妊娠合并可逆性后部脑病综合征临床影像特点对比分析  

Clinical and imaging features of posterior reversible encephalopathy syndrome in pregnancy and postpartum: a comparative analysis with non-pregnant patients

作　　者：周雁[1] 倪俊[1] 朱以诚[1] 周立新[1] 姚明[1] 关鸿志[1] 牛婧文[1] 范思远[1] 彭斌[1] 崔丽英[1,2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经科,北京100730 [2]中国医学科学院神经科学中心,北京100730

出　　处：《中国实用内科杂志》2015年第4期355-358,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的分析孕产妇合并可逆性后部脑病综合征（posterior reversible encephalopathy syndrome,PRES）患者的临床影像特点,并与非孕产妇合并PRES患者进行比较。方法回顾性分析2002年10月至2012年12月在北京协和医院住院的12例孕产妇PRES患者的临床、影像表现及治疗和预后,并与同期收治的25例非孕产妇PRES进行比较。结果 12例孕产妇合并PRES患者平均年龄25.8岁（18~39岁）。9例发生在晚孕期,1例中孕期,2例产后。临床特征：12例患者就诊时血压均不同程度升高,平均收缩压164 mm Hg（140~180 mm Hg）。临床表现头痛10例,抽搐9例,不同程度意识障碍5例,视觉障碍5例。影像学特征：12例患者急性期行头颅磁共振成像（MRI）和（或）计算机断层扫描（CT）均可见局部脑组织水肿信号,大部分病灶位于双侧顶枕叶皮层下白质,其中顶叶病变11例,枕叶10例,颞叶7例,额叶6例,其他如脑干、小脑、基底节、丘脑病变者4例。治疗转归：12例患者均给予不同程度的降压、硫酸镁及甘露醇降颅压等治疗,10例孕期发病患者均给予急诊剖宫产终止妊娠。所有患者最终均好转出院,未遗留神经系统症状体征,复查影像学病灶明显减少或消失。与25例非孕产妇PRES比较,孕产妇PRES患者在发病年龄、临床表现、病灶分布上差异无统计学意义,但是预后相对更好。结论孕产妇合并PRES多发生在孕晚期或产后,与子痫好发时间及临床表现类似,及时影像学检查非常必要;孕产妇合并PRES的临床影像特征与非孕产妇PRES比较差异无统计学意义,但是治疗及时预后相对更好。Objective To investigate the cinical and imaging features of posterior reversible encephalopathy syndrome（PRES） in pregnancy and postpartum, and to find differences between pregnant and non-pregnant patients. Methods The clinical and imaging features, treatments and outcomes of 12 pregnant patients with PRES were analyzed retrospectively, which were also compared with 25 non-pregnant patients. All patients were admitted to Peking Union Medical College Hospital between October 2002 and December 2012. Results Nine of 12 patients were in late pregnancy, 1 in the second trimester of pregnancy, and 2 in postpartum. The average age was 25.8（18-39） years. Clinical features： the blood pressure of all the patients were higher at the onset; the average systolic blood pressure was 164 mm Hg（140-180 mm Hg）; 10 of the 12 patients were with headache（83.3%）, 9 with seizures（9/12, 75%）, 5 with visual disorders（5/12, 41.7%）, and 5 with reduced consciousness（5/12, 41.7%）. Involvement of brain regions was as follows： parietal lobar（11/12, 91.7%）; occipital（10/12, 83.3%）; frontal（6/12, 50%）; temporal（7/12, 58.3%）; other regions such as deep gray matter, cerebellum and brain stem（4/12,33.3%）. Treatment and outcome： all the patients received hypotensive, magnesium sulfate and intracranial pressure reducing therapy, and 10 patients received timely emergency cesarean section. All the patients had excellent outcome. There were no neurological symptoms or signs of residual on discharge. Imaging re-examination showed the brain lesions alleviated or disappeared. Compared with the 25 non-pregnant patients, pregnant patients had no significant differences in the clinical and imaging features. The pregnant patients seemed to have better prognosis in this investigation. Conclusions Since the clinical manifestations and onset time of PRES in pregnancy are similar to eclampsia, timely imaging examinations are necessary for the patient. There are no significant differences in the clinical and i

关 键 词：可逆性后部脑病综合征 妊娠 子痫 影像 

分 类 号：R742[医药卫生—神经病学与精神病学]