A REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME

Background and Methods. In some patients who are hospitalized for acut e illness, we have noted a reversible syndrome of headache, altered me ntal functioning, seizures, and loss of vision associated with finding s indicating predominantly posterior leukoencephalopathy on imaging st udies, To elucidate this syndrome, we searched the log books listing c omputed tomographic (CT) and magnetic resonance imaging (MRI) studies performed at the New England Medical Center in Boston and Hopital Sain te Anne in Paris; we found 15 such patients who were evaluated from 19 88 through 1994. Results. Of the 15 patients, 7 were receiving immunos uppressive therapy after transplantation or as treatment for aplastic anemia, 1 was receiving interferon for melanoma, 3 had eclampsia, and 4 had acute hypertensive encephalopathy associated with renal disease (2 with lupus nephritis, 1 with acute glomerulonephritis, and 1 with a cetaminophen-induced hepatorenal failure), Altogether, 12 patients had abrupt increases in blood pressure, and 8 had some impairment of rena l function. The clinical findings included headaches, vomiting, confus ion, seizures, cortical blindness and other visual abnormalities, and motor signs, CT and MRI studies showed extensive bilateral white-matte r abnormalities suggestive of edema in the posterior regions of the ce rebral hemispheres, but the changes often involved other cerebral area s, the brain stem, or the cerebellum. The patients were treated with a ntihypertensive medications, and immunosuppressive therapy was withdra wn or the dose was reduced, In all 15 patients, the neurologic deficit s resolved within two weeks. Conclusions. Reversible, predominantly po sterior leukoencephalopathy may develop in patients who have renal ins ufficiency or hypertension or who are immunosuppressed, The findings o n neuroimaging are characteristic of subcortical edema without infarct ion. (C) 1996, Massachusetts Medical Society.