發(fā)布時(shí)間：2019-03-24 13:19

【摘要】：可逆性后部白質(zhì)腦病綜合癥(reversible posterior leukoencephalopathy syndrome, RPLS)是一種由多種病因引起的以神經(jīng)系統(tǒng)受損為主要表現(xiàn)的相對(duì)良性的神經(jīng)影像學(xué)綜合癥。主要臨床特點(diǎn)為頭痛、嘔吐、癇性發(fā)作、視覺(jué)障礙、意識(shí)障礙、精神異常、智能障礙�？赡嫘詮V泛性雙側(cè)大腦半球后部(以頂枕葉為主)白質(zhì)水腫是主要的影像學(xué)改變。及時(shí)發(fā)現(xiàn)并治療,一般無(wú)神經(jīng)系統(tǒng)后遺癥。國(guó)內(nèi)關(guān)于兒童RPLS的報(bào)道不多,為提高對(duì)該病的認(rèn)識(shí),本文對(duì)3例分別因過(guò)敏性紫癜、系統(tǒng)性紅斑狼瘡、異基因造血干細(xì)胞移植引發(fā)的RPLS患兒的臨床表現(xiàn)、影像特征及治療結(jié)果進(jìn)行分析討論。 方法對(duì)鄭州大學(xué)第一附屬醫(yī)院2009年至2011年收治的3例RPLS患兒的臨床表現(xiàn),影像學(xué)資料及治療結(jié)果進(jìn)行回顧性分析,復(fù)習(xí)相關(guān)文獻(xiàn)資料。 結(jié)果3例患兒均在原發(fā)疾病的治療過(guò)程中出現(xiàn)不同程度的頭痛、嘔吐、癇性發(fā)作、意識(shí)障礙、視覺(jué)障礙等臨床癥狀,影像學(xué)資料顯示對(duì)稱性局部大腦后部白質(zhì)水腫。病例1的頭顱CT示低密度灶,病例2的頭顱MRI的T2加權(quán)像呈長(zhǎng)信號(hào),病例3的頭顱MRI的T2加權(quán)像呈長(zhǎng)信號(hào),FLAIR序列呈稍高信號(hào),DWI序列未見(jiàn)明顯受限。3例患兒經(jīng)停用可疑藥物、降血壓、降顱壓對(duì)癥治療,短期內(nèi)臨床癥狀消失,復(fù)查頭顱CT/MRI未見(jiàn)異常,符合RPLS的診斷。 結(jié)論RPLS是由多種原因引起神經(jīng)影像學(xué)綜合癥,其臨床表現(xiàn)以神經(jīng)系統(tǒng)癥狀為主,影像學(xué)檢查是診斷本病的主要依據(jù),且MRI是確診本病最有價(jià)值的方法。雖然積極停用可疑藥物、降血壓、降顱壓對(duì)癥治療,臨床癥狀及影像學(xué)改變可短期內(nèi)恢復(fù)正常,但是仍需跟蹤隨訪。
[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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R742.89

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相關(guān)期刊論文 前7條

1 胡潔;趙紅軍;徐勛華;周義成;;可逆性后部腦病綜合征的影像學(xué)表現(xiàn)及診斷[J];臨床放射學(xué)雜志;2009年01期

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