The Study Of Clinical And MR Image In Posterior Reversible Encephalopathy Syndrome

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.