可逆性后部脑病综合征

Common location of PRES
Parietal-occipital
most common Posterior frontal Temporal Thalamus Cerebellum Brainstem Basal ganglia
Case1： A Reversible Posterior Leukoencephalopathy Syndrome （N
J Pediatr Neurosci. 2011 Jul-Dec; 6(2): 138–140.
血管源性水肿.Vasogenic edema
Case3：Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes
Case 4： Posterior Reversible Encephalopathy Syndrome Mimicking a Left Middle Cerebral Artery Stroke
Open Neuroimag J. 2012; 6: 10–12.
Comparison of magnesium sulfate and mannitol in treatment of eclamptic women with posterior reversible encephalopathy syndrome
intravenous immunoglobulin (IVIg) treatment
post-transplantation stage in liver disease acute phases of autoimmugy of PRES
Hypertension
可逆性后部脑病综合征
Reversible posterior encephalopathy syndrome
reversible posterior leukoencephalopathy syndrome reversible posterior cerebral edema syndrome
Eclampsia and preeclampsia
Drugs: - Recreational: Cocaine, Amphetamines, PCP, LSD - Others: Anti-depressants (Tricyclics, MAO Inhibitors), Bronchodilators, Erythropoietin, Midodrine, Fludrocortisone, Triple H therapy, Intravenous immunoglobulins (IVIG). Neoplastic drugs: Cyclosporine-A, Tacrolimus, Interferons, Indinavir, Cisplatin, Cytarabine, Gemcitabine. Autoimmune and Systemic: Systemic lupus erythematosus (SLE), Scleroderma, Vasculitis like PAN, Wegener's, Thrombotic thrombocytopenic purpura (TTP), HenochSchönlein purpura, Hemolytic uremic syndrome (HUS), Amyloid angiopathy, Tumor lysis syndrome, Systemic inflammatory response syndrome (SIRS), Sepsis, Multiple organ Dysfunction, Electrolyte imbalance (Hypomagnesemia, hypercalcemia), Hypocholesterolemia,, GBS, Head injury, Renal failure due to any etiology.
Engl J Med. 1996 Feb 22;334(8):494-500. ）
Several risk factors of PRES
hypertensive encephalopathy
chronic renal insufficiency blood transfusion Eclampsia immunosuppressive drugs
Case2：Reversible posterior encephalopathy syndrome due to
intravenous immunoglobulin in a child with GBS
MRI examination of the brain. Axial FLAIR T2 at day 5 after completing IVIg One week after first MRI
Clinical Findings neurologic abnormalities
Headache
decreased alertness altered mental function
visual loss
stupor seizures
Common location of PRES
Case 4： Posterior Reversible Encephalopathy Syndrome Mimicking a Left Middle Cerebral Artery Stroke

Initial Head CT without contrast showed no evidence of acute left middle cerebral infarct or hemorrhage but showed subcortical white matter hypodensity with slight mass effect in bilateral posterior frontal, parietal, occipital, and temporal lobes most consistent with vasogenic edema.


Abstract OBJECTIVE: To evaluate and compare the effectiveness of magnesium sulfate (MgSO(4)) and mannitol in the treatment of posterior reversible encephalopathy syndrome (PRES) in eclamptic women. STUDY DESIGN: This retrospective analysis includes 62 eclamptic women between 22 and 40 weeks of gestation who were diagnosed with PRES in a tertiary care center. To treat neurological symptoms, 34 women received magnesium sulfate (Group 1) and the remaining 28 received 20% mannitol (Group 2) at the discretion of treating physician. RESULTS: Ten patients from both Group 1 (29%) and Group 2 (35.7%) were normotensive at admission. 59 of 62 patients presented with seizure. All patients underwent fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). Parietooccipital region and cerebellum were the most commonly affected areas. The duration of treatment was significantly shorter in Group 1 than Group 2 (p < 0.001). Neurological examinations and the recovery after treatment were significantly better in favor of MgSO(4) group (p = 0.039). CONCLUSION:
Mannitol is not superior to magnesium sulfate in achieving neurological recovery. Magnesium sulfate seems to be the agent of choice for treatment of PRES.
MRI images in PRES
Int J Emerg Med. 2012; 5: 12.
Case3：Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes
Int J Emerg Med. 2012; 5: 12.