Reversible posterior leukoencephalopathy occurring during resection of a posterior fossa tumor: Case report and review of the literature

OBJECTIVE AND IMPORTANCE: Our goal was to present a clinically and radiogra phically documented case of reversible posterior leukoencephalopathy (RPL) that occurred during resection of a posterior fossa tumor. Although RPL has been previously described in multiple nonsurgical settings, we hope that t his case description makes RPL more clinically and radiographically recogni zable to neurosurgeons. CLINICAL PRESENTATION: RPL is the clinical syndrome of headaches, altered m ental status, seizures, and visual loss, with radiographic findings of reve rsible parieto-occipital changes on cerebral computed tomographic and magne tic resonance imaging scans. it has been previously reported in the setting s of malignant hypertension, renal disease, eclampsia, and immunosuppressio n. To our knowledge, the patient presented represents the first clinically and radiographically documented case of RPL occurring during resection of a posterior fossa tumor. The patient intraoperatively exhibited wide fluctua tions in blood pressure and awoke with clinical and radiographic findings c onsistent with RPL. INTERVENTION: Aggressive intraoperative and postoperative management of the patient's blood pressure, supportive intensive care, rehabilitation, and c lose radiographic follow-up were performed. CONCLUSION: RPL can occur as a result of intraoperative variations in blood pressure, even among young, previously healthy individuals. With the afore mentioned interventions, the patient experienced significant clinical and r adiographic recovery.