Reversible Posterior Leukoencephalopathy Syndrome in Preeclampsia-A Case Report

報告一發生在43歲孕婦併有子癇前症的可逆性後腦白質病變之臨床及核磁掃描表現。這位病人在她第十三次懷孕的第29週時發生頭痛及嚴重視覺喪失。檢查時發現兩眼皆只剩可辨手動的視力，然而瞳孔反應、細隙燈檢查、眼底檢查皆為正常，因此予以安排腦部核磁掃描。核磁掃描發現FLAIR影像在兩側枕葉有高強度訊號，在中央前回則有一急性血塊。同時發現病人血壓為180/120毫米汞柱、兩腳水腫、輕度尿蛋白。在緊急剖腹產後，病人血壓即恢復正常，隔天視力即恢復至20/25。可逆性後腦白質病變是子癇前症一少見的併發症，迅速診斷及治療是確保視力恢復的關鍵。在此病人，急性高血壓在椎動脈－基底動脈系統支配的枕葉造成血管性積水，卻在內頸動脈系統支配的中央前回造成出血。

關鍵字

可逆性後腦白質病變；子癇前症；椎動脈－基底動脈系統；內頸動脈系統

並列摘要

The aim of this study was to report a typical clinical course and magnetic resonance imaging (MRI) findings in a 43-year-old woman with preeclampsia and reversible posterior leukoencephalopathy syndrome (RPLS). A 43-year-old Taiwanese woman developed headache and bilateral profound visual loss in the 29th week of her 13th pregnancy. On examination, her visual acuity was hand motion/70 cm in the right eye and hand motion/90 cm in the left eye. The pupils were isocoric and promptly reactive to light. Slit lamp and ophthalmoscopic examinations revealed no abnormal findings. Emergent brain MRI was arranged. Brain FLAIR images revealed high intensity signals in bilateral occipital lobes and an acute hematoma measuring 9×8 mm in the left frontal precentral gyrus. Systemic checkup demonstrated blood pressure of 180/120 mmHg, bilateral lower extremity edema, and mild proteinuria. Her blood pressure returned to the normal range after she delivered via cesarean section. On the day following delivery, the best- corrected visual acuity returned to 20/25 in both eyes. RPLS is a rare complication of preeclampsia. Prompt diagnosis and treatment is the key to good reversibility. Acute severe hypertension resulted in vasogenic edema in the vertebrobasilar vessels but hemor rhage in the internal carotid system in this patient.

並列關鍵字

reversible posterior leukoencephalopathy ； preeclampsia ； vertebrobasilar system ； internal carotid system

國際替代計量

Reversible Posterior Leukoencephalopathy Syndrome in Preeclampsia-A Case Report

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