Clinical and imaging features of reversible posterior leukoenphalopathy syndrome: a report of 6 cases

Abstract

Objective To explore the clinical and imaging features of reversible posterior leukoencephalopathy syndrome (RPLS). Methods The etiology, clinical manifestations, imaging features, treatment and prognosis of 6 patients with RPLS, admitted to our hospital from December 2007 to August 2010, were retrospectively analyzed. Results Among the 6 patients with RPLS, 1 was secondary to leukemia, 1 secondary to nephrotic syndrome, 1 secondary to renal transplantation, 1 secondary to pheochromocytoma, and 2 secondary to primary hypertention. The clinical manifestations of patients included seizure, dizziness, headache, nausea, vomit, conscious disturbance, behavioral and psychological abnormalities, and visual disorder. Cranial CT showed that 4 patients had low-density white matter lesions; cranial MRI mainly indicated posterior cerebral hemisphere white matter lesions,and the lesions showed low or iso-signal in T1WI, high signal in T2WI and FLAIR, low or iso-signal in diffusion-weighted magnetic imaging (DWI) and high signal in apparent diffusion coefficient (ADC)map. Five patients received the right treatment got rapid improvement of clinical symptoms with normal imaging examinations. One patient with renal transplantation who refused to disable cyclosporin A and mycophenolate mofetil eventually died. Conclusion The diagnosis of RPLS relys on history, clinical features and imaging characteristics. Most patients have a better prognosis, but a few patients have poor prognosis due to various reasons. Key words: Reversible posterior leukoenphalopathy syndrome; Clinical feature; Imaging feature