可逆性后部白质脑病综合征的临床及影像学特点

目的 探讨可逆性后部白质脑病综合征（PRES）的临床和影像学特点。方法 回顾性分析7例PRES患者临床及影像学资料。结果 本组继发于妊娠高血压综合征3例，肾功能衰竭3例，高血压1例。临床表现：7例均有头痛及视物模糊，伴有癫痫发作6例，恶心、呕吐4例，轻偏瘫、共济失调各1例。6例行头颅CT检查，3例枕叶低密度影，其中2例广泛脑白质水肿；1例多发小血肿；2例未发现异常。7例MRI检查显示枕叶均受累，同时伴小脑受累3例，脑干2例，额顶叶皮质下白质2例，尾状核、丘脑各1例。在脑叶呈脑回样、在其他部位呈斑片样异常信号；T1WI呈略低或等信号，T2WI和Fair像呈高信号。2例增强扫描1例无强化，1例呈脑回样、斑片样和环状强化。4例DWI扫描，2例呈略高信号，1例呈低信号，1例未见异常。结论 头痛、视觉障碍和癫痫发作是PRES主要临床表现，影像学特征主要为大脑后部白质对称性长T1、长T2信号。

Clinical and imaging characteristics of posterior reversible encephalopathy syndrome

Objective To investigate the clinical and imaging characteristics of posterior reversible encephalopathy syndrome (PRES).Methods The clinical and imaging data of 7 patients with PRES were analyzed retrospectively.Results Among the 7 cases with PRES, 3 cases were secondary to pregnancy induced hypertension syndrome, 3 cases secondary to renal failure, 1 case secondary to hypertension.The clinical characteristics were that 7 cases presented with headache and disturbance of vision, 6 with epilepsy, 4 with nausea and vomitting, 1 with hemiparesis, 1 with ataxia.Cranial CT examination in 6 cases revealed occipital low density lesions in 3, widely white matter edema in 2, multiple small hematomas in 1, and no lesion in 2. Brain MRI showed that the occipital lobe was involved in 7 cases, cerebellar in 3, brain stem in 2, fronto-parietal subcortical white matter in 2, caudate nucleus in 1, thalamus in 1. The lesion showed gyrus-like abnominal signals in lobes and patchy abnormal signals in the other areas. The lesion showed low or iso-signal in T1WI, high signal in T2WI and Flair. 2 cases enhancement scannings showed no enhancement effect in 1 and gyrus, patchy and ring-like enhancement in another. The lesions demonstrated mild high signals in 2, low signal in 1 and no abnormalmality in 1 on DWI among 4 cases.Conclusions The headache, disturbance of vision and epilepsy are the principal clinical symptom in PRES . The imaging features of PRES are symmetrical long T1 and T2 signals on the bilateral posterior white matters of cerebrum.