Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathy: Three names for an old syndrome

Children with hypertension, seizures, lethargy, encephalopathy, headache, a nd occipital blindness are reviewed. After undergoing antihypertensive ther apy, most children improve. Some patients have a similar syndrome associate d with chemotherapy, transplantation, transfusion, or human immunodeficienc y virus-1 (HIV-1) infection. These latter children can develop symptoms wit h only minimal or no discernible elevations in blood pressure and improve, in the case of cancer-associated encephalopathy, after discontinuing chemot herapy. The reported children with this distinctive clinical condition are compared to adults with reversible posterior leukoencephalopathy syndrome. Since both gray and white matter are involved, we had suggested previously that the name be changed to (reversible) occipitoparietal encephalopathy sy ndrome. However, reversible posterior leukoencephalopathy has been used in the adult population and probably should be employed in children for the sa ke of uniformity, since both children and adults have the same clinical pre sentation and presumably a similar pathophysiology for the encephalopathy s yndrome. The diagnosis is confirmed by reversible posterior abnormalities s een on T-2-weighted brain magnetic resonance imaging, and by the presence o f either headache, altered mental status, seizures, or visual disturbances.