患儿为16岁青春期女孩,主因“间断抽搐12 h”就诊,入院前40 d有坠楼史,之后出现精神行为异常,左足切口感染.入院后出现发热,白细胞、CRP升高,查体发现患儿血压明显升高,最高达25.3/16.7kPa.入院时结合患儿足部切口化脓性感染、发热及CRP升高曾考虑脑脓肿,血压高为颅压高所导致,但入院后发现患儿血压升高不能用颅压高解释,且无其他颅内压增高的表现,因而考虑患儿血压升高并非高颅压所致,而是高血压脑病直接导致惊厥发作.头颅MRI弥散加权像显示后头部为主的枕叶、额叶、顶叶高信号,符合大脑后部可逆性脑病综合征的影像诊断,亦支持高血压脑病的临床诊断.检查发现患儿左侧肾小且为无功能肾,左肾动脉发育畸形,考虑高血压产生的原因与左肾血管先天发育异常有关.经过降血压及对症治疗,患儿临床症状明显好转,血压稳定(收缩压波动在11.3 ～15.9 kPa,舒张压波动在8.7 ～11.3 kPa),复查头颅MRI病灶明显缩小.总结:重视临床体格检查,尤其是血压等临床基础项目；重视多学科、多专业的交叉合作.%There was a 16-year-old adolescent girl complaining of intermittent convulsions in 12 hours.Forty days before her admission,she fell from a building and had mental and behavioral disorders since then;she wound her left foot and got infected.After her admission,she had a fever,hypertension (blood pressure up to 25.3/16.7 kPa),and elevation of C-reactive protein (CRP).At the beginning of admission,there was a suspect that she had brain abscess because of her fever,elevated CRP and an infectious wound in left foot,and the high blood pressure might be attributed to the intracranial hypertension.But soon,it was found that the hypertension could not be explained by intracranial hypertension because she had no other signs of high intracranial pressure.Therefore,the hypertensive encephalopathy might be resulted in convulsions.The head magnetic resonance imaging diffusion weighted imaging displayed high signal mainly in the head including occipital,frontal and parietal lobes.These images were in accordance with posterior reversible encephalopathy and supported the diagnosis of hypertensive encephalopathy.Further examination for the cause of hypertension showed that her left kidney was small and functioned poorly,and the left renal artery was malformed.After antihypertensive and symptomatic treatment,the girl's condition was significantly improved.Her blood pressure became stable (11.3-15.9 kPa / 8.7-11.3 kPa).The lesions on head magnetic resonance imaging were significantly reduced.Conclusions:More attention should be paid on basal physical examination (such as measurement of blood pressure),and multidisciplinary collaboration should be emphasized and developed.
展开▼
