CT and CT-perfusion findings of reversible leukoencephalopathy during triple-H therapy for symptomatic subarachnoid hemorrhage-related vasospasm.
BACKGROUND
Reversible leukoencephalopathy syndrome (RLS) is an acute neurological syndrome associated with altered mental status and visual disturbances described in patients with sudden elevations in systemic blood pressure and other medical conditions. In this process, neuroimaging studies usually demonstrate diffuse edema involving the subcortical structures of the posterior regions of the brain. Triple H (HHH) therapy is an established treatment for symptomatic vasospasm following subarachnoid hemorrhage (SAH). RLS has not been reported in the scientific literature as a complication of HHH therapy with perfusion computed tomography (CTP) imaging documentation.


METHODS
A 73-year-old woman developed iatrogenic RLS during HHH therapy for SAH-related vasospasm. The computed tomography (CT) revealed bilateral parieto-occipital hypodensities. The CTP study showed increased cerebral blood volume and blood flow as well as decreased mean transit time in both parietal-occipital regions, which is compatible with vasogenic edema.


CONCLUSIONS
The induction of hypertension as part of HHH therapy for SAH-related cerebral vasospasm may result in RLS. Therefore, it should be considered as a potentially reversible cause in the differential diagnosis of neurological deterioration in SAH patients while on HHH therapy. CTP study can offer an alternative for the assessment of this cerebrovascular syndrome.
Wartenberg
Katja E
KE
Division of Stroke and Neurocritical Care, Columbia University, College of Physicians & Surgeons, Neurological Institute, 710 West 168th Street, New York, NY 10032, USA.
Parra
Augusto
A
D000368:Aged; D000418:Albumins / Q000009:adverse effects / Q000627:therapeutic use; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology*; D010656:Phenylephrine / Q000009:adverse effects / Q000627:therapeutic use; D012965:Sodium Chloride / Q000009:adverse effects / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
D000418:Albumins; D010656:Phenylephrine; D012965:Sodium Chloride