Sébire G, Husson B, Lasser C, Tardieu M, Dommergues J P, Landrieu P
Service de neurologie, hôpital de Bicêtre, Le Kremlin, France.
Arch Pediatr. 1995 Jun;2(6):513-8. doi: 10.1016/0929-693x(96)81193-6.
Neuroradiological features of hypertensive encephalopathy are not yet well-known.
The clinical manifestations, neuroradiological aspects and treatment of four patients suffering from hypertensive encephalopathy were studied; special attention was paid to manifestations presented by one patient which appeared representative of the usual manifestations of hypertensive encephalopathy.
The main clinical features were visual disturbances (n = 4); altered consciousness (n = 2) and seizures (n = 3). Visual disturbances resulted from cortical lesions (n = 4) associated with optic nerve damage and retinopathy (n = 2). Cerebral imaging showed low density images (CT scan) and hypersignal (MRI, T2 sequence) located in parieto-occipital cortical ribbon and adjacent white matter from the first 24 hours following the onset of neurologic symptoms. In the studied patient, the abnormal images resolved within 1 month after the onset of the disease. Unilateral infarction of the anterior visual pathway affected two patients in whom: 1) hypertension remaining undetected for a long time was revealed by neurological signs; 2) visual impairment was preceded by an hypotensive episode induced by antihypertensive therapy.
Neuroradiological features of hypertensive encephalopathy are useful in establishing the diagnosis. A gradual reduction of blood pressure could prevent the risk of visual complications.
高血压脑病的神经放射学特征尚不为人熟知。
对4例高血压脑病患者的临床表现、神经放射学表现及治疗进行了研究；特别关注了1例患者所呈现的表现，这些表现似乎代表了高血压脑病的常见表现。
主要临床特征为视觉障碍（4例）；意识改变（2例）和癫痫发作（3例）。视觉障碍由与视神经损伤和视网膜病变相关的皮质病变引起（2例）。脑部影像学检查显示，在神经症状出现后的最初24小时内，位于顶枕叶皮质带及相邻白质的低密度影像（CT扫描）和高信号（MRI，T2序列）。在所研究的患者中，异常影像在疾病发作后1个月内消失。前视觉通路的单侧梗死影响了2例患者，在这2例患者中：1）神经系统体征揭示长期未被发现的高血压；2）视力损害之前有降压治疗诱发的低血压发作。
高血压脑病的神经放射学特征有助于确立诊断。逐渐降低血压可预防视觉并发症的风险。
