需行去骨瓣减压术的产后后部可逆性脑病综合征：病例报告及文献综述

摘要(中文译文)

可逆性后部脑病综合征（posterior reversible encephalopathy syndrome，PRES）是一种不常见但若未能识别并适当治疗则可能造成严重损害的综合征。顾名思义，对该病的识别和恰当处理可使临床和影像学表现逆转。然而，诊断并非总是显而易见。我们报告一例24岁女性，产后4天，表现为头痛、颈部疼痛和新发癫痫发作。她在分娩时接受了硬膜外麻醉，初始影像学提示颅内低压或硬脑膜炎。尽管初始采取了保守治疗，包括抗癫痫药物、镁剂治疗、经验性抗生素和头低足高位，患者病情仍持续恶化。随访影像学提示PRES并伴有颅内高压征象。患者因难治性且严重的PRES接受了枕下减压颅骨切除术，随后完全康复。本病例凸显了PRES有时难以诊断、可能与妊娠、子痫/子痫前期和/或脑脊液引流相关，以及在严重病例中罕见但可挽救生命的减压需求。

Abstract

Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis. Despite initial conservative therapy including anti-epileptic drugs, magnesium therapy, empiric antibiotics, and Trendelenburg positioning, the patient continued to deteriorate. Follow-up imaging was suggestive of PRES with signs of intracranial hypertension. The patient underwent a decompressive suboccipital craniectomy for refractory and severe PRES and later fully recovered. This case highlights the sometimes difficult diagnosis of PRES, possible association with pregnancy, eclampsia/preeclampsia and/or cerebrospinal fluid drainage, and the rare but life-saving need for decompression in severe cases.

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