可逆性后部白质脑病综合征临床特征及MRI影像学分析.docVIP

可逆性后部白质脑病综合征临床特征及MRI影像学分析 　　[摘要] 目的 探讨可逆性后部白质脑病综合征（RPLS）的MRI影像学特征及临床表现、早期诊断和治疗。方法 分析 8例 RPLS 患者的临床及影像学资料。结果 主要临床表现为头晕、头痛、视物模糊、癫痫发作、恶心、呕吐、精神障碍和行为改变。MRI检查显示双侧大脑后部白质水肿，额叶、顶叶、颞叶、脑干、小脑、基底节区和大脑皮质亦可累及。MRI表现T1WI为略低或等信号，T2WI和FLAIR为高信号，DWI呈等或低信号，ADC图呈高信号。结论 RPLS的发病机制为急性脑白质血管源性水肿。绝大多数患者通过积极的治疗后，症状、体征和MRI表现可以完全恢复至病前水平。DWI和 ADC 图对早期明确诊断和指导治疗具有非常重要的意义。 　　[关键词] 可逆性后部白质脑病综合征；诊断；影像学 　　[中图分类号] R742 [文献标识码] B [文章编号] 1673-9701（2013）36-0070-02 　　The clinical characteristics and MRI imaging analysis of reversible posterior leukoencephalopathy syndrome 　　LI Jiaogen SUN Xiaoming 　　Department of Radiology，Ningde Mindong Hospital Affiliated to Fujian Medical University，Ningde 355000，China 　　[Abstract] Objective To study the MRI imaging features，clinical manifestations，early diagnosis and treatment of reversible posterior leukoencephalopathy syndrome（RPLS）. Methods The clinical and imaging features of 8 cases with RPLS were analyzed. Results The main clinical manifestations included headache，disturbance of vision，nausea， vomiting，epilepsy，conscious disturbance，psychiatric disorder and action abnormality.Neuroimaging test found that edema mainly appeared in the posterior cerebral white matter bilaterally，frontal lobe，parietal lobe， temporal lobe，brainstem，cerebellum and basal nucleus，and the grey matter could be also involved. The lesions showed hypointense or isosignal in T1WI，low signal in T2WI and FLAIR high signal. The lesion also demonstrated hyperintense in apparent diffusion coefficient（ADC） map and hypointense or isosignal in diffusion weighted magnetic resonance imaging（DWI）. Conclusion The pathophysiological mechanism of RPLS is acute vasogenic edema.The symptoms，signs and MRI features could fully recover in most of RPLS cases. DWI and ADC map may be crucial to the exact diagnosis and treatment in early stage. 　　[Key words] Reversible posterior leukoencephalopathy syndrome； Diagnosis； Imaging 　　可逆性后部白质脑病综合征（reversible posterior leukoencephalopathy syndrome，RPLS）于1996年由Hinch