可逆性后部脑病综合征

1、可逆性后部脑病综合征Reversible posterior encephalopathy syndromereversible posterior leukoencephalopathy syndrome reversible posterior cerebral edema syndrome Clinical Findingsneurologic abnormalities Headachedecreased alertness altered mental functionvisual lossstuporseizuresCommon location of PRESCommon loc

2、ation of PRESParietal-occipital most commonPosterior frontal TemporalThalamusCerebellumBrainstemBasal gangliaCase1： A Reversible Posterior Leukoencephalopathy Syndrome （N Engl J Med. 1996 Feb 22;334(8):494-500. ）Several risk factors of PRES hypertensive encephalopathychronic renal insufficiencyblood

3、 transfusionEclampsiaimmunosuppressive drugsintravenous immunoglobulin (IVIg) treatmentpost-transplantation stage in liver diseaseacute phases of autoimmune disorders Etiology of PRESHypertension Eclampsia and preeclampsia Drugs: - Recreational: Cocaine, Amphetamines, PCP, LSD - Others: Anti-depress

4、ants (Tricyclics, MAO Inhibitors), Bronchodilators, Erythropoietin, Midodrine, Fludrocortisone, Triple H therapy, Intravenous immunoglobulins (IVIG).Neoplastic drugs: Cyclosporine-A, Tacrolimus, Interferons, Indinavir, Cisplatin, Cytarabine, Gemcitabine. Autoimmune and Systemic: Systemic lupus eryth

5、ematosus (SLE), Scleroderma, Vasculitis like PAN, Wegeners, Thrombotic thrombocytopenic purpura (TTP), Henoch-Schnlein purpura, Hemolytic uremic syndrome (HUS), Amyloid angiopathy, Tumor lysis syndrome, Systemic inflammatory response syndrome (SIRS), Sepsis, Multiple organ Dysfunction, Electrolyte i

6、mbalance (Hypomagnesemia, hypercalcemia), Hypocholesterolemia, GBS, Head injury, Renal failure due to any etiology. Case2：Reversible posterior encephalopathy syndrome due to intravenous immunoglobulin in a child with GBS MRI examination of the brain. Axial FLAIR T2 at day 5 after completing IVIgOne

7、week after first MRIJ Pediatr Neurosci. 2011 Jul-Dec; 6(2): 138140.血管源性水肿.Vasogenic edema Case3：Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changesMRI images in PRESInt J Emerg Med. 2012; 5: 12. Case3：Posterior reversible encephalopathy syndrome (PRES) and CT perfusion chang

8、esInt J Emerg Med. 2012; 5: 12. Case 4： Posterior Reversible Encephalopathy Syndrome Mimicking a Left Middle Cerebral Artery StrokeInitial Head CT without contrast showed no evidence of acute left middle cerebral infarct or hemorrhage but showed subcortical white matter hypodensity with slight mass

9、effect in bilateral posterior frontal, parietal, occipital, and temporal lobes most consistent with vasogenic edema. Case 4： Posterior Reversible Encephalopathy Syndrome Mimicking a Left Middle Cerebral Artery StrokeOpen Neuroimag J. 2012; 6: 1012. Comparison of magnesium sulfate and mannitol in tre

10、atment of eclamptic women with posterior reversible encephalopathy syndrome AbstractOBJECTIVE: To evaluate and compare the effectiveness of magnesium sulfate (MgSO(4) and mannitol in the treatment of posterior reversible encephalopathy syndrome (PRES) in eclamptic women.STUDY DESIGN: This retrospect

11、ive analysis includes 62 eclamptic women between 22 and 40 weeks of gestation who were diagnosed with PRES in a tertiary care center. To treat neurological symptoms, 34 women received magnesium sulfate (Group 1) and the remaining 28 received 20% mannitol (Group 2) at the discretion of treating physi

12、cian.RESULTS: Ten patients from both Group 1 (29%) and Group 2 (35.7%) were normotensive at admission. 59 of 62 patients presented with seizure. All patients underwent fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). Parietooccipital region and cerebellum were the most commonly affected areas. The duration of treatment was significantly shorter in Group 1 than Group 2 (p 0.001). Neurological examinations and the recovery after treatment were significantly better in f