可逆性后部白质脑病综合征患者临床表现与磁共振影像学特点分析  

Analysis of clinical manifestations and magnetic resonance imaging characteristics of patients with reversible posterior leukoencephalopathy syndrome

作　　者：马力[1] 邹梅[2] 苏国华[1] 廖佳佳 张荣萍[1] MA Li;ZOU Mei;SU Guo-hua;LIAO Jia-jia;ZHANG Rong-ping(Department of Radiology,The First People′s Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,China;Department of Neurology,The First People′s Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,China)

机构地区：[1]凉山彝族自治州第一人民医院放射科,四川西昌615000 [2]凉山彝族自治州第一人民医院神经内科,四川西昌615000

出　　处：《实用医院临床杂志》2022年第1期64-67,共4页Practical Journal of Clinical Medicine

基　　金：凉山州科技计划重点研发项目(编号:20ZDYF0027)。

摘　　要：目的分析可逆性后部白质脑病综合征(RPLS)患者的临床表现及磁共振(MRI)影像学特点。方法回顾性分析115例RPLS患者的临床及影像学资料。结果115例RPLS患者表现为血压升高(89.56%)、痫性发作(74.78%)、头痛(59.13%)、视觉障碍(32.17%)、神经系统体征(20.00%)和意识改变(15.65%),其中101例(87.83%)患者头颅MRI异常,累及枕叶(71.29%)、顶叶(59.40%)、额叶(49.50%)、颞叶(38.26%)、侧室脑旁(1.98%)、脑干(3.96%)、小脑(3.96%)、皮质(3.96%)、丘脑(0.99%)、基底节区(0.99%),病灶为等或低T1WI信号,高T2WI信号,等或低DWI信号,高ADC及FLAIR信号。治疗后随访3~60月,81例预后良好,21例预后不良,5例死亡。预后不良组头痛发生率、住院期间mRS评分≥3分及并发症比例高于预后良好组(P<0.05)。结论RPLS的MRI表现具有特征性,结合临床表现可作出正确判断,及时治疗,改善预后。Objective To analyze the clinical manifestations and magnetic resonance imaging(MRI)characteristics of patients with reversible posterior leukoencephalopathy syndrome(RPLS).Methods Clinical and imaging data of 115 patients with RPLS were retrospectively analyzed.Results The 115 patients with RPLS showed elevated blood pressure(89.56%),epileptic seizures(74.78%),headache(59.13%),paropsia(32.17%),nervous system signs(20.00%)and altered state of consciousness(15.65%).Of the patients,101 patients(87.83%)had abnormal head MRI results,involving occipital lobe(71.29%),parietal lobe(59.40%),frontal lobe(49.50%),and temporal lobe(38.26%)as well as lateral ventricle(1.98%),brainstem(3.96%),cerebellum(3.96%),cortex(3.96%),thalamus(0.99%),and basal ganglia region(0.99%).The lesions showed equal or low T1WI signal,high T2WI signal,equal or low DWI signal,high ADC and FLAIR signal.The patients were followed up for 3-60 months after treatment.There were 81 patients with good prognosis and 21 patients with poor prognosis,and 5 patients died.The incidence of headache,mRS score≥3 points during hospitalization,and complications in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Conclusion The MRI appearance of RPLS is characteristic.The imaging data combined with clinical manifestations can help make correct judgment,and carry out treatment in time.Thus,the prognosis of the patients may be improved.

关 键 词：可逆性后部白质脑病综合征 临床表现 磁共振成像 影像学特点 预后 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]