Teaching NeuroImages: Hemorrhage associated with reversible posterior leukoencephalopathy syndrome
Peter E. Turkeltaub, MD, PhD and
Jennifer Graves, MD, PhD
From the Neurology Department, University of Pennsylvania Health System, Philadelphia.
Address correspondence and reprint requests to Dr. Peter E. Turkeltaub, University of Pennsylvania Health System, 3400 Spruce Street, 3 West Gates Building, Philadelphia, PA 19104 peter.turkeltaub{at}uphs.upenn.edu
A 23-year-old woman developed vision loss and a generalizedseizure after a rise in blood pressure. Neuroimaging revealedreversible posterior leukoencephalopathy syndrome (RPLS) andintracerebral hemorrhage (ICH) (figure, A).
Figure Two cases of reversible posterior leukoencephalopathy syndrome with hemorrhage
(A) Head CT shows occipital white matter hypodensity with left occipito-parietal and internal capsule intracerebral hemorrhage. Magnetic resonance venography showed no thrombosis. MRI confirmed posteriorly predominant vasogenic edema, which completely resolved on a 10-month follow-up scan (MRIs not shown). (B) Head CT demonstrates subarachnoid hemorrhage in the left precentral sulcus. (C) MRI fluid-attenuated inversion recovery image demonstrates posteriorly predominant vasogenic edema.
A 30-year-old woman with renal failure had a seizure after missingher antihypertensive medications. Head CT demonstrated subarachnoidhemorrhage (SAH). CT angiogram was unremarkable. MRI revealedRPLS (figure, B and C).
RPLS causes vasogenic subcortical edema associated with acutehypertension or medications. In one series, 2/38 cases had associatedICH.1 In a series of isolated convexity SAH, 5/20 cases hadRPLS.2 The co-occurrence of RPLS should be considered in patientswith acute hypertension and ICH or SAH.
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