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。
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