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目的:探讨脑后部可逆性脑病综合征(posterior reversible encephalopathy syndrome,PRES)的临床及影像学特征,并进一步分析该病临床与影像学特征间的关联,以期阐明其发病机制。方法:连续入组2007年5月1日至2016年12月1日在重庆医科大学附属第一医院住院的23名PRES患者,对其病历资料进行回顾性分析。结果:共识别23名PRES患者(男性4例,女性19例),平均年龄(32.96±15.10)岁,分别见于高血压、子痫或先兆子痫、应用免疫抑制剂、肝硬化、肾功能不全及自身免疫性疾病患者。最常见的症状是头痛(n=18,78.2%)和痫性发作(n=16,69.6%)。在21名接受磁共振成像(magnetic resonance imaging,MRI)检查的患者中,除典型的顶枕叶受累外,额叶、基底节区、颞叶、脑干、小脑等不典型部位受累也常见,且有1/3的患者其病灶非完全对称分布。另外,痫性发作的患者颞叶更易受累;合并自身免疫性疾病的患者小脑更易受累。结论:PRES的不典型表现多见,临床工作者需全面掌握其临床和影像学特征及两者间的关联,方能对该病进行准确的诊断及治疗。
Objective: To investigate the clinical and imaging features of posterior reversible encephalopathy syndrome (PRES) and to further analyze the association between the clinical and imaging features of the disease so as to elucidate its pathogenesis. Methods: A total of 23 PRES patients admitted to the First Affiliated Hospital of Chongqing Medical University from May 1, 2007 to December 1, 2016 were retrospectively analyzed. RESULTS: A total of 23 PRES patients (4 males and 19 females) were identified, with an average age of (32.96 ± 15.10) years, respectively, as seen in hypertension, eclampsia or preeclampsia, immunosuppressive agents, cirrhosis, renal insufficiency And autoimmune diseases. The most common symptoms were headache (n = 18,78.2%) and seizures (n = 16,69.6%). In 21 patients undergoing magnetic resonance imaging (MRI), in addition to the typical top occipital involvement, frontal lobe, basal ganglia, temporal lobe, brainstem, and cerebellar atypical sites were also common, And 1/3 of the patients whose lesions are not completely symmetrical distribution. In addition, patients with epileptic seizures are more susceptible to temporal lobe involvement; patients with autoimmune diseases are more likely to suffer from cerebellar involvement. Conclusions: PRES atypical manifestations more common, clinicians need to fully grasp the clinical and imaging features and the correlation between the two, in order to accurately diagnose and treat the disease.