Reversible posterior leukoencephalopathy syndrome (RPLS) in a postpartum woman after postdural puncture headache following combined-spinal epidural anesthesia

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical syndrome, which is manifested clinically by headache, seizure, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. We present a case of postpartu women who developed RPLS after combined -spinal epidural anesthesia which was complicated by a postdural puncture headache. The patient was treated with magnesium sulfate, midazolam, mannitol and carbamazepine for seizure control and prophylaxis. Blood pressure was controlled with labetolol and nicardipine. The patient was discharged home two weeks later with no neurologic deficit, and repeated magnetic resonance imaging (MRI) showd normal. Cerebral MRI served as a diagnostic method for RPLS. The hallmark feature is bilateral symmetrical vasogenic edema in the territories of the posterior cerebral circulation (occipital and posterior parietal lobes). If promptly recognized and treated, symptoms and neuroradiographic changes are reversible when blood pressure is controlled. However, if the diagnosis is delayed or unrecognized, cerebral ischemia and infarction can occur, which might result in permanent brain injury or death. Key words: Postdural puncture headache; Reversible posterior leukoencephalopathy syndrome