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Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging.

P Mukherjee1, R C McKinstry

  • 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA. mukherjeep@mir.wustl.edu

Radiology
|May 29, 2001
PubMed
Summary

Reversible posterior leukoencephalopathy syndrome (RPLS) causes increased brain water diffusion and reduced anisotropy, which are correlated and potentially reversible. These diffusion changes support a vasogenic edema mechanism in RPLS.

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Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Reversible posterior leukoencephalopathy syndrome (RPLS) is a neurological condition characterized by specific clinical and imaging findings.
  • Understanding the underlying pathophysiologic mechanisms of RPLS is crucial for diagnosis and management.

Purpose of the Study:

  • To characterize the changes in brain water diffusion associated with Reversible Posterior Leukoencephalopathy Syndrome (RPLS).
  • To investigate the relationship between diffusion changes and potential reversibility in RPLS.

Main Methods:

  • Diffusion-tensor echo-planar MR imaging was performed on 12 patients with RPLS.
  • Isotropic diffusion coefficient (D) and diffusion anisotropy (A(sigma)) were measured in affected and normal-appearing brain regions.

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Main Results:

  • Affected posterior brain regions showed a 26% increase in mean D and a 35% decrease in mean A(sigma) compared to normal-appearing anterior regions.
  • A significant inverse correlation was found between D and A(sigma) in affected posterior regions.
  • Follow-up imaging in one patient demonstrated reversal of diffusion changes and partial recovery of anisotropy after symptom resolution.

Conclusions:

  • RPLS is characterized by increased brain water diffusion (elevated D) and reduced diffusion anisotropy (decreased A(sigma)).
  • These diffusion abnormalities are correlated and may be reversible, supporting a vasogenic edema mechanism.
  • Cerebrovascular autoregulatory dysfunction is proposed as the underlying cause of RPLS.