化學療法引起可逆型大腦後葉白質病變症候群之病例報告

Chemotherapy-Related Reversible Posterior Leukoencephalopathy Syndrome-A Case Report

郭淑貞(Shu-Chen Kuo) ； 高玲玉(Ling-Yuh Kao)

《中華民國眼科醫學會雜誌》 45卷1期 (2006/03) Pp. 56-62

https://doi.org/10.30048/ACTASOS.200603.0010

摘要

目的：喚起醫師注意以包含認Vincristine之化學療法醫治急性白血病後，出現可逆型大腦後葉白質病變。
方法：病例報告
結果：一位11歲男孩因急性白血病而接受包含Vincristine之化學療法後，引發大腦白質病變，出現癲癇、失去意識、發燒及視力驟降等臨床症狀，核磁共振影像檢查顯現廣泛的大腦後葉白質水腫現象。停止化學治療後，病患臨床症狀迅速恢復，視力回復至20/20，然而視野殘留右側不對稱型同側偏盲，對應核磁共振影像檢查顯示殘留左側大腦枕葉白質水腫。
結論：藉由熟悉臨床症狀及影像學證據，醫師得以正確診斷可逆型大腦後葉白質病變症候群，並及時介入，改善預後。核磁共振影像是診斷時最佳工具；而視野檢查是除視力外追蹤的重點。

並列摘要

Purpose: To report a case of reversible posterior leukoencephalopathy syndrome (RPLES) secondary to chemotherapy.
Material and methods: a case report
Result: An 11-year-old boy with acute lymphoblastic leukemia developed seizures, altered consciousness and cortical blindness during the vincrisitne-containing chemotherapy. The brain MRI showed extensive white matter edema in the posterior regions of both cerebral hemispheres, which implicated posterior leukoencephalopathy. After the discontinuation of chemotherapy, the patient recovered from RPLES rapidly but incompletely. A sequela of incongruous right homonymous hemianopia was noted. The temporal relationship between chemotherapy and onset of cortical blindness suggests vincristine as the possible causative agent in our case. Another brain MRI was performed two weeks later, and it showed residual cerebral edema in left occipital region.
Conclusion: A patient with RPLES might recover his vision rapidly from chemotherapy-related cortical blindness with prompt diagnosis and discontinuation of causative agents. A series of MM is the most efficient tool for the diagnosis of RPLES, and visual field examination is superior to visual acuity test in evaluating the recovery of visual function.

並列關鍵字

reversible posterior leukoencephalopathy syndrome ； cortical blindness ； chemotherapy