Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia
Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia
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DOI：
10.1016/j.ajog.2013.02.015
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发表时间：
2013-06-01
影响因子：
9.8
通讯作者：
Martin, James N., Jr.
中科院分区：
文献类型：
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作者：
Brewer, Justin;Owens, Michelle Y.;Martin, James N., Jr.
目的：探讨子痫后可逆性脑病综合征(PRES)合并子痫的发生率，并描述产科、放射学和危重病的相关性。研究设计：2001-2010年单中心回顾性队列研究，所有子痫患者接受磁共振成像(MRI)或计算机断层扫描(CT)的神经成像，有或无对比。结果：47例子痫患者中，46例(97.9%)通过一种或多种方式显示了PRES：41例(87.2%)MRI平扫；27例(57.4%)增强MRI；CT平扫16例(34%)，CT增强7例(14.8%)，和(或)磁共振血管造影/磁共振静脉造影2例(4.3%)。PRES存在于大脑的顶叶、枕叶、额叶、颞叶和基底节/脑干/小脑区。子痫发生在产前23例，产后24例。头痛是最常见的症状(87.2%)，其次是精神状态改变(51.1%)、视力障碍(34%)和恶心/呕吐(19.1%)。22例(47%)患者存在严重的收缩期高血压。结论：子痫患者常见的PRES表现提示，PRES是子痫发病机制的核心组成部分。以预防或逆转PreS发病机制为目标的治疗可能预防或促进子痫的恢复。
OBJECTIVE: We sought to investigate the concurrence of posterior reversible encephalopathy syndrome (PRES) with eclampsia and to describe the obstetric, radiological, and critical care correlates.STUDY DESIGN: This was a single-center, 2001-2010 retrospective cohort study of all patients with eclampsia who underwent neuroimaging via magnetic resonance imaging (MRI) or computerized tomography (CT) with or without contrast.RESULTS: Forty-six of 47 of eclamptic patients (97.9%) revealed PRES on neuroimaging using 1 or more modalities: MRI without contrast, 41 (87.2%); MRI with contrast, 27 (57.4%); CT without contrast, 16 (34%); CT with contrast, 7 (14.8%); and/or magnetic resonance angiography/magnetic resonance venography, 2 (4.3%). PRES was identified within the parietal, occipital, frontal, temporal, and basal ganglia/brainstem/cerebellum areas of the brain. Eclampsia occurred antepartum in 23 patients and postpartum in 24 patients. Headache was the most common presenting symptom (87.2%) followed by altered mental status (51.1%), visual disturbances (34%), and nausea/vomiting (19.1%). Severe systolic hypertension was present in 22 patients (47%).CONCLUSION: The common finding of PRES in patients with eclampsia suggests that PRES is a core component of the pathogenesis of eclampsia. Therapy targeted at prevention or reversal of PRES pathogenesis may prevent or facilitate recovery from eclampsia.