38例可逆性后部白质脑病综合征的临床影像学特征及病因学分析

Clinical and imaging features and etiology of reversible posterior leukoencephalopathy syndrome: an analysis of 38 cases

摘要:

目的 探讨可逆性后部白质脑病综合征(RPLS)的临床影像学特点以及病因学.方法 回顾性分析2009年至2014年间在中南大学湘雅医院神经内科就诊的38例病人临床资料、影像学资料及治疗过程.结果 38例患者中女性23例,男性15例;高血压病史31例,有子痫或子痫前期病史6例;服用免疫抑制剂5例,肿瘤化疗史3例.30例(78.9%)患者首发表现为头痛头晕,此外血压增高、恶心呕吐、视力下降、痫性发作和意识障碍为主要临床表现.磁共振影像表现为大脑后半部对称性稍长T₁、长T₂信号,FLAIR序列为高信号,DWI低信号,并可发现皮质受累.结论 RPLS是一类预后良好的脑病综合征,病因复杂,目前主要依靠临床表现以及影像学明确诊断.

Abstract:

Objective To investigate the clinical and imaging features and etiology of reversible posterior leukoencephalopathy syndrome (RPLS).Methods A retrospective analysis was performed on the clinical and imaging data and the treatment process of 38 patients with RPLS who were admitted to the Xiangya Hospital, Central South University, from 2009 to 2014.Results The 38 RPLS patients included 23 females and 15 males. There were 36 cases having a history of hypertension, and 6 having a history of eclampsia or pre-eclampsia. Additionally, 5 had immunosuppressant and 3 had a history of chemotherapy. Headache and dizzy were the primary symptoms among 30 patients (78.9%), and blood pressure increase, nausea and vomiting, blurred vision, epileptic seizure, and disturbance of consciousness were the most common clinical symptoms. Cranial magnetic resonance imaging revealed symmetric long T₁ and T₂ signals in bilateral white matter of the posterior cerebral hemisphere, with high FLAIR and low DWI signals; cerebral cortex was commonly involved.Conclusions RPLS is an encephalopathy syndrome with good prognosis and complex etiology. The diagnosis of RPLS mainly relies on clinical and imaging features.