Yonekura Satoru, Anno Takayuki, Kobayashi Nobuyuki
Department of Neurosurgery, Tochigi Medical Center Shimotsuga.
Neurol Med Chir (Tokyo). 2018 Oct 15;58(10):453-458. doi: 10.2176/nmc.cr.2018-0049. Epub 2018 Aug 3.
We report a case of head injury with posterior reversible encephalopathy syndrome (PRES), followed by Guillain-Barré syndrome (GBS). A 74-year-old man was brought to our hospital after a fall. Computed tomography revealed intracranial hemorrhage. Magnetic resonance imaging showed bilateral reversible intensities with features of vasogenic edema in parietooccipital areas, suggesting PRES. After admission, weakness and areflexia of extremities and respiratory muscles developed gradually, which favored a diagnosis of GBS. Common etiologies of PRES were absent. Concurrent occurrence of PRES and GBS is rare. Given that PRES can be an initial manifestation of GBS, GBS must be considered in head trauma patients with PRES.
我们报告一例头部损伤后出现可逆性后部脑病综合征(PRES),随后并发吉兰-巴雷综合征(GBS)的病例。一名74岁男性在跌倒后被送至我院。计算机断层扫描显示颅内出血。磁共振成像显示双侧顶枕叶区域出现具有血管源性水肿特征的可逆性强化,提示为PRES。入院后,四肢及呼吸肌逐渐出现无力和腱反射消失,这支持GBS的诊断。PRES的常见病因并不存在。PRES和GBS同时发生的情况较为罕见。鉴于PRES可能是GBS的初始表现,对于患有PRES的头部外伤患者必须考虑GBS的可能性。