儿童可逆性后部白质脑病综合征三例分析及文献复习
发布时间：2019-03-24 13:19
【摘要】：可逆性后部白质脑病综合症(reversible posterior leukoencephalopathy syndrome, RPLS)是一种由多种病因引起的以神经系统受损为主要表现的相对良性的神经影像学综合症。主要临床特点为头痛、呕吐、痫性发作、视觉障碍、意识障碍、精神异常、智能障碍。可逆性广泛性双侧大脑半球后部(以顶枕叶为主)白质水肿是主要的影像学改变。及时发现并治疗,一般无神经系统后遗症。国内关于儿童RPLS的报道不多,为提高对该病的认识,本文对3例分别因过敏性紫癜、系统性红斑狼疮、异基因造血干细胞移植引发的RPLS患儿的临床表现、影像特征及治疗结果进行分析讨论。 方法对郑州大学第一附属医院2009年至2011年收治的3例RPLS患儿的临床表现,影像学资料及治疗结果进行回顾性分析,复习相关文献资料。 结果3例患儿均在原发疾病的治疗过程中出现不同程度的头痛、呕吐、痫性发作、意识障碍、视觉障碍等临床症状,影像学资料显示对称性局部大脑后部白质水肿。病例1的头颅CT示低密度灶,病例2的头颅MRI的T2加权像呈长信号,病例3的头颅MRI的T2加权像呈长信号,FLAIR序列呈稍高信号,DWI序列未见明显受限。3例患儿经停用可疑药物、降血压、降颅压对症治疗,短期内临床症状消失,复查头颅CT/MRI未见异常,符合RPLS的诊断。 结论RPLS是由多种原因引起神经影像学综合症,其临床表现以神经系统症状为主,影像学检查是诊断本病的主要依据,且MRI是确诊本病最有价值的方法。虽然积极停用可疑药物、降血压、降颅压对症治疗,临床症状及影像学改变可短期内恢复正常,但是仍需跟踪随访。
[Abstract]:Reversible posterior leukoencephalopathy syndrome (reversible posterior leukoencephalopathy syndrome, RPLS) is a relatively benign neuroimaging syndrome characterized by neurological damage caused by multiple causes. The main clinical features are headache, vomiting, seizures, visual disorders, consciousness disorders, mental disorders. Reversible extensive white matter edema in the posterior hemisphere (mainly parietal and occipital lobe) is a major imaging change. Timely detection and treatment, generally no neurological sequelae. There are few reports about RPLS in children. In order to improve the understanding of the disease, the clinical manifestations of 3 cases of RPLS caused by Henoch-Schonlein purpura, systemic lupus erythematosus and allogeneic hematopoietic stem cell transplantation were studied in this paper. The imaging features and treatment results were analyzed and discussed. Methods the clinical manifestations, imaging data and treatment results of 3 children with RPLS admitted to the first affiliated Hospital of Zhengzhou University from 2009 to 2011 were retrospectively analyzed and the related literature materials were reviewed. Results the clinical symptoms of headache, vomiting, seizure, disturbance of consciousness, visual disturbance and so on appeared in all 3 cases during the treatment of primary diseases. Imaging data showed symmetrical local white matter edema in the posterior part of the brain. [WT5 "HZ] [WT5" BZ] [WT5 "BZ] The CT of case 1 showed low-density foci, the T2-weighted images of MRI in case 2 showed long signal intensity, the T2-weighted images of MRI in case 3 showed long signal intensity, and the FLAIR sequence showed slightly higher signal intensity. No obvious limitation was found in DWI sequence. 3 children were treated with suspected drugs, hypotension and cranial pressure, and the clinical symptoms disappeared in a short time. No abnormality was found in the brain CT/MRI, which was in accordance with the diagnosis of RPLS. Conclusion RPLS is a neuroimaging syndrome caused by a variety of causes, and its clinical manifestations are mainly nervous system symptoms. Imaging examination is the main basis for the diagnosis of the disease, and MRI is the most valuable method for the diagnosis of the disease. Although active withdrawal of suspicious drugs, lowering blood pressure, lowering cranial pressure, clinical symptoms and imaging changes can be restored to normal in a short time, but still need to follow-up.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.89
[Abstract]:Reversible posterior leukoencephalopathy syndrome (reversible posterior leukoencephalopathy syndrome, RPLS) is a relatively benign neuroimaging syndrome characterized by neurological damage caused by multiple causes. The main clinical features are headache, vomiting, seizures, visual disorders, consciousness disorders, mental disorders. Reversible extensive white matter edema in the posterior hemisphere (mainly parietal and occipital lobe) is a major imaging change. Timely detection and treatment, generally no neurological sequelae. There are few reports about RPLS in children. In order to improve the understanding of the disease, the clinical manifestations of 3 cases of RPLS caused by Henoch-Schonlein purpura, systemic lupus erythematosus and allogeneic hematopoietic stem cell transplantation were studied in this paper. The imaging features and treatment results were analyzed and discussed. Methods the clinical manifestations, imaging data and treatment results of 3 children with RPLS admitted to the first affiliated Hospital of Zhengzhou University from 2009 to 2011 were retrospectively analyzed and the related literature materials were reviewed. Results the clinical symptoms of headache, vomiting, seizure, disturbance of consciousness, visual disturbance and so on appeared in all 3 cases during the treatment of primary diseases. Imaging data showed symmetrical local white matter edema in the posterior part of the brain. [WT5 "HZ] [WT5" BZ] [WT5 "BZ] The CT of case 1 showed low-density foci, the T2-weighted images of MRI in case 2 showed long signal intensity, the T2-weighted images of MRI in case 3 showed long signal intensity, and the FLAIR sequence showed slightly higher signal intensity. No obvious limitation was found in DWI sequence. 3 children were treated with suspected drugs, hypotension and cranial pressure, and the clinical symptoms disappeared in a short time. No abnormality was found in the brain CT/MRI, which was in accordance with the diagnosis of RPLS. Conclusion RPLS is a neuroimaging syndrome caused by a variety of causes, and its clinical manifestations are mainly nervous system symptoms. Imaging examination is the main basis for the diagnosis of the disease, and MRI is the most valuable method for the diagnosis of the disease. Although active withdrawal of suspicious drugs, lowering blood pressure, lowering cranial pressure, clinical symptoms and imaging changes can be restored to normal in a short time, but still need to follow-up.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.89
【参考文献】
相关期刊论文 前7条
1 胡洁;赵红军;徐勋华;周义成;;可逆性后部脑病综合征的影像学表现及诊断[J];临床放射学杂志;2009年01期
2 卢红艳;谢炳s，
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