妊娠合并可逆性后部脑病综合征临床影像特点对比分析

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目的分析孕产妇合并可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)患者的临床影像特点,并与非孕产妇合并PRES患者进行比较。方法回顾性分析2002年10月至2012年12月在北京协和医院住院的12例孕产妇PRES患者的临床、影像表现及治疗和预后,并与同期收治的25例非孕产妇PRES进行比较。结果 12例孕产妇合并PRES患者平均年龄25.8岁(18~39岁)。9例发生在晚孕期,1例中孕期,2例产后。临床特征:12例患者就诊时血压均不同程度升高,平均收缩压164 mm Hg(140~180 mm Hg)。临床表现头痛10例,抽搐9例,不同程度意识障碍5例,视觉障碍5例。影像学特征:12例患者急性期行头颅磁共振成像(MRI)和(或)计算机断层扫描(CT)均可见局部脑组织水肿信号,大部分病灶位于双侧顶枕叶皮层下白质,其中顶叶病变11例,枕叶10例,颞叶7例,额叶6例,其他如脑干、小脑、基底节、丘脑病变者4例。治疗转归:12例患者均给予不同程度的降压、硫酸镁及甘露醇降颅压等治疗,10例孕期发病患者均给予急诊剖宫产终止妊娠。所有患者最终均好转出院,未遗留神经系统症状体征,复查影像学病灶明显减少或消失。与25例非孕产妇PRES比较,孕产妇PRES患者在发病年龄、临床表现、病灶分布上差异无统计学意义,但是预后相对更好。结论孕产妇合并PRES多发生在孕晚期或产后,与子痫好发时间及临床表现类似,及时影像学检查非常必要;孕产妇合并PRES的临床影像特征与非孕产妇PRES比较差异无统计学意义,但是治疗及时预后相对更好。 Objective To analyze the clinical features of maternal combined with posterior reversible encephalopathy syndrome (PRES) and to compare with nonpregnant women with PRES. Methods The clinical presentation, treatment, and prognosis of 12 pregnant women with PRES at hospital Beijing Peking Union Medical College Hospital from October 2002 to December 2012 were retrospectively analyzed. The results were compared with those of 25 nonpregnant PRESs who were treated at the same period. Results The average age of 12 pregnant women with PRES was 25.8 years old (18-39 years old). Nine cases occurred in the second trimester, one in the second trimester and two in the postpartum period. Clinical Features: Blood pressure was elevated to varying degrees in 12 patients with an average systolic blood pressure of 164 mm Hg (140-180 mm Hg). Clinical manifestations of headache in 10 cases, 9 cases of convulsions, varying degrees of consciousness in 5 cases, 5 cases of visual impairment. Radiographic Features: Local brain edema signals were observed in all 12 patients undergoing MRI and / or computed tomography (CT) in the acute phase. Most of the lesions were located on the white matter of the bilateral top occipital cortex, with the top There were 11 cases of leaf lesions, 10 cases of occipital lobe, 7 cases of temporal lobe, 6 cases of frontal lobe, and 4 cases of other such as brain stem, cerebellum, basal ganglia and thalamic lesions. Treatment outcome: 12 patients were given different levels of antihypertensive, magnesium sulfate and mannitol intracranial pressure and other treatment, 10 cases of pregnancy were given emergency cesarean section termination of pregnancy. All patients were eventually discharged after improvement, leaving no neurological symptoms and signs, review imaging lesions significantly reduced or disappeared. Compared with 25 nonpregnant PRESs, there was no significant difference in the onset age, clinical manifestations and lesion distribution among PRES patients, but the prognosis was relatively better. Conclusions The pregnant women with PRES often occur in the third trimester of pregnancy or postnatal period, which is similar to the time of onset and clinical manifestations of preeclampsia. It is necessary to carry out timely radiological examination. There is no significant difference in the clinical features of PRES between pregnant women and non-pregnant women , But the treatment of timely prognosis is relatively better.
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