并发颅内出血的可逆性后部脑病综合征5例临床分析并文献复习  

Posterior reversible encephalopathy syndrome complicated with intracranial hemorrhage:clinical analysis of 5 patients and literature review

作　　者：文延斌[1] 贺威[1] 黄清[1,2] 刘运海[1,2] 

机构地区：[1]中南大学湘雅医院神经内科,长沙410008 [2]湖南省脑血管病临床医学研究中心

出　　处：《中国神经精神疾病杂志》2016年第9期537-541,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)并发颅内出血的临床及影像学特点。方法回顾性分析我院5例并发颅内出血的PRES患者的临床及影像学特点。结果 5例PRES患者均为年轻女性,4例继发于子痫前期,另1例继发于慢性肾衰竭。临床表现为头痛、癫痫发作、视物模糊、意识状态改变及局灶性神经功能缺损等。影像主要表现为双侧大脑后部为主的血管源性脑水肿,但也有额叶、基底节、脑干、小脑受累和细胞毒性脑水肿等不典型表现。5例患者均合并脑实质血肿,4例位于水肿周围,1例并发硬膜下血肿。5例患者均合并血小板减少及凝血功能异常,且均因病情危重而入住重症监护病房,经积极治疗后临床表现及影像学表现均明显好转。结论合并凝血功能异常的PRES较易出现颅内出血等并发症。Objective To investigate the clinical and radiologic features of postpartum posterior reversible encepha- lopathy syndrome （PRES） complicated with intracranial hemorrhage （ICH）. Methods A retrospective analysis was per- formed on five cases of PRES-ICH to examine the clinical and radiologic features of PRES. Results All 5 patients with PRES are young women. Among them, four patients was secondary to preeclampsia and one predisposed by chronic renal failure. Clinical manifestations included headache, seizures, blurred vision, altered consciousness and focal neurologic deficits, etc. Radiologic presentations were characterized by bilateral vasogenic edema primarily located in posterior brain including parietal-occipital lobe and temporal lobe. Patients also had many atypical radiologic presentations includ- ing involvement of frontal lobe, stem, basal ganglion and cerebellum together with cytotoxic brain edema. Besides, all pa- tients were complicated with parenchymal hematoma, most of which located near the parenchymal edema. Furthermore, one patient was also complicated with a rarely reported subdural hematoma. All patients were complicated with thrombo- cytopenia and coagulant function abnormalities and were admitted into intensive care unit for severe condition. Their clin- ical manifestations and imaging findings improved significantly after intensive treatment. Conclusions PRES patients with concurrent coagulant function abnormalities are susceptible to complications such as ICH.

关 键 词：可逆性后部脑病综合征 颅内出血 磁共振 子痫前期 

分 类 号：R743.34[医药卫生—神经病学与精神病学]