Title

Spectrum and Potential Pathogenesis of Reversible Posterior Leukoencephalopathy Syndrome

Publication/Presentation Date

11-1-2012

Abstract

BACKGROUND: Controversy still exists over the etiology and pathophysiology of reversible posterior leukoencephalopathy syndrome (RPLS). This large single-center case series aims to describe the clinical and imaging features of RPLS in an attempt to deduce the etiology of the disorder and the mechanisms of brain injury.

METHODS: A retrospective chart and imaging review was conducted on 59 cases of RPLS in 55 patients.

RESULTS: Five RPLS imaging patterns were observed: posterior predominant (n = 40), anterior predominant (n = 7), diffuse lesion (n = 7), basal ganglia predominant (n = 3), and brainstem/cerebellum predominant patterns (n = 2). RPLS resulted in permanent neurologic deficits in 14 patients and death in 4 patients. Hypertension was seen in 57 (97%) cases, and mean arterial blood pressure exceeded 140 mm Hg in 30 (51%) cases. Follow-up magnetic resonance imaging scans revealed a significant worsening of vasogenic edema in 2 cases, both with persistent hypertension. Magnetic resonance imaging scans revealed areas of ischemia in 14 cases, all within or at areas closely adjacent to vasogenic edema. Diffuse vasculopathy was seen in 8 cases. There was a lack of correlation between the presence of vasculopathy and the degree of vasogenic edema (P = .62), but a correlation was suggested between ischemia and vasculopathy (P = .02).

CONCLUSIONS: This study strongly suggests that hypertension-induced vasodilation rather than vasoconstriction-mediated hypoxia is likely the major mechanism responsible for the development of vasogenic edema, and that vasoconstriction may contribute to the development of ischemia in RPLS.

Volume

21

Issue

8

First Page

873

Last Page

882

ISSN

1532-8511

Disciplines

Medical Sciences | Medical Specialties | Medicine and Health Sciences | Neurology | Neurosciences | Radiology

PubMedID

21703874

Department(s)

Department of Medicine, Department of Medicine Faculty, Department of Radiology and Diagnostic Medical Imaging, Network Office of Research and Innovation

Document Type

Article