可逆性后部脑病综合征的临床与磁共振影像学研究
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摘要
目的:可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)是近年来逐渐被认识的临床-放射学综合征。此综合征以迅速进展的症状体征为特点,若诊断和治疗及时,症状及影像学异常可完全恢复正常;若延误诊断,将会导致持久的脑功能障碍,甚至死亡。
本文通过分析10例PRES患者的临床及影像学资料,旨在探讨PRES的临床和磁共振表现特点,从而指导临床与其他疾病鉴别,做到早期发现、正确识别及合理恰当的治疗,以争取其病变的“可逆性”。
方法:回顾性分析10例在河北医科大学第二医院住院治疗的PRES患者的临床及磁共振影像学资料。
结果:本组10例患者中继发于妊娠高血压综合症7例,高血压病2例,系统性红斑狼疮1例。临床表现:癫痫发作10例,头痛、头晕8例,视物模糊6例,意识障碍4例,恶心、呕吐3例,轻偏瘫1例。磁共振表现:10例患者均行常规MRI扫描,显示顶叶10例均受累,同时伴枕叶受累9例,额叶7例,颞叶5例,扣带回1例,半卵圆中心1例,海马1例,病变位于皮层及皮层下,呈多发脑回状或斑片状稍长T1、长T2、高FlAIR异常信号;7例患者行MRV扫描,6例未见明显异常,1例见左侧横窦局限性信号减弱,经治疗好转后复查脑实质病变区较前明显好转,MRV仍显示左侧横窦局限性信号减弱,故考虑为局部慢血流而非静脉窦血栓形成; 2例行DWI扫描,均呈高信号,2例ADC图均呈高信号,EADC图均呈低信号;2例行T1WI增强扫描,1例无明显强化,1例病变区脑沟内软脑膜呈线状强化;1例行SWI检查,病变呈高信号,其内尚可见小斑点状低信号,考虑为少量渗血。5例经治疗(1～2周)后复查MRI,3例病变较前明显好转,2例MRI完全恢复正常。
结论:癫痫发作、视觉障碍和头痛、头晕是PRES主要临床表现,磁共振影像学特征主要表现为大脑后部皮层及皮层下对称性长T1、长T2信号,尤以FLAIR高信号更为明显;DWI呈高信号,ADC图呈高信号,提示病变主要为血管源性水肿;SWI对观察病灶内合并出血有重要价值。治疗后临床症状和磁共振影像学改变可完全恢复正常。
Objective:Posterior reversible encephalopathy syndrome(PRES) was a clinical-radiological syndrome which was gradually recognized in recent years.The characters of this syndrome was the rapidly developing symptoms and signs.If diagnosis and treatment was performed in time,the symptoms and the radiological singularity may get right;If the diagnosis was delayed,it will lead to disturbance of brain function for long time,even to death.
This article discussed the characters of the clinical and MR image by analyzing the clinical and radiological data of 10 patients with PRES. The purpose of the study was to distinguish the PRES from the other diseases,as well as to discover in early,identify correctly,treat properly and try our best for the“reversibility”of the disease.
Methods:The clinical and MR image data of 10 patients with PRES who were treated in the second hospital of HeBei Medical University were analyzed retrospectively.
Results:Among the 10 cases with PRES,7 cases were secondary to pregnancy induced hypertension syndrome, 2 cases were secondary to hypertension,1 case was secondary to Systemic Lupus Erythematosus.The clinical characters were epilepsy in 10 cases,headache and dizziness in 8 cases, disturbance of vision in 6 cases, disturbance of consciousness in 1 case, nausea and vomiting in 3 cases and hemiparesis in 1 case.The 10 patients accepted routine MRI examination which showed that the parietal lobe was destroyed in 10 cases,occipital lobe in 9 cases,frontal lobe in 7 cases,temporal lobe in 5 cases, cingulate gyrus in 1 case, centrum ovale majus in 1 case and hippocampus in 1 case.The lesion showed gyrus-like or patchy signal: hypointense signal on T1WI, hyperintense signal on T2WI and FlAIR.7 patients accepted the MRV examination which showed no signal changes in 6 cases and left transverse portion of lateral sinus partly lower signal in 1 case which was considered as local slow blood flow becase the lesion in post-treatment was smaller than that in pre-treatment, but the MRV remained as before.2 patients accepted the DWI examination which showed hyperintense signal,while the ADC map showed hyperintense signal and the EADC map showed hypointense signal.T1WI enhancement scannings were performed in 2 cases. 1 case showed no enhancement effect and 1 case showed linear strain-hardening in cerebral pia mater in sulcus . The mainly leision showed hypointense signal and patchy hypointense signal on SWI which was considered as microbleed.5 cases accepted the MRI examination after treatment(1～2 weeks),which showed that the lesions were obviously smaller in 3 cases and no signal changes in 2 cases.
Conclusions:The epilepsy,disturbance of vision,headache and dizziness were the principal clinical symptoms in PRES. The characteristics of PRES on MRI were long T1 and long T2 signals,especially the hyperintense signal on FlAIR in the bilateral posterior while matters of cerebrum.;It showed hyperintense signal on DWI, hyperintense signal on ADC, which indicated that the lesion was mainly vasogenic edema.The SWI was helpful to observe the microbleed in the lesion.The clinical and MR imaging changes can entirely get better after proper treatment.
本文通过分析10例PRES患者的临床及影像学资料,旨在探讨PRES的临床和磁共振表现特点,从而指导临床与其他疾病鉴别,做到早期发现、正确识别及合理恰当的治疗,以争取其病变的“可逆性”。
方法:回顾性分析10例在河北医科大学第二医院住院治疗的PRES患者的临床及磁共振影像学资料。
结果:本组10例患者中继发于妊娠高血压综合症7例,高血压病2例,系统性红斑狼疮1例。临床表现:癫痫发作10例,头痛、头晕8例,视物模糊6例,意识障碍4例,恶心、呕吐3例,轻偏瘫1例。磁共振表现:10例患者均行常规MRI扫描,显示顶叶10例均受累,同时伴枕叶受累9例,额叶7例,颞叶5例,扣带回1例,半卵圆中心1例,海马1例,病变位于皮层及皮层下,呈多发脑回状或斑片状稍长T1、长T2、高FlAIR异常信号;7例患者行MRV扫描,6例未见明显异常,1例见左侧横窦局限性信号减弱,经治疗好转后复查脑实质病变区较前明显好转,MRV仍显示左侧横窦局限性信号减弱,故考虑为局部慢血流而非静脉窦血栓形成; 2例行DWI扫描,均呈高信号,2例ADC图均呈高信号,EADC图均呈低信号;2例行T1WI增强扫描,1例无明显强化,1例病变区脑沟内软脑膜呈线状强化;1例行SWI检查,病变呈高信号,其内尚可见小斑点状低信号,考虑为少量渗血。5例经治疗(1～2周)后复查MRI,3例病变较前明显好转,2例MRI完全恢复正常。
结论:癫痫发作、视觉障碍和头痛、头晕是PRES主要临床表现,磁共振影像学特征主要表现为大脑后部皮层及皮层下对称性长T1、长T2信号,尤以FLAIR高信号更为明显;DWI呈高信号,ADC图呈高信号,提示病变主要为血管源性水肿;SWI对观察病灶内合并出血有重要价值。治疗后临床症状和磁共振影像学改变可完全恢复正常。
Objective:Posterior reversible encephalopathy syndrome(PRES) was a clinical-radiological syndrome which was gradually recognized in recent years.The characters of this syndrome was the rapidly developing symptoms and signs.If diagnosis and treatment was performed in time,the symptoms and the radiological singularity may get right;If the diagnosis was delayed,it will lead to disturbance of brain function for long time,even to death.
This article discussed the characters of the clinical and MR image by analyzing the clinical and radiological data of 10 patients with PRES. The purpose of the study was to distinguish the PRES from the other diseases,as well as to discover in early,identify correctly,treat properly and try our best for the“reversibility”of the disease.
Methods:The clinical and MR image data of 10 patients with PRES who were treated in the second hospital of HeBei Medical University were analyzed retrospectively.
Results:Among the 10 cases with PRES,7 cases were secondary to pregnancy induced hypertension syndrome, 2 cases were secondary to hypertension,1 case was secondary to Systemic Lupus Erythematosus.The clinical characters were epilepsy in 10 cases,headache and dizziness in 8 cases, disturbance of vision in 6 cases, disturbance of consciousness in 1 case, nausea and vomiting in 3 cases and hemiparesis in 1 case.The 10 patients accepted routine MRI examination which showed that the parietal lobe was destroyed in 10 cases,occipital lobe in 9 cases,frontal lobe in 7 cases,temporal lobe in 5 cases, cingulate gyrus in 1 case, centrum ovale majus in 1 case and hippocampus in 1 case.The lesion showed gyrus-like or patchy signal: hypointense signal on T1WI, hyperintense signal on T2WI and FlAIR.7 patients accepted the MRV examination which showed no signal changes in 6 cases and left transverse portion of lateral sinus partly lower signal in 1 case which was considered as local slow blood flow becase the lesion in post-treatment was smaller than that in pre-treatment, but the MRV remained as before.2 patients accepted the DWI examination which showed hyperintense signal,while the ADC map showed hyperintense signal and the EADC map showed hypointense signal.T1WI enhancement scannings were performed in 2 cases. 1 case showed no enhancement effect and 1 case showed linear strain-hardening in cerebral pia mater in sulcus . The mainly leision showed hypointense signal and patchy hypointense signal on SWI which was considered as microbleed.5 cases accepted the MRI examination after treatment(1～2 weeks),which showed that the lesions were obviously smaller in 3 cases and no signal changes in 2 cases.
Conclusions:The epilepsy,disturbance of vision,headache and dizziness were the principal clinical symptoms in PRES. The characteristics of PRES on MRI were long T1 and long T2 signals,especially the hyperintense signal on FlAIR in the bilateral posterior while matters of cerebrum.;It showed hyperintense signal on DWI, hyperintense signal on ADC, which indicated that the lesion was mainly vasogenic edema.The SWI was helpful to observe the microbleed in the lesion.The clinical and MR imaging changes can entirely get better after proper treatment.
引文
1 Hinchey J,Chaves C,Appignani B,et al.A reversible posterior leukoencephalopathy syndrome [J].N Engl J Med,1996,334;494-500
2张慧,王得新,赵伟秦。可逆性后部白质脑病综合征1例报告[J]。中华神经科杂志,2005,38:600
3 Sheth RD,Riggs JE,Bodenstenier JB,et al.Parietal occipital edema in hypertensive encephalopathy;a pathogenic mechanism[J].Eur Neurol, 1996,(36):25-28
4 Ay H,Buonanno FS,Schaefer PW,et al.Posterior leukoencephalopathy without severe hypertension;Utility of diffusion weighted MRI[J]. Neurology,1998,(5):1369-1376
5 Pavlakis SG,Frank Y,Kalina P,et al.Occipital-parietal encephalopathy:a new name for an old syndrome[J].Pediatr Neurol,1997,16:145-148
6 Sean O Casey,Ricardo C Sampaio,Edyard Michel,et al.Posteeior rever- sible leukoencephalopathy syndrome:utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lensions[J].American Journal of Neuroradiology,2000,21(7):1199
7 Lamy C,Oppenheim C,Meder JF,et al.Neuroimaging in posterior rever- sible encephalopathy syndrome[J].J Neuroimaging,2004,14(2):89-96
8 Covarrubias D J,Luetmer PH,Campeau NG.Posterior reversible en- cephalopathy syndrome[J].J Neuroimaging,2004,14(2):89-96
9 Doelken M,Lanz S,Rennert J,et al.Differentiation of cytotoxic and vasogenic edema in a patient with reversible posterior leukoence- phalopathy syndrome using diffusion-weighted MRI[J].Diagn Interv Radiol,2007,13(3):125-128
10 Kinoshita T,Moritani T,Shrier DA,et al.Diffusion-weighted MR imaging of posterior reversible leukoencephalopathy syndrome[J].Clin Imaging, 2003,27:307-315
11王光彬,单瑞芹,赵斌,等。脑后部可逆性脑病综合征的CT、MRI诊断[J]。中华放射学杂志,2006,40(9):908-912
12 Sehgal V,Delproposto Z,Haacke Em,et al.Clinical application of neuroimaging with susceptibility weighted imaging.J Magn Reson Imaging,2005,22:439-450
1 Hinchey J,Chaves C,Appignani B,et al.A reversible posterior leukoen- cephalopathy syndrome [J].N Engl J Med,1996,334;494-500
2 Dillon WP, Rowley H.The reversible posterior cerebral edema syndro- me [J]. AJNR,1998,19: 591
3 Casey SO,Sampaio RC,Michel E,et al.Posteri or reversible encephalo- pathy syndrome:utility of fluid-attenuated inversion recoveryMR imaging in the detection of cortical and subcortical lesions[J]. AJNR Am J Neuroradiol, 2000,21(7):1199-1206
4 Ay H,Buonanno FS,Schaefer PW,et al.Posterior leukoencephalopathy without severe hypertension;Utility of diffusion weighted MR[I J].Neurology,1998,(5):1369-1376
5 Min L,Zwerling J,Ocava LC,et al.Reversible posterior leukoencephalo- pathy in connective tissue diseases[J].Semin Arthritis Rheum, 2006,35(6):388-395
6 Williams LR ,Darragh RK, Sokol DK, et al.Reversible posterior leukoencephalopathy syndrome associated with left ventricular assist device[J].Transplant Proc,2005,37(10): 4513-4514
7 Ozyurek H,Qguz G,Ozen S,et al.Reversible posterior leukoencephalo- pathy syndrome:report of three cases[J].Child Neurol,2005,20 (12) :990-993
8 Yano Y,Kario K,Fukunaga T,et al.A case of reversible posterior leukoencephalopathy syndrome caused by transient hypercoagulable state induced by infection[J].Hypertens Res,2005,28(7): 619-623
9 Aydin K,Elmas S,Guzes EA.Reversible posterior leukoencephalopathy and Adie’s pupil after measles vaccination [J].J Child Neurol, 2006, 21(6):525-552
10 Moawad FJ,Hartzell JD,Bieca TJ,et al.Transient blindness due to poste- rior reversible encephalopathy syndrome following ephedra overdose [J].South Med J,2006,99(5):511-514
11 Karapanayiotides T,Meuli R,Devuyst G,et al Postcarotid endarterectomy hyperperfusion or reperfusion syndrome [J]. Stroke,2005,36(1):21-26
12 Symonds EM.Hypertension in pregnancy [J].Arch Dis Child Fetal Ne- onatal Ed,1995,72(2):139-144
13 Banerjee AK. Posterior leukoencephalopathy syndrome [J].Postgraduate Medical Journal,2001,77:551
14 Port JD,Beauchamp NJ.Reversible intracerebral pathologic entities me- diated by vascular autoregulatory dysfunction[J]. Radiographics, 1998, 18:353-367
15 Cosottini M,Lazzar otti G,Ceravolo R,et al. Cyclosporine-related pos- terior reversible encephalopathy syndrome(PRES) in nontransplant patient:a case report and literature review[J]. Eur J Neurol,2003,10 (4): 461-462
16 Wong D,Dorovini-Zis K,Vincent SR.Cytokines, nitric oxide,and cGMP modulate the permeability of an in vitro model of the human blood-brain barrier[J].Exp Neurol,2004,190:446-455
17 Sanchez CR,Narbona J,de LopezMR,et al.Transient posterior encephalo- pathy induced by chemotherapy in children[J].Pediatr Neurol,2001, 24:145-148
18 Lavique CM,Shrier DA,Ketkar M,et al.Tacrolimus leukoencephalop- athy:Aneuropathologic confirmation[J].Neurology,2004,63:1132-1133
19 Covarrubias DJ,Luetmer PH,Campeau NG.Posterior reversible encepha- lopathy syndrome:prognostic utility of quantitative diffusion-weighted MR images[J].Am J Neuroradiol,2002,23:1038-1048
20 Mukherjee P,McKinstry RC.Reversible posterior leukoencephalo- pathy syndrome:evaluation with diffusion tensor MR imaging[J].Radio- logy,2001,219:756—765
21韩顺昌,张辉,郭阳,等.可逆性后部脑病CT与MRI诊断[J].中国临床医学影像杂志,2007,18(3):160-163
22 Kwon S, Koo J, Lee S.Clinical spectrum of reversible posterior leukoenc ephalopathy syndrome[J].Pediatr Neurol,2001,24(5):361-364
23 Larry C,Oppenheim C,Meder JF,et al.Neuroimaging in posterior reversi- ble encephalopathy syndrome [J].J Neuroimaging,2004,14(2): 89-96
24 Ahn KJ,You WJ,Jeong SL,et al.Atypical manifestations of reversible posterior leukoencephalopathy syndrome:findings on diffusion imaging and ADC mapping[J].Neuroradiology,2004,46(12):978-83
25 Kitaguchi H,Tomimoto H,Miki Y,et a1.A brainstem variant of reversible Posterior leukoencephalopathy syndrome[J].Neuroradiology,2005,47 (9):625-626
26 Pavlakis SG,Frank Y,Kalina P,et a1.Occipital-parietal encephalopathy:a new name for an old syndrome[J].Pediatr Neurol,1997,16(2):145—148
27 Finocehi V,Bozzao A,Bonamini M,et a1.Magnetic resonance imaging in posterior reversible encephalopathy syndrome:report of three cases and review of Literature[J].Arch Gynecol Obstet,2005,271(1):79-85
28 Finsterer J,Schlager T,Kop sa W.Wild E Nitroglycerin-aggravated pre- eclamptic posterior reversible encephalopathy syndrome[J].Neurology, 2003,61:715-716
29 Solinas C,Briellmann RS,Harvey AS,et al.Hypertensive encephalopathy antecedent to hippocampal sclerosis and temporal lobe ep ilepsy?[J]. Neurology,2003,60(9):1534-1536
30 Lawn N,Laich E,Ho S,et al.Eclampsia,hippocampal sclerosis and temporal lobe epilepsy:accident or association?[J].Neurology,2004,62(8): 1352-1356
31 Zeeman GG,Fleckenstein JL,Twickler DM,et a1.Cerebral infarction in eclampsia[J].Am J Obstet Gynecol,2004,190(3):714-720
32 Sundgren PC,Edvardsson B,Holtas S.Serial investigation of perfusion disturbances and vasogenic oedma in hypertensive encephalopathy by diffusion and perfusion weighted maging[J].Neuroradiology,2002,44 (4): 299-304
33 Yoshida K,Yamamoto T,Mori K,et al.Reversible posterior leuko- encephalopathy syndrome in a patient with hypertensive encephalopathy: case report[J]. Neurol Med Chir(Tokyo),2001,41(7):364-369
2张慧,王得新,赵伟秦。可逆性后部白质脑病综合征1例报告[J]。中华神经科杂志,2005,38:600
3 Sheth RD,Riggs JE,Bodenstenier JB,et al.Parietal occipital edema in hypertensive encephalopathy;a pathogenic mechanism[J].Eur Neurol, 1996,(36):25-28
4 Ay H,Buonanno FS,Schaefer PW,et al.Posterior leukoencephalopathy without severe hypertension;Utility of diffusion weighted MRI[J]. Neurology,1998,(5):1369-1376
5 Pavlakis SG,Frank Y,Kalina P,et al.Occipital-parietal encephalopathy:a new name for an old syndrome[J].Pediatr Neurol,1997,16:145-148
6 Sean O Casey,Ricardo C Sampaio,Edyard Michel,et al.Posteeior rever- sible leukoencephalopathy syndrome:utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lensions[J].American Journal of Neuroradiology,2000,21(7):1199
7 Lamy C,Oppenheim C,Meder JF,et al.Neuroimaging in posterior rever- sible encephalopathy syndrome[J].J Neuroimaging,2004,14(2):89-96
8 Covarrubias D J,Luetmer PH,Campeau NG.Posterior reversible en- cephalopathy syndrome[J].J Neuroimaging,2004,14(2):89-96
9 Doelken M,Lanz S,Rennert J,et al.Differentiation of cytotoxic and vasogenic edema in a patient with reversible posterior leukoence- phalopathy syndrome using diffusion-weighted MRI[J].Diagn Interv Radiol,2007,13(3):125-128
10 Kinoshita T,Moritani T,Shrier DA,et al.Diffusion-weighted MR imaging of posterior reversible leukoencephalopathy syndrome[J].Clin Imaging, 2003,27:307-315
11王光彬,单瑞芹,赵斌,等。脑后部可逆性脑病综合征的CT、MRI诊断[J]。中华放射学杂志,2006,40(9):908-912
12 Sehgal V,Delproposto Z,Haacke Em,et al.Clinical application of neuroimaging with susceptibility weighted imaging.J Magn Reson Imaging,2005,22:439-450
1 Hinchey J,Chaves C,Appignani B,et al.A reversible posterior leukoen- cephalopathy syndrome [J].N Engl J Med,1996,334;494-500
2 Dillon WP, Rowley H.The reversible posterior cerebral edema syndro- me [J]. AJNR,1998,19: 591
3 Casey SO,Sampaio RC,Michel E,et al.Posteri or reversible encephalo- pathy syndrome:utility of fluid-attenuated inversion recoveryMR imaging in the detection of cortical and subcortical lesions[J]. AJNR Am J Neuroradiol, 2000,21(7):1199-1206
4 Ay H,Buonanno FS,Schaefer PW,et al.Posterior leukoencephalopathy without severe hypertension;Utility of diffusion weighted MR[I J].Neurology,1998,(5):1369-1376
5 Min L,Zwerling J,Ocava LC,et al.Reversible posterior leukoencephalo- pathy in connective tissue diseases[J].Semin Arthritis Rheum, 2006,35(6):388-395
6 Williams LR ,Darragh RK, Sokol DK, et al.Reversible posterior leukoencephalopathy syndrome associated with left ventricular assist device[J].Transplant Proc,2005,37(10): 4513-4514
7 Ozyurek H,Qguz G,Ozen S,et al.Reversible posterior leukoencephalo- pathy syndrome:report of three cases[J].Child Neurol,2005,20 (12) :990-993
8 Yano Y,Kario K,Fukunaga T,et al.A case of reversible posterior leukoencephalopathy syndrome caused by transient hypercoagulable state induced by infection[J].Hypertens Res,2005,28(7): 619-623
9 Aydin K,Elmas S,Guzes EA.Reversible posterior leukoencephalopathy and Adie’s pupil after measles vaccination [J].J Child Neurol, 2006, 21(6):525-552
10 Moawad FJ,Hartzell JD,Bieca TJ,et al.Transient blindness due to poste- rior reversible encephalopathy syndrome following ephedra overdose [J].South Med J,2006,99(5):511-514
11 Karapanayiotides T,Meuli R,Devuyst G,et al Postcarotid endarterectomy hyperperfusion or reperfusion syndrome [J]. Stroke,2005,36(1):21-26
12 Symonds EM.Hypertension in pregnancy [J].Arch Dis Child Fetal Ne- onatal Ed,1995,72(2):139-144
13 Banerjee AK. Posterior leukoencephalopathy syndrome [J].Postgraduate Medical Journal,2001,77:551
14 Port JD,Beauchamp NJ.Reversible intracerebral pathologic entities me- diated by vascular autoregulatory dysfunction[J]. Radiographics, 1998, 18:353-367
15 Cosottini M,Lazzar otti G,Ceravolo R,et al. Cyclosporine-related pos- terior reversible encephalopathy syndrome(PRES) in nontransplant patient:a case report and literature review[J]. Eur J Neurol,2003,10 (4): 461-462
16 Wong D,Dorovini-Zis K,Vincent SR.Cytokines, nitric oxide,and cGMP modulate the permeability of an in vitro model of the human blood-brain barrier[J].Exp Neurol,2004,190:446-455
17 Sanchez CR,Narbona J,de LopezMR,et al.Transient posterior encephalo- pathy induced by chemotherapy in children[J].Pediatr Neurol,2001, 24:145-148
18 Lavique CM,Shrier DA,Ketkar M,et al.Tacrolimus leukoencephalop- athy:Aneuropathologic confirmation[J].Neurology,2004,63:1132-1133
19 Covarrubias DJ,Luetmer PH,Campeau NG.Posterior reversible encepha- lopathy syndrome:prognostic utility of quantitative diffusion-weighted MR images[J].Am J Neuroradiol,2002,23:1038-1048
20 Mukherjee P,McKinstry RC.Reversible posterior leukoencephalo- pathy syndrome:evaluation with diffusion tensor MR imaging[J].Radio- logy,2001,219:756—765
21韩顺昌,张辉,郭阳,等.可逆性后部脑病CT与MRI诊断[J].中国临床医学影像杂志,2007,18(3):160-163
22 Kwon S, Koo J, Lee S.Clinical spectrum of reversible posterior leukoenc ephalopathy syndrome[J].Pediatr Neurol,2001,24(5):361-364
23 Larry C,Oppenheim C,Meder JF,et al.Neuroimaging in posterior reversi- ble encephalopathy syndrome [J].J Neuroimaging,2004,14(2): 89-96
24 Ahn KJ,You WJ,Jeong SL,et al.Atypical manifestations of reversible posterior leukoencephalopathy syndrome:findings on diffusion imaging and ADC mapping[J].Neuroradiology,2004,46(12):978-83
25 Kitaguchi H,Tomimoto H,Miki Y,et a1.A brainstem variant of reversible Posterior leukoencephalopathy syndrome[J].Neuroradiology,2005,47 (9):625-626
26 Pavlakis SG,Frank Y,Kalina P,et a1.Occipital-parietal encephalopathy:a new name for an old syndrome[J].Pediatr Neurol,1997,16(2):145—148
27 Finocehi V,Bozzao A,Bonamini M,et a1.Magnetic resonance imaging in posterior reversible encephalopathy syndrome:report of three cases and review of Literature[J].Arch Gynecol Obstet,2005,271(1):79-85
28 Finsterer J,Schlager T,Kop sa W.Wild E Nitroglycerin-aggravated pre- eclamptic posterior reversible encephalopathy syndrome[J].Neurology, 2003,61:715-716
29 Solinas C,Briellmann RS,Harvey AS,et al.Hypertensive encephalopathy antecedent to hippocampal sclerosis and temporal lobe ep ilepsy?[J]. Neurology,2003,60(9):1534-1536
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