title: Reversible posterior leukoencephalopathy in a patient with autonomic dysreflexia: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a case of reversible posterior leukoencephalopathy (RPL) in a patient with traumatic cervical spinal cord injury.
  
  
  METHODS
  Neurologic inpatient Unit, Lahey Clinic, Burlington, MA, USA.
  
  
  METHODS
  A 55-year-old woman with a residual spastic quadriparesis from a traumatic C5-C6 fracture developed, during an assisted cough maneuver, sudden severe headache followed by cortical blindness in the setting of high blood pressure. Magnetic resonance imaging (MRI) showed T2 hyperintensities in the subcortical white matter of both medial occipital lobes and left post-central gyrus.
  
  
  RESULTS
  Elevation of the head of the bed during subsequent cough maneuvers with occasional use of sublingual nifedipine prevented further episodes of acute arterial hypertension and development of new symptoms. Repeat MRI of the head done one month later was normal.
  
  
  CONCLUSIONS
  RPL can occur in the setting of autonomic dysreflexia in patients with traumatic cervical cord injury. The prompt recognition of this syndrome is of importance to prevent further morbidity and mortality in patients with spinal cord injury.
authors.affiliation: Department of Neurology, Lahey Clinic, Lexington, MA 02421, USA. claudia.j.chaves@lahey.org
authors.forename: C J
authors.initials: CJ
authors.lastname: Chaves
authors.forename: G
authors.initials: G
authors.lastname: Lee
mesh_terms: D020211:Autonomic Dysreflexia / Q000209:etiology / Q000473:pathology*; D019575:Blindness, Cortical / Q000209:etiology / Q000473:pathology; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000150:complications*