Spectrum and Potential Pathogenesis of Reversible Posterior Leukoencephalopathy Syndrome
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.
Published In/Presented At
Li, Y., Gor, D., Walicki, D., Jenny, D., Jones, D., Barbour, P., & Castaldo, J. (2012). Spectrum and potential pathogenesis of reversible posterior leukoencephalopathy syndrome. Journal Of Stroke And Cerebrovascular Diseases: The Official Journal Of National Stroke Association, 21(8), 873-882. doi:10.1016/j.jstrokecerebrovasdis.2011.05.010
Medical Sciences | Medical Specialties | Medicine and Health Sciences | Neurology | Neurosciences | Radiology
Department of Medicine, Department of Medicine Faculty, Department of Radiology and Diagnostic Medical Imaging, Network Office of Research and Innovation