部脑病综合征（posterior reversible encephalopathy syndrome,PRES）的临床及影像学特点,为发病早期与颅内静脉窦血栓形成（cerebral venous and sinus thrombosis,CVST）的鉴别提供依据.方法 回顾性分析4例产后PRES患者的临床特点、影像学资料及治疗经过.结果 4例患者均出现不同程度的头痛、恶心、呕吐、癫痫发作以及血压升高,3例患者出现视力下降,其中1例出现双侧视网膜脱落.病变主要位于双侧顶枕叶为主的大脑后部白质区域,在MRI上呈长T1、长T2信号.2例患者使用抗凝治疗,仅2例患者严格控制血压.4例患者临床表现及影像学表现均明显好转,仅1例患者遗留视力下降.结论 PRES患者可以出现与CVST相似的临床及影像学特点,特别是PRES患者出现颅内静脉窦显影不良时,应根据其相对特征性的临床及影像学表现早期排除颅内静脉窦血栓形成.Objective To investigate the clinical and radiologic features of postpartum posterior reversible encephalopathy syndrome （PRES） and provide the clues for differentiation from cerebral venous sinus thrombosis （CVST）. Methods Four cases of postpartum PRES were retrospectively studied based on clinical, radiologic features and treatment. Results All of four eases presented with headache, nausea, vomiting, seizures and hypertension. Three of them presented visual disturbances, one of whom was found bilateral retinal detachment. Magnetic resonance imaging （MRI） revealed bilateral parieto-occipital long TI and T2 lesions, which mainly located in subcortical regions. Anticoagulant drugs were applied in two cases, while two other cases underwent strict control of blood pressure. The clinical presentation and radiologie features were all improved markedly in the four cases, except blurred vision left in one case. Conclusions The clinical and radiological manifestations of PRES can be similar to CVST. CVST should be excluded based on the characteristic clinical and radiologie features of PRES in the early stage, especially when patients have poor visualization of sinus flow on MRI.

关 键 词：后部白质脑病综合征 窦血栓形成 颅内 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学]