J Korean Radiol Soc.  2001 Oct;45(4):339-346. 10.3348/jkrs.2001.45.4.339.

Reversible Posterior Leukoencephalopathy Syndrome

• Lee EJ
• Song CJ
• Yu WJ
• Ahn KJ
• Jung SL
• Lee YS
• Kim JC
• Song SY
• Koo JH
• Kim MD
• Kang SW

• KMID: 1832926
• DOI: http://doi.org/10.3348/jkrs.2001.45.4.339

Abstract

PURPOSE
To review reversible posterior leukoencephalopathy syndrome.
MATERIALS AND METHODS
We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI.
RESULTS
Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement; in one, enhancement was mild, and in two, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions; in two, small infarctions remained but the extent of the lesions had decreased.
CONCLUSION
Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immonosuppresive therapy. The characteristic MR finding is edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the need for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis.

Keyword

Brain, MR; Brain, diseases; Brain, edema

MeSH Terms

Basal Ganglia
Brain
Cerebellum
Cyclosporine
Eclampsia
Edema
Female
Follow-Up Studies
Frontal Lobe
Gadolinium DTPA
Headache
Hematoma
Humans
Hypertension
Infarction
Magnetic Resonance Imaging
Migraine with Aura
Neurologic Manifestations
Occipital Lobe
Pons
Posterior Leukoencephalopathy Syndrome*
Pre-Eclampsia
Pregnancy
Prognosis
Rabeprazole
Renal Insufficiency
Seizures
Temporal Lobe
Thalamus
Cyclosporine
Gadolinium DTPA