【病例】可逆性后部脑病综合征PRES一例MR

30 4月

Description:

A 55-year-old man on tacrolimus, status post-liver transplant, with sudden-onset seizures and loss of consciousness

55岁男性,肝移植术后,他克莫司(免疫抑制剂)治疗中。突发癫痫、意识丧失。

【病例】可逆性后部脑病综合征PRES一例MR

【病例】可逆性后部脑病综合征PRES一例MR

Legends:

Axial FLAIR at baseline demonstrates grossly unremarkable white matter. Follow-up study following transplantation and tacrolimus treatment demonstrates confluent signal abnormality involving the centrum semiovale bilaterally.

治疗前横断位FLAIR图像示白质区未见明显异常信号。肝移植和他克莫司治疗随访的图像示双侧半卵圆区大片状异常信号。


Posterior Reversible Encephalopathy Syndrome

可逆性后部脑病综合征

  • Posterior reversible encephalopathy syndrome (PRES) can be attributed to numerous causes; common ones include hypertension and antitransplant medications, and tacrolimus is one such cause of PRES.可逆性后部脑病综合征(PRES)的病因可以很多,最常见的原因包括高血压、抗移植排斥反应药物应用,他克莫司引起PRES就属于这个原因。

Clinical Features:

Nonspecific, including seizures and change in mental status

无明显特异性,常包括癫痫、精神状态异常。

Key Diagnostic Features

  • Confluent signal abnormality involving the subcortical white matter, especially the occipital lobes斑片状异常信号相互融合,常发生于皮层下白质区,特别好发于枕叶
  •  The frontal lobes and other white matter regions of the brain can also be involved.

额叶及其他白质区也可受累。

  • Most such lesions disappear following discontinuation of the offending agent/treatment of the underlying cause.停止可能引起该病的药物或治疗后,大部分病灶会消失。
  • Rarely, progression of vasogenic edema to cause infarcts, especially involving the cortex, can be seen.很少情况下,可见血管源性水肿加重引起梗死,特别容易累及皮层。
  • Microhemorrhages微出血

DDx:

  • Superior sagittal sinus thrombosis

上矢状窦栓塞

  • Radiation-induced change

放射性脑损伤

  • Toxic and metabolic disorders

中毒和代谢异常

Rx:

Discontinuation of the offending agent; treatment of the underlying cause and observation

停止可能引起该病的药物或治疗,并随访观察

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