化學治療的可逆性後側白質腦病變症候群

Reversible Posterior Leukoencephalopathy Syndrome after Chemotherapy

可逆性後側白質腦病變症候群，症狀包括頭痛、噁心、嘔吐、癲癇、意識或視覺障礙等，主要因後腦頂枕區有水腫性病灶，產生原因不明，但推想與藥物及高血壓有關，診斷以磁振造影檢查最準確。容易發生在妊娠、尿毒性、紅斑性狼瘡、或器官移植後使用免疫抑制劑，或化學治療等。如能早期診斷並立即治療，症狀很快會消失，但如延誤診治，會產生嚴重後遺症甚至死亡。

Reversible posterior leukoencephalopathy syndrome(RPLS) is characterized by the presence of posterior white matter lesions predominantly bilaterally in the parieto-occipital regions on brain magnetic resonance imaging. The most common clinical syndromes are headache, vomiting, agitation, altered alertness, and behavior that ranges from drowsiness to stupor, abnormalities of visual perception, and epileptic seizures. Various causative factors gave been described and include hyperensin, preeclampsia, renal diseases, immunosuppressive drugs and chemotherapeutic drugs. The mechanism of the syndrome is probably a brain-capillary leak syndrome related to hypertension, fluid retention, and possibly the cytotoxic effects of drugs on the vascular endothelium. Quick recognition will allow immediate alteration in chemotherapy and supportive measures to reverse this condition.