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Asymmetric reversible posterior leukoencephalopathy syndrome
Heidi M Schambra1, David M Greer
1Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Neurocritical Care
|June 8, 2006
Summary
Reversible posterior leukoencephalopathy syndrome (RPLS) typically affects the parietal and occipital lobes symmetrically. This case highlights an unusual asymmetric RPLS presentation in the frontal lobe, associated with severe hypertension and carotid artery stenosis.
Area of Science:
- Neurology
- Radiology
- Vascular Neurology
Background:
- Reversible posterior leukoencephalopathy syndrome (RPLS) is a neurological condition often associated with hypertension.
- Radiographic findings typically include symmetric white matter hyperintensities in the parietal and occipital lobes on MRI, indicative of cerebral edema.
- Standard presentations of RPLS involve bilateral involvement.
Observation:
- This report details an atypical case of RPLS in a patient with severe hypertension and chronic internal carotid artery stenosis.
- The magnetic resonance imaging (MRI) findings revealed asymmetric white matter hyperintensities predominantly affecting a single frontal lobe.
- This presentation was associated with ipsilateral vasogenic edema.
Findings:
- The case demonstrates an unusual asymmetric manifestation of RPLS, deviating from the typical symmetric posterior involvement.
- Severe hypertension and internal carotid artery stenosis were identified as potential contributing factors in this unique presentation.
- The presence of ipsilateral vasogenic edema further characterized the localized cerebral edema.
Implications:
- This case expands the understanding of RPLS radiographic variability and clinical presentations.
- It underscores the importance of considering RPLS in patients with severe hypertension and carotid artery disease, even with atypical imaging findings.
- Further research may elucidate the mechanisms behind asymmetric RPLS and its specific risk factors.
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