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Posterior encephalopathy with vasospasm: MRI and angiography
1Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany. Weidauer@em.uni-frankfurt.de
Neuroradiology
|October 24, 2003
Summary
Posterior encephalopathy, a condition causing neurological symptoms, may result from severe vasospasm, particularly in the brain's posterior regions. This study highlights cerebral vasospasm as a potential cause, offering new insights into posterior encephalopathy.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Posterior encephalopathy presents with headache, altered consciousness, seizures, and vision loss.
- MRI typically reveals bilateral, posterior cortical and subcortical lesions.
- The underlying pathophysiology of posterior encephalopathy remains incompletely understood.
Observation:
- Three patients with posterior encephalopathy underwent serial MRI (including DWI and ADC mapping) and four-vessel digital subtraction angiography (DSA).
- DWI showed high signal in parieto-occipital grey and white matter.
- ADC values indicated both vasogenic and cytotoxic edema, with subsequent focal cortical laminar necrosis and white matter changes.
Findings:
- DSA demonstrated diffuse arterial narrowing, more pronounced in the posterior circulation.
- The MRI lesion pattern and angiographic findings suggest diffuse, severe vasospasm as a potential cause.
- This vasospasm appears to disproportionately affect the parieto-occipital grey matter due to its ischemic vulnerability.
Implications:
- Posterior encephalopathy may be caused by severe cerebral vasospasm, particularly affecting the posterior brain regions.
- This finding offers a new perspective on the pathophysiology of posterior encephalopathy.
- The study identifies a potential link between digitoxin intoxication, cerebral vasospasm, and posterior encephalopathy, a previously undescribed association.