title: [Brainstem variant of reversible posterior leukoencephalopathy syndrome with a prolonged clinical course: a case report].
abstract: A 38-year-old man gradually developed gait instability, dysarthria, and dysphagia over two months associated with an elevated blood pressure after starting hemodialysis therapy for diabetic nephropathy. Brain MRI studies indicated vasogenic edema in the brainstem, extending from the lower midbrain to the upper medulla oblongata. The patient's high blood pressure was refractory to treatment, and his neurological disabilities and MRI abnormalities progressed. FDG-PET, MR spectroscopy, and cerebrospinal fluid studies did not suggest neoplastic pathologies. The patient was diagnosed with a brainstem variant of reversible posterior leukoencephalopathy syndrome, and received three courses of steroid pulse therapy. After the pulse therapy, the clinical manifestations and MR findings improved. By maintaining strict management of blood pressure and body water balance during hemodialysis, he did not experience any further clinical exacerbation, and the lesion on MR images continued to regress. Ten months after the pulse therapy, T1-weighted images showed slightly hyperintense signal. This case suggests that reversible posterior leukoencephalopathy syndrome (RPLS) may take a chronic clinical course without acute onset.
authors.affiliation: Department of Neurology, Kyorin University School of Medicine.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Oishi
authors.forename: Haruko
authors.initials: H
authors.lastname: Okano
authors.forename: Kazuya
authors.initials: K
authors.lastname: Uegama
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Motoo
authors.initials: M
authors.lastname: Nagane
authors.forename: Atsuro
authors.initials: A
authors.lastname: Chiba
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakuta
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001929:Brain Edema / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D001933:Brain Stem / Q000473:pathology*; D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy; D018450:Disease Progression; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D054038:Posterior Leukoencephalopathy Syndrome / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D020551:Pulse Therapy, Drug; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D008775:Methylprednisolone