Analysis Of5Patients With Posterior Reversible Encephalopathy Syndrome

Objective:To explore the etiology, mechanism, clinical manifestations, laboratory examinations and imaging characteristics, diagnosis, therapy and prognosis of posterior reversible encephalopathy syndrome, and to improve the recognition of the disease. Methods:Retrospectively analyzing clinical manifestations, laboratory examinations and imaging data of patients diagnosed of posterior reversible encephalopathy syndrome in the second hospital of Shanxi medical university from January1,2010to March31,2012.Results:1.5patients were collected, who were all female. Their ages were form17to41years, and mean age was32.4years old.2. Etiology:3cases had preeclampsia/eclampsia.1case had chronic bronchitis with acute episode of asthma, pulmonary heart disease, right heart failure, and pulmonary infection.1case had primary hypertension.3. Clinical manifestations:All were acute onset. Blood pressure was elevated in4cases. The most common clinical manifestations included visual disturbances (5cases), headache (4cases), conscious disturbance (4cases) and seizures (3cases).4. Imaging:All patients underwent CT scanning,1case showed no abnormal findings, and4cases showed bilateral parieto-occipital hypodensity lesions, in which1case showed high density lesions in the left frontal lobe.4underwent MRI scanning, T1WI (T1-weighted imaging) showed hypointensities or isointense in these lesions areas, and T2WI(T2-weighted imaging) and FLAIR (fluid attenuated inversion recovery) showed increased signal intensity.4underwent DWI (diffusion-weighted imagin) scanning,2cases showed hypointensities, the other2cases showed hypointensities merger of increased signal intensity lesions.1underwent ADC (apparent diffusion coefficient) scanning, which showed increased signal intensity merger of hypointensities abnormal areas. Lesions were symmetry. parietal lobe and occipital lobe(5cases), frontal lobe (4cases), centrum semiovale(4cases), cortex (3cases), basal ganglia (2cases), splenium of corpus callosum(2cases), and cerebral ganglion(lcases) were involved.4underwent MRA (magnetic resonance angiography) scanning,1showed that the right posterior cerebral artery was irregularly narrow,1showed that bilateral anterior cerebral artery, middle cerebral artery and posterior cerebral artery were irregularly narrow, and the others showed that arteries were slender and the distal branches were reduced.2underwent carotid artery ultrasound, which showed bilateral internal carotid artery and external caroitid artery spasming.3underwent imaging examination again after therapy, all showed lesions area significantly reduced, but not disappeared completely.5. Laboratory examinations:4cases had LDH(plasma lactate dehydrogenase) examination, which was elevated in3cases and normal in1case.1case had spinal puncture and cerebrospinal fluid(CSF) examination, showed that the intracranial pressure was rised, but the examination of CSF was normal.6. Therapy and prognosis:after giving patients therapy of stopping seizures, actively controlling blood pressure, termination of pregnancy, treating primary diseases, and supportive treatment, symptoms quickly disappeared, and imaging changes significantly reduced. All patients had no recurrence.Conclusion:1. Most of PRES is second to serious disease, such as hypertension and eclampsia/preeclampsia, all kinds of acute or chronic kidney disease and serious infection, etc.2. Acute or subacute onset, most of the blood pressure of patients is elevated. The major Clinical symptoms include headache, visual disturbances, seizures, conscious disturbance and changes in spirit.3. Typical characteristics of imaging findings:symmetry, lesions are majorly in white matter of bilateral posterior cerebrum, vasogenic edema, lesions on CT are hypodensity, on Tl WI are hypointense or isointense, on T2WI are hyperintense, on FLAIR are hyperintense, on DWI is hypointense, on ADC are hyperintense.4. Most of PRES has high LDH levels.5. Therapy of PRES is stopping seizures, actively controlling blood pressure, termination of pregnancy, treating primary diseases, and supportive treatment.6. Early diagnosis and early treatment is very important, after positive treatment, the clinical symptoms and imaging changes are reversible, a delay in diagnosis and treatment can lead to irreversible damage.