Posterior leukoencephalopathy in erythropoietin induced hypertensive encephalopathy

Hypertensive encephalopathy is a recognised entity in patients with renal d iseases and in patients on dialysis. Human recombinant erythropoietin is us ed to treat anaemia in patients with end stage renal failure and it is know n to cause hypertension in dialysis patients, even precipitating hypertensi ve encephalopathy. Hinchey y cols. have described a new reversible posterio r leukoencephalopathy syndrome, in which imaging abnormalities are seen in the parieto-occipital regions of the brain in patient with hypertensive enc ephalopathy or eclampsia, as well as in those receiving immunosuppresive tr eatment. We describe a 47-year-old woman on hemodialysis, who, after starti ng erythropoietin therapy, developed headache, blurred vision, and seizures in the setting of a high blood pressure. Head CT revealed bilateral pariet o-occipital hypodensity and T2-weighted MR showed high signal intensity in the subcortical occipital white matter bilaterally. All symptoms and imagin g abnormalities resolved following blood pressure control and stopping the erythropoietin therapy.