Hypertension-induced reversible posterior leukoencephalopathy syndrome causing obstructive hydrocephalus
Hypertension-induced reversible posterior leukoencephalopathy syndrome causing obstructive hydrocephalus
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DOI：
10.1016/j.jocn.2006.12.019
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发表时间：
2008-04-01
影响因子：
2
通讯作者：
Thomas, J.
中科院分区：
文献类型：
--
作者：
Lee, S. Y.;Dinesh, S. K.;Thomas, J.
可逆性后部白质脑病综合征（RPLS）的临床特征是头痛、精神状态改变、视觉异常和癫痫发作。它与以可逆性白色异常为特征的神经放射学发现相关，主要在顶枕区。自1996年首次描述以来，它已被越来越多的医疗条件所认可，包括高血压脑病，子痫和免疫抑制治疗。临床和神经放射学异常的快速消退提示脑水肿，这被认为是脑血管自动调节受损和内皮损伤的结果。我们报告一位急性发作的病人，头痛和意识混乱的恶化与不受控制的高血压有关。CT和MRI显示继发于小脑和脑桥水肿的急性非交通性脑积水。患者变得昏昏欲睡，因此插入脑室外引流管以减压急性脑积水，并积极控制其血压。患者恢复良好，临床和影像学完全消退。这个病例说明了如果早期诊断并采取适当的治疗，RPLS是可逆的。(C)2007年由Elsevier Ltd.出版
Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, altered mental status, abnormal visual perception and seizures. It is associated with neuroradiological findings characterized by reversible white matter abnormalities, predominantly in the parietal-occipital areas. Since the first description in 1996, it has been recognized in an increasing number of medical conditions, including hypertensive encephalopathy, eclampsia, and immunosuppressive treatment. The rapid resolution of clinical and neuroradiologic abnormalities suggests cerebral oedema, which is thought to result front impaired cerebrovascular autoregulation and endothelial injury. We report a patient presenting with acute onset progressively worsening headache and confusion associated with uncontrolled hypertension. CT and MRI revealed acute non-communicating hydrocephalus secondary to cerebellar and pontine oedema. The patient became drowsy, so an external ventricular drain was inserted for decompression of the acute hydrocephalus, and his blood pressure was aggressively managed. The patient recovered well with complete clinical and radiological resolution. This case illustrates the reversibility of RPLS if it is diagnosed early and appropriate treatment is instituted. (C) 2007 Published by Elsevier Ltd.