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. 2001 Jan;77(903):24–28. doi: 10.1136/pmj.77.903.24

Posterior leukoencephalopathy syndrome

R Garg 1
PMCID: PMC1741870  PMID: 11123390

Abstract

Posterior leukoencephalopathy syndrome is a newly recognised brain disorder that predominantly affects the cerebral white matter. Oedematous lesions particularly involve the posterior parietal and occipital lobes, and may spread to basal ganglia, brain stem, and cerebellum. This rapidly evolving neurological condition is clinically characterised by headache, nausea and vomiting, seizures, visual disturbances, altered sensorium, and occasionally focal neurological deficit. Posterior leukoencephalopathy syndrome is often associated with an abrupt increase in blood pressure and is usually seen in patients with eclampsia, renal disease, and hypertensive encephalopathy. It is also seen in the patients treated with cytotoxic and immunosuppressive drugs such as cyclosporin, tacrolimus, and interferon alfa. The lesions of posterior leukoencephalopathy are best visualised with magnetic resonance (MR) imaging. T2 weighted MR images, at the height of symptoms, characteristically show diffuse hyperintensity selectively involving the parieto-occipital white matter. Occasionally the lesions also involve the grey matter. Computed tomography can also be used satisfactorily to detect hypodense lesions of posterior leukoencephalopathy. Early recognition of this condition is of paramount importance because prompt control of blood pressure or withdrawal of immunosuppressive agents will cause reversal of the syndrome. Delay in the diagnosis and treatment can result in permanent damage to affected brain tissues.


Keywords: leukoencephalopathy; eclampsia; hypertensive encephalopathy; occipital lobe seizures

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Selected References

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  1. Adams H. P., Jr, Brott T. G., Crowell R. M., Furlan A. J., Gomez C. R., Grotta J., Helgason C. M., Marler J. R., Woolson R. F., Zivin J. A. Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1994 Sep;25(9):1901–1914. doi: 10.1161/01.str.25.9.1901. [DOI] [PubMed] [Google Scholar]
  2. Antunes N. L., Small T. N., George D., Boulad F., Lis E. Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol. 1999 Mar;20(3):241–243. doi: 10.1016/s0887-8994(98)00148-9. [DOI] [PubMed] [Google Scholar]
  3. Arai M., Shigeno K., Wada M. [A reversible posterior leukoencephalopathy syndrome in a patient with classical polyarteritis nodosa]. Rinsho Shinkeigaku. 1997 Jan;37(1):64–66. [PubMed] [Google Scholar]
  4. Ay H., Buonanno F. S., Schaefer P. W., Le D. A., Wang B., Gonzalez R. G., Koroshetz W. J. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology. 1998 Nov;51(5):1369–1376. doi: 10.1212/wnl.51.5.1369. [DOI] [PubMed] [Google Scholar]
  5. Bakshi R., Bates V. E., Mechtler L. L., Kinkel P. R., Kinkel W. R. Occipital lobe seizures as the major clinical manifestation of reversible posterior leukoencephalopathy syndrome: magnetic resonance imaging findings. Epilepsia. 1998 Mar;39(3):295–299. doi: 10.1111/j.1528-1157.1998.tb01376.x. [DOI] [PubMed] [Google Scholar]
  6. Bakshi R., Shaikh Z. A., Bates V. E., Kinkel P. R. Thrombotic thrombocytopenic purpura: brain CT and MRI findings in 12 patients. Neurology. 1999 Apr 12;52(6):1285–1288. doi: 10.1212/wnl.52.6.1285. [DOI] [PubMed] [Google Scholar]
  7. Cain M. S., Burton G. V., Holcombe R. F. Fatal leukoencephalopathy in a patient with non-Hodgkin's lymphoma treated with CHOP chemotherapy and high-dose steroids. Am J Med Sci. 1998 Mar;315(3):202–207. doi: 10.1097/00000441-199803000-00011. [DOI] [PubMed] [Google Scholar]
  8. Chester E. M., Agamanolis D. P., Banker B. Q., Victor M. Hypertensive encephalopathy: a clinicopathologic study of 20 cases. Neurology. 1978 Sep;28(9 Pt 1):928–939. doi: 10.1212/wnl.28.9.928. [DOI] [PubMed] [Google Scholar]
  9. Delanty N., Vaughan C., Frucht S., Stubgen P. Erythropoietin-associated hypertensive posterior leukoencephalopathy. Neurology. 1997 Sep;49(3):686–689. doi: 10.1212/wnl.49.3.686. [DOI] [PubMed] [Google Scholar]
  10. Dinsdale H. B. Hypertensive encephalopathy. Neurol Clin. 1983 Feb;1(1):3–16. [PubMed] [Google Scholar]
  11. Frank Y., Pavlakis S., Black K., Bakshi S. Reversible occipital-parietal encephalopathy syndrome in an HIV-infected child. Neurology. 1998 Sep;51(3):915–916. doi: 10.1212/wnl.51.3.915. [DOI] [PubMed] [Google Scholar]
  12. Garg M. K., Mohapatro A. K., Dugal J. S., Singh A. P. Cortical blindness in acute intermittent porphyria. J Assoc Physicians India. 1999 Jul;47(7):727–729. [PubMed] [Google Scholar]
  13. Haug C., Duell T., Lenich A., Kolb H. J., Grünert A. Elevated plasma endothelin concentrations in cyclosporine-treated patients after bone marrow transplantation. Bone Marrow Transplant. 1995 Jul;16(1):191–194. [PubMed] [Google Scholar]
  14. Hinchey J., Chaves C., Appignani B., Breen J., Pao L., Wang A., Pessin M. S., Lamy C., Mas J. L., Caplan L. R. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996 Feb 22;334(8):494–500. doi: 10.1056/NEJM199602223340803. [DOI] [PubMed] [Google Scholar]
  15. Idilman R., De Maria N., Kugelmas M., Colantoni A., Van Thiel D. H. Immunosuppressive drug-induced leukoencephalopathy in patients with liver transplant. Eur J Gastroenterol Hepatol. 1998 May;10(5):433–436. doi: 10.1097/00042737-199805000-00015. [DOI] [PubMed] [Google Scholar]
  16. Jarosz J. M., Howlett D. C., Cox T. C., Bingham J. B. Cyclosporine-related reversible posterior leukoencephalopathy: MRI. Neuroradiology. 1997 Oct;39(10):711–715. doi: 10.1007/s002340050492. [DOI] [PubMed] [Google Scholar]
  17. Lanzino G., Cloft H., Hemstreet M. K., West K., Alston S., Ishitani M. Reversible posterior leukoencephalopathy following organ transplantation. Description of two cases. Clin Neurol Neurosurg. 1997 Aug;99(3):222–226. doi: 10.1016/s0303-8467(97)00028-0. [DOI] [PubMed] [Google Scholar]
  18. Lyass O., Lossos A., Hubert A., Gips M., Peretz T. Cisplatin-induced non-convulsive encephalopathy. Anticancer Drugs. 1998 Jan;9(1):100–104. doi: 10.1097/00001813-199801000-00013. [DOI] [PubMed] [Google Scholar]
  19. Manfredi M., Beltramello A., Bongiovanni L. G., Polo A., Pistoia L., Rizzuto N. Eclamptic encephalopathy: imaging and pathogenetic considerations. Acta Neurol Scand. 1997 Nov;96(5):277–282. doi: 10.1111/j.1600-0404.1997.tb00284.x. [DOI] [PubMed] [Google Scholar]
  20. Mathy I., Gille M., Van Raemdonck F., Delbecq J., Depré A. Neurological complications of intravenous immunoglobulin (IVIg) therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature. Acta Neurol Belg. 1998 Dec;98(4):347–351. [PubMed] [Google Scholar]
  21. Pavlakis S. G., Frank Y., Kalina P., Chandra M., Lu D. Occipital-parietal encephalopathy: a new name for an old syndrome. Pediatr Neurol. 1997 Feb;16(2):145–148. doi: 10.1016/s0887-8994(96)00292-5. [DOI] [PubMed] [Google Scholar]
  22. Perloff D. Hypertension and pregnancy-related hypertension. Cardiol Clin. 1998 Feb;16(1):79–101. doi: 10.1016/s0733-8651(05)70386-6. [DOI] [PubMed] [Google Scholar]
  23. Raps E. C., Galetta S. L., Broderick M., Atlas S. W. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol. 1993 Feb;33(2):222–225. doi: 10.1002/ana.410330215. [DOI] [PubMed] [Google Scholar]
  24. Schaefer P. W., Buonanno F. S., Gonzalez R. G., Schwamm L. H. Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke. 1997 May;28(5):1082–1085. doi: 10.1161/01.str.28.5.1082. [DOI] [PubMed] [Google Scholar]
  25. Schwartz R. B. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996 Jun 27;334(26):1743–1746. doi: 10.1056/NEJM199606273342613. [DOI] [PubMed] [Google Scholar]
  26. Tajima Y., Isonishi K., Kashiwaba T., Tashiro K. Two similar cases of encephalopathy, possibly a reversible posterior leukoencephalopathy syndrome: serial findings of magnetic resonance imaging, SPECT and angiography. Intern Med. 1999 Jan;38(1):54–58. doi: 10.2169/internalmedicine.38.54. [DOI] [PubMed] [Google Scholar]
  27. Truwit C. L., Denaro C. P., Lake J. R., DeMarco T. MR imaging of reversible cyclosporin A-induced neurotoxicity. AJNR Am J Neuroradiol. 1991 Jul-Aug;12(4):651–659. [PMC free article] [PubMed] [Google Scholar]
  28. Vaughn D. J., Jarvik J. G., Hackney D., Peters S., Stadtmauer E. A. High-dose cytarabine neurotoxicity: MR findings during the acute phase. AJNR Am J Neuroradiol. 1993 Jul-Aug;14(4):1014–1016. [PMC free article] [PubMed] [Google Scholar]
  29. Weingarten K., Barbut D., Filippi C. G., Filippi C., Zimmerman R. D. Acute hypertensive encephalopathy: findings on spin-echo and gradient-echo MR imaging. AJR Am J Roentgenol. 1994 Mar;162(3):665–670. doi: 10.2214/ajr.162.3.8109519. [DOI] [PubMed] [Google Scholar]

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