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目的分析子痫前期-子痫并发可逆性后部白质脑病综合症的临床表现、影像学特征及治疗后改变。方法回顾性分析子痫前期-子痫合并可逆性后部白质脑病综合症患者9例的临床表现、影像学表现及随访结果。结果 9例均为急性、亚急性发病,收缩压/舒张压短期内平均升高42/37mmHg,主要表现为突发性癫痫发作7例(78%)、意识障碍9例(100%)、视力障碍8例(89%),伴有不同程度头痛、恶心、呕吐等颅高压症状及精神行为异常。影像学改变呈多发片状、斑片状局部水肿灶对称性分布6例(67%),非对称性分布3例(33%),病变累及顶叶白质区8例(89%)、枕叶白质区9例(100%)、皮层下白质9例(100%)及大脑皮层6例(67%),部分病例累及额叶5例(56%)、颞叶2例(22%)、小脑白质1例(11%)、基底节区1例(11%)及脑干2例(22%),病变区继发出血1例(11%),急性梗塞灶1例(11%)。5例MRV检查未见脑静脉及静脉窦阻塞,4例MRA检查颅内动脉未见狭窄。治疗1-2周后复查MRI:6例(67%)患者颅内病灶消失,3例(33%)病灶明显吸收、缓解。结论根据子痫前期-子痫患者突发血压升高、癫痫发作、视力障碍、颅高压症状及精神行为异常,结合影像学病灶特征性分部部位及血管源性水肿性质可明确诊断,T1WI可发现出血、DWI有助于发现梗塞等继发性改变。治疗及时,病变可完全逆转,预后良好。
Objective To analyze the clinical manifestations, imaging features and post-treatment changes of reversible posterior segment of leukoencephalopathy in patients with preeclampsia-eclampsia. Methods The clinical manifestations, imaging findings and follow-up results of 9 cases with posterior leukoencephalopathy syndrome in patients with preeclampsia and eclampsia were analyzed retrospectively. Results All the 9 cases were acute and subacute. The average systolic blood pressure / diastolic blood pressure increased 42 / 37mmHg in a short period. The main manifestations were sudden onset of seizures in 7 cases (78%), disturbance of consciousness in 9 cases (100%), visual acuity Eight patients (89%) had headache, nausea, vomiting and other intracranial hypertension symptoms and mental disorders. There were 6 cases (67%) with symmetrical patchy edema lesions, 3 cases (33%) with asymmetric distribution, 8 cases (89%) with lesions involving white matter in parietal lobe, occipital lobe White matter in 9 cases (100%), subcortical white matter in 9 cases (100%) and cerebral cortex in 6 cases (67%), in some cases involving the frontal lobe in 5 cases (56%), temporal lobe in 2 cases (22% One case (11%) of white matter, one case (11%) of basal ganglia and two cases of brain stem (22%), one case of secondary bleeding in lesion area (11%) and one case of acute infarction (11%). No cerebral venous and sinus occlusion were found in 5 cases of MRV. No stenosis was found in 4 cases of MRA. MRI was reviewed 1-2 weeks after treatment. Intracranial lesions disappeared in 6 patients (67%), and lesions in 3 patients (33%) were significantly absorbed and relieved. Conclusion According to the elevated blood pressure, epileptic seizures, visual acuity, intracranial hypertension and mental behavioral abnormalities in patients with preeclampsia and eclampsia, combined with the characteristics of subdivision and vasogenic edema in imaging lesions, T1WI can be diagnosed Found bleeding, DWI helps to detect secondary changes such as infarction. Timely treatment, the disease can be completely reversed, the prognosis is good.