可逆性后部脑白质综合征12例临床分析  

Clinical analysis of 13 cases of reversible posterior leukoenphalopathy syndrome

作　　者：李可[1] 胡珍珠[1] 张尊胜[1] 

机构地区：[1]江苏省徐州医学院附属医院神经内科,223002

出　　处：《中华全科医学》2014年第11期1757-1759,共3页Chinese Journal of General Practice

摘　　要：目的探讨可逆性后部脑白质综合征(RPLS)的临床及影像学特点,提高临床医师对RPLS的认识。方法回顾性分析近10年徐州医学院附属医院确诊的RPLS 12例患者的临床资料,并结合文献对该病的诊治及误诊特点进行讨论。结果本组男性3例,女性9例,继发于子痫、妊娠高血压综合征共5例,剖宫产术后1例,高血压病2例,其他病因为应用化疗药物、应用免疫抑制剂。RPLS主要临床表现为头痛、癫痫发作、意识障碍、视觉异常、精神行为异常。影像学表现为大脑后部为主对称性白质水肿,头颅CT表现为双侧顶枕叶为主的对称片状低密度影,头颅MRI对本病诊断意义更大。本组12例患者有7例曾被误诊,误诊率58.3%,其中误诊为病毒性脑炎2例,误诊为静脉窦血栓形成2例,误诊为外伤性脑梗塞、短暂性脑缺血发作、脱髓鞘疾病各1例。经对因对症治疗,10例患者痊愈,复查影像学改变基本或完全消失,2例患者死亡。结论 RPLS发病多有诱因,头痛、癫痫发作、意识障碍、视觉异常、精神行为异常是RPLS的常见临床表现,影像学特征主要是大脑后部对称性脑白质水肿,本病易被误诊为脑炎、静脉窦血栓形成、缺血性脑血管病、脱髓鞘疾病。通过积极的病因干预及对症治疗,大部分患者预后良好,极少数病情严重患者也可能出现死亡。Objective To investigate the clinical and imaging characteristics of reversible posterior leukoenphalopathy syndrome（RPLS） ,improve the understanding of RPLS for clinicians. Methods The clinic files of 12 cases of RPLS in our hospital in the past 10 years were analyzed retrospectively;The diagnosis, treatment and misdiagnosis characteristics of this disease were studied in the light of academic articles. Results There were 3 male and 9 female patients in this group. 5 cases were secondary to preeclampsia or eclampsia, 1 case was secondary to Cesarean section,2 cases were secondary to hypertension, other reasons included the use of radiochemotherapy drugs and immunosuppressive agent. The main clinical characteristics of RPLS were headache, epileptic attack, conscious disturbance, visual disorder and mental and behavior disorder. Radiologic findings showed symmetrical white matter edema in posterior cerebral white matter. The computed tomography（CT） feature was symmetric bilateral occipital flake low density areas,and magnetic resonance ima- ging（MRI） was more significance to the diagnosis of this disease. 7 cases were misdiagnosed among the 12 patients with a misdiagnosis rate of 58.3% ,2 cases were misdiagnosed as viral encephalitis,2 cases were misdiagnosed as venous sinus thrombosis, 1 case was misdiagnosed as traumatic cerebral infarction, 1 case was misdiagnosed as transient ischemic attack, 1 case was misdiagnosed as demyelinating diseases. The clinical manifestations and imaging lesions of 10 cases were both improved soon after the treatment. Two cases died. Conclusion There are always inducements in the development of RPLS. The headache, epileptic attack, conscious disturbance, visual disorder and mental and behavior disorder are the principal clinical symptoms in RPLS. The imaging features of RPLS are symmetrical on the bilateral posterior white matters of cerebrum. The disease is easy to be misdiagnosed as encephalitis, venous sinus thrombosis, ischemic cerebrovascular diseases,demyelinating

关 键 词：可逆性后部脑白质综合征 临床 核磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学]