累及不典型部位的可逆性后部脑病综合征  

Atypical Posterior Reversible Encephalopathy Syndrome

作　　者：赵晗 孙锦平[2] 郭永华 刘学军[1] ZHAO Han;SUN Jinping;GUO Yonghua;LIU Xuejun(Department of Radiology,Affiliated Hospital of Qingdao University,Qingdao 266003,China;不详)

机构地区：[1]青岛大学附属医院放射科,山东青岛266003 [2]青岛大学附属医院神经内科,山东青岛266003

出　　处：《中国医学影像学杂志》2021年第6期544-548,共5页Chinese Journal of Medical Imaging

摘　　要：目的分析累及双侧深部脑白质及颞极白质的非典型部位可逆性后部脑病综合征(PRES)的临床特点及MRI表现。资料与方法回顾性分析4例诊断为对称性累及双侧侧脑室周围深部白质及颞极白质的PRES患者的临床及MRI资料,总结其临床及影像特征。结果4例均为男性,年龄2838岁,有长期原发性高血压病史。发病时血压骤升,伴有肾功能异常。临床表现:头晕头痛4例,视物模糊1例。颅脑MRI表现:双侧侧脑室周围深部白质(4例)、颞极白质(4例)对称性血管源性水肿,T1WI呈低信号,T2WI及T2-FLAIR呈高信号,DWI呈等信号;3例出现点状细胞毒性水肿,DWI呈高信号。经过510 d对症治疗后,患者临床症状及影像表现消失或明显缓解。结论非典型部位PRES好发于年轻男性,患者有长期高血压病史,起病时血压骤升并可伴有肾功能异常,症状多为头晕头痛。MRI特征主要为累及双侧深部白质及颞极白质的血管源性水肿,可伴点状细胞毒性水肿。经短期治疗,病变可逆。Purpose To describe and analyze the clinical and MRI features of posterior reversible encephalopathy syndrome(PRES) involving deep white matter and temporal polar white matter. Materials and Methods A total of four PRES patients with bilateral periventricular and temporal white matter involvement were analyzed, and the clinical data and neuroimaging features were retrospectively summarized. Results Four cases were all male patients(28-38 years old) with a long history of primary hypertension. All patients with PRES had a sudden rise in blood pressure accompanied by abnormal renal function. There were 4 cases with dizziness and headache and 1 case with blurred vision. MRI showed symmetrical white matter angiogenic edema around bilateral ventricles(4 cases) and bilateral temporal polar region(4 cases), with low signal on T1 WI, high signal on T2 WI and T2-FLAIR, and equal signal on DWI. Three patients presented punctate cytotoxic edema with high signal on DWI. After 5-10 days of symptomatic treatment, the clinical symptoms and imaging abnormalities disappeared or significantly relieved. Conclusion PRES involving atypical sites is most common in young men with a long history of primary hypertension. The onset of PRES can be accompanied by sudden rise in blood pressure and abnormal renal function. Patients with PRES are usually with symptoms, such as dizziness and headache. The lesions involved bilateral deep white matter and temporal polar white matter, mainly with vasogenic edema, accompanied by punctate cytotoxic edema. PRES can be reversible via short-term treatment.

关 键 词：可逆性后部脑病综合征 磁共振成像 扩散加权成像 深部白质 颞极 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742[医药卫生—诊断学]