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Reversible posterior leukoencephalopathy syndrome in a patient with hypertensive encephalopathy--case report
K Yoshida1, T Yamamoto, K Mori
1Department of Neurosurgery, Juntendo University, Izunagaoka Hospital, Shizuoka.
Abstract:
A 58-year-old male presented with reversible posterior leukoencephalopathy syndrome (RPLS) manifesting as headache, papilledema, and renal hypertension. T2-weighted magnetic resonance (MR) imaging showed hyperintensity lesions in the medulla, pons, bilateral thalami, and bilateral deep white matter of the parieto-occipital lobes. The pons was swollen. Diffusion-weighted MR imaging did not show increased intensity in these lesions. The lesions disappeared with improvement of clinical symptoms after treatment for hypertension. These findings suggested the lesions were vasogenic edema and the diagnosis was RPLS. T2-weighted and diffusion-weighted MR imaging are useful modalities to differentiate RPLS from other central nervous system abnormalities such as infarction, multiple sclerosis, and central pontine myelinolysis. The clinical and neuroradiological findings of RPLS can be reversed by timely initiation of treatment for the causative factor.
Insights
Reversible posterior leukoencephalopathy syndrome (RPLS) causes reversible brain lesions, often due to hypertension. Prompt treatment of hypertension can resolve these neurological symptoms and imaging findings.
Area of Science:
- Neurology
- Radiology
Background:
- Reversible posterior leukoencephalopathy syndrome (RPLS) is a neurological condition characterized by specific brain abnormalities.
- Hypertension is a common precipitating factor for RPLS.
Observation:
- A 58-year-old male presented with symptoms including headache, papilledema, and renal hypertension.
- Magnetic resonance (MR) imaging revealed hyperintense lesions in the brainstem, thalami, and parieto-occipital white matter on T2-weighted sequences.
- Diffusion-weighted imaging did not show restricted diffusion in these lesions.
Findings:
- The observed lesions were consistent with vasogenic edema.
- Complete resolution of lesions occurred following hypertension treatment and clinical improvement.
- T2-weighted and diffusion-weighted MR imaging are valuable for differentiating RPLS from other central nervous system conditions.
Implications:
- Early diagnosis and management of hypertension are crucial for reversing RPLS.
- Neuroimaging plays a key role in identifying and monitoring RPLS.
- Understanding the pathophysiology of RPLS aids in distinguishing it from mimics like infarction or demyelination.