Posterior Reversible Encephalopathy Syndrome Combined with Uremia Encephalopathy

Sang Mi Noh; Sung Chul Lim; Hyun Goo Kang

doi:10.17340/jkna.2018.4.37

J Korean Neurol Assoc > Volume 36(4); 2018 > Article

요독증에 동반된 가역적후뇌병증

신경영상

J Korean Neurol Assoc 2018; 36(4): 415-416.

Published online: November 1, 2018

DOI: https://doi.org/10.17340/jkna.2018.4.37

요독증에 동반된 가역적후뇌병증

노상미, 임성철, 강현구^a

가톨릭대학교 성빈센트병원 신경과

^a전북대학교 의과대학 신경과학교실

Posterior Reversible Encephalopathy Syndrome Combined with Uremia Encephalopathy

Sang Mi Noh, MD, Sung Chul Lim, MD, Hyun Goo Kang, MD^a

Department of Neurology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea

^aDepartment of Neurology, Chonbuk National University Medical School, Jeonju, Korea

Address for correspondence: Hyun Goo Kang, MD Department of Neurology, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea Tel: +82-63-250-1590 Fax: +82-63-251-9363 E-mail: naroo12@naver.com

Received May 29, 2018 Revised July 3, 2018 Accepted July 3, 2018

당뇨병, 고혈압, 만성콩팥병을 앓고 있는 51세 여자가 의식변화로 내원하였다. 당시 혈압은 220/100 mmHg로 높았으며 혈중요소질소 78.9 mg/dL, 크레아티닌 9.1 mg/dL로 요독증 소견이 관찰되었다. 뇌 자기공명영상의 액체감쇠역전회복영상과 T2 강조영상에서 양측 기저핵에 고신호강도가 보였으며, 양측 전두엽과 두정엽에 대칭적으로 고신호강도 병변이 관찰되었다(Fig.). 투석과 혈압조절 후 의식은 호전되었고, 한 달 후 시행한 추적영상에서는 전두엽과 두정엽의 병변은 소실되었고 기저핵 주변의 부종도 호전양상을 보였다. 한달 후 다시 의식변화로 내원하였고 전두엽과 두정엽 병변이 악화되었다. 기저핵에 전형적인 변화가 동반된 요독성 뇌병증과 가역적후뇌병증이[1] 호전과 악화를 반복한 드문 증례로 이를 보고하는 바이다.

REFERENCES

1. Shim EJ, Kim HA, Yi HA, Sohn SI, Lim JG, Yi SD, et al. A case of diabetic uremic encephalopathy with symmetric MR signal changes in the basal ganglia. J Korean Neurol Assoc 2006;24:511-513.

Figure.

Fluid attenuated invention recovery images (FLAIR) and T2 weighted images of brain magnetic resonance image (MRI) show bilateral high signal intensity at both lentiform nuclei, frontal lobe and parietal lobe (A). One month follow up MRI reveal decreased edema on both lentiform nuclei and loss of high signal intensities on both frontal and parietal lobe (B). On readmission, follow up MRI shows newly develop high signal intensity lesions in cortical regions of both frontal and parietal lobe cortices (C).

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