Clinical spectrum of reversible posterior leukoencephalopathy syndrome.
Reversible posterior leukoencephalopathy syndrome is a recently recognized disorder with characteristic radiologic findings that mainly involve the white/gray matter of the parieto-occipital lobes. This complex syndrome is associated with cyclosporine A therapy or a variety of other conditions in which blood pressure rises acutely. Twelve patients from a variety of conditions who met the diagnostic criteria for this syndrome were studied. Interestingly, three of these patients had intra-abdominal neurogenic tumors, which have rarely been reported. Initial cranial magnetic resonance imaging scans revealed fairly symmetric areas of increased T(2) signal involving both white and gray matter of parieto-occipital lobes in the majority of the patients. However, the lesions were often located outside the parieto-occipital regions. Four patients had occipital region magnetic resonance spectroscopy during the acute phase, which revealed high lactate peak and normal N-acetyl aspartate/creatine and choline peaks. With appropriate treatment, most patients recovered from this syndrome and experienced almost complete resolution of brain lesions on follow-up magnetic resonance imaging. One patient, however, continued to have small residual hemosiderin deposits on a follow-up magnetic resonance imaging with neurologic sequellae. In conclusion, a better understanding of this complex syndrome may obviate unnecessary investigations and allow management of the associated problems in prompt and appropriate ways.
Kwon
S
S
Department of Pediatrics, Kyungpook National University Hospital, Samdeok 2-50, Joong-Gu, Taegu 7000-721, South Korea.
Koo
J
J
Lee
S
S
D000293:Adolescent; D000328:Adult; D001812:Blood-Brain Barrier / Q000502:physiology*; D001929:Brain Edema / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009460:Neurologic Examination; D009778:Occipital Lobe / Q000473:pathology*; D010296:Parietal Lobe / Q000473:pathology*; D012075:Remission, Spontaneous; D012307:Risk Factors; D013577:Syndrome
D019344:Lactic Acid; D016572:Cyclosporine; D006485:Hemosiderin