妊娠相关可逆性后部脑病综合征36例临床分析  

Clinical analysis of 36 patients with pregnancy-related PRES

作　　者：阳柏凤 文延斌[2] 刘运海[2] 曹红桂 雷达 李静[2] 

机构地区：[1]湘雅博爱康复医院神经内科,湖南长沙410000 [2]中南大学湘雅医院神经内科,湖南长沙410008

出　　处：《中风与神经疾病杂志》2018年第2期145-148,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家临床重点专科建设项目[国卫办医函(2013)544号];国家自然科学基金资助项目(81471225)

摘　　要：目的探讨妊娠相关可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)的临床及影像学特点。方法检索2010年1月-2016年6月在湘雅医院妇产科和神经内科住院的所有行头部影像学检查的子痫前期/子痫/PRES患者,进一步从中筛选出妊娠相关的PRES患者,并总结其临床特点、影像学资料及治疗经过。结果本组共检索到90例子痫前期/子痫/PRES患者,最终确诊的妊娠相关PRES患者36例。28例子痫患者中有26例(92%)被确诊为PRES。最常见的临床表现是头痛(81%),其次依次为癫痫发作(73%)、意识状态改变(57%)、恶心/呕吐(47%)、视物模糊(33%)及局灶性神经功能缺损等。PRES的典型影像学表现为大脑后部为主的皮质和皮质下可逆性血管源性水肿,不典型的累及部位包括额叶(72%)、颞叶(67%)、基底节(50%)、小脑(47%)、脑干(14%)和丘脑(8%)。不典型的影像学特点包括弥散受限(33%)、出血(19%)和对比强化(16%)。并发症包括血小板减少(25%)、肺部感染(25%)、贫血(19%)、发热(17%)、急性肾衰竭(8%)、HELLP综合征(6%)及DIC(3%)。大部分患者经积极诊治后可明显好转,但有1例并发DIC的患者最终死亡。结论大部分子痫患者可能进一步诊断为PRES;妊娠相关PRES临床及影像学表现多样,提高对该疾病的认识具有重要临床意义。Objective To investigate the clinical and radiologic features of pregnancy-related posterior reversible encephalopathy syndrome（ PRES）. Methods To search all imaged patients with preeclampsia/eclampsia/PRES in our hospital,then we select pregnancy-related PRES and summarize clinical and radiologic findings together with treatment. Results A total of 36 patients were eventually included as confirmed pregnancy-related PRES. Of 28 eclamptics,26 eclamptics（ 92%） had confirmed PRES. Headache was the most common presenting symptom（ 81%） followed by seizures（ 73%）,altered mental status（ 57%）,nausea/vomiting（ 47%） and visual disturbance（ 33%）. Atypical involved regions included frontal lobe（ 72%）,temporal lobe（ 67%）,basal ganglia（ 50%）,cerebellum（ 47%）,brain stem（ 14%） and thalamus（ 8%）. Typical imaging findings of PRES were reversible vasogenic edema mainly located in bilateral parieto-occipital areas and subcortical white matter. Atypical neuroimaging features included restricted diffusion（ 33%）,contrast enhancement（ 19%） and hemorrhage（ 19%）. Comorbidities included thrombocytopenia（ 25%）,pulmonary infection（ 25%）,anemia（ 19%）,fever（ 17%）,acute renal failure（ 8%）,HELLP syndrome（ 6%）,DIC（ 3%）. Most of patients recovered completely with timely diagnosis and treatment. 1 patients who suffered DIC eventually died. Conclusion Nearly all eclamptic patients who underwent imaging had clinical and radiologic findings of PRES; Patients with pregnancy-related PRES may present with atypical neuroimaging findings.

关 键 词：妊娠 可逆性后部脑病综合征 磁共振 

分 类 号：R742[医药卫生—神经病学与精神病学]