Serial MR spectroscopy in relapsing reversible posterior leukoencephalopathy syndrome.
BACKGROUND
Reversible posterior leukoencephalopathy syndrome (RPLS) in atypical locations is difficult to diagnose. Magnetic resonance spectroscopy (MRS) can help, but results to date are discrepant. We aimed to describe MRS findings in each phase of RPLS and evaluate their diagnostic potential.


METHODS
We performed MRS, diffusion-weighted imaging and conventional MR during 2 episodes in a patient with hypertensive encephalopathy.


RESULTS
There were multifocal edematous lesions in both frontal lobes, the left temporo-occipital region and both cerebellar hemispheres in the first episode, and in both cerebellar hemispheres and the left pons in the second. Apparent diffusion coefficient values were high. Choline was normal in the acute phase and elevated in the subacute period. N-acetylaspartate was low throughout, even after clinical recovery and disappearance of the lesion on conventional MR. No lactate peak was detected.


CONCLUSIONS
MRS helps differentiate RPLS from several encephalopathies and a N-acetylaspartate decrease does not predict a poor outcome.
Lee
Seo-Young
SY
Department of Neurology, Kangwon National University, Kangwon-Do, Korea.
Kim
Sung Hun
SH
Lee
Seung Hwan
SH
Baek
Hyun Jeong
HJ
Shon
Hong Seok
HS
Kim
Sam Soo
SS
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D010725:Phosphocreatine / Q000378:metabolism; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis* / Q000378:metabolism
D010725:Phosphocreatine; D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine