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Published on: July 4, 2007
Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed
V L Stott1, M A Hurrell, T J Anderson
1Department of General Medicine, Christchurch Hospital, Christchurch, New Zealand.
Internal Medicine Journal
|February 12, 2005
Summary
Reversible posterior leukoencephalopathy syndrome (RPLS) involves headache, seizures, and vision loss, often due to high blood pressure. Early treatment is crucial to prevent permanent brain damage, though recovery is not always complete.
Area of Science:
- Neurology
- Radiology
- Nephrology
Background:
- Reversible posterior leukoencephalopathy syndrome (RPLS) is a neurological disorder characterized by headache, seizures, and visual disturbances.
- It is frequently associated with acute hypertension and can be triggered by certain medications, including immunosuppressants and chemotherapy agents.
Purpose of the Study:
- To present six illustrative cases of RPLS encountered at Christchurch Hospital.
- To review the clinical presentation, diagnostic findings, and outcomes of RPLS.
- To discuss the limitations of the term 'reversible posterior leukoencephalopathy'.
Main Methods:
- Case series review of six patients diagnosed with RPLS.
- Analysis of clinical data including blood pressure, medication history, and presenting symptoms.
- Review of neuroimaging findings, particularly MRI characteristics.
Main Results:
- All six patients presented with hypertension.
- Two patients were on immunosuppressants post-transplantation, and one was receiving chemotherapy.
- Only three out of the six patients achieved a full recovery, highlighting that the condition is not always reversible.
- MRI findings showed increased T2 and FLAIR signals predominantly in posterior cerebral regions.
Conclusions:
- The term RPLS is a misnomer, as the condition can be irreversible, affect non-posterior brain regions, and involve both white and grey matter.
- Prompt diagnosis and management, including antihypertensives, anticonvulsants, and offending drug removal, are essential.
- Characteristic MRI findings are key to alerting clinicians to this diagnosis.
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