雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Brain and Nerve No to Shinkei Volume 56, Issue 12 （December 2004）

Brain and Nerve 脳と神経 56巻12号（2004年12月発行）

Japanese English

症例報告

Reversible posterior leukoencepalopathy syndrome―3症例の臨床経験 Reversible Posterior Leukoencephalopathy Syndrome : Experience in 3 Cases 嶋田淳一 ¹ , 武田信昭 ¹ , 山内茂人 ² , 漆原俊夫 ² , 川口洋 ³ Junichi Shimada ¹ , Nobuaki Takeda ¹ , Shigeto Yamauchi ² , Toshio Urushibara ² , Hiroshi Kawaguchi ³ ¹太田総合病院脳神経外科 ²太田総合病院産婦人科 ³太田総合病院放射線科 ¹Department of Neurosurgery, Ohta General Hospital ²Department of Gynecology, Ohta General Hospital ³Department of Radiology, Ohta General Hospital キーワード： reversible posterior leukoencephalopathy syndrome , eclampsia , hypertensive encephalopathy , MR angiography Keyword: reversible posterior leukoencephalopathy syndrome , eclampsia , hypertensive encephalopathy , MR angiography pp.1036-1041

発行日 2004年12月1日 Published Date 2004/12/1

DOI https://doi.org/10.11477/mf.1406100372

PDF(448KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　要旨　子癇および高血圧性脳症に伴って生じたreversible posterior leukoencephalopathy syndrome（RPLS）3症例を報告した。いずれも周産期の27歳から39歳の症例であった。高血圧性脳症の症例は，その本態はvasogenic edemaであると考えられた。すなわちMRIのT2 WIやFLAIR画像にて脳浮腫所見を捉えたものの拡散画像での所見に乏しく，またMR angiography（MRA）では正常所見であった。一方，子癇症例は拡散画像にても異常所見が認められ，vasogenic edemaとcytotoxic edemaとの併存が示唆される一方，MRAにて血管攣縮所見を認めた。しかし，その所見と臨床症状の程度とは相関せず，他の因子の関与が推定された。二次的な障害を防ぐためにも早期診断が必要であり，現時点では拡散画像を含めたMRIおよびMRAが必須である。

　We report 3 cases with reversible posterior leukoencephalopathy syndrome（RPLS） accompanied by eclampsia or hypertensive encephalopathy. RPLS may develop in patients who have eclampsia or hypertensive encephalopathy or who are immunosuppressed. The findings on neuroimaging are characteristic of subcortical edema without infarction.

　A 27-year-old primigravida developed eclampsia at 37 weeks of gestation. MRI was performed 4 hours after the onset. The FLAIR sequence delineated extensive hyperintense lesions in the temporal and occipital lobe bilaterally. MR angiography（MRA） performed 6 days after the onset of symptoms clearly demonstrated intracranial vasospasm. Follow up MRI and MRA were performed 3 weeks after the onset. The MRI showed slight residual hyperintensity in the occipital lobe. The MRA showed the disappearance of the vasospasm.

　A 39-year-old woman on the 8th postpartum day presented with thunderclap headache, which led to a search for SAH. She visited our hospital, whose high arterial blood pressure（220/110mmHg） was observed. Both CT and MRA were normal. MRI revealed abnormalities in the parieto-occipital regions bilaterally. Treatment of hypertension led to resolution of the posterior leukoencephalopathy.

　A 38-year-old woman on the 11th postpartum day suddenly developed vertigo, visual disturbance and generalized convulsion. MRI was performed 7 days after the onset. The FLAIR sequence delineated extensive hyperintense lesions in the occipital lobe bilaterally. MRA clearly demonstrated diffuse intracranial vasospasm. MRA performed 3 weeks after the onset showed the disappearance of the vasospasm.

　In conclusion, our experience suggests that the MRI and MRA noninvasively provide valuable findings which are complementary in the diagnosis and follow-up examination of a brain edema and vasospasm in RPLS.

（Received : October 6, 2004）