Hypertension-induced reversible posterior leukoencephalopathy syndrome causing obstructive hydrocephalus.

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, altered mental status, abnormal visual perception and seizures. It is associated with neuroradiological findings characterized by reversible white matter abnormalities, predominantly in the parietal-occipital areas. Since the first description in 1996, it has been recognized in an increasing number of medical conditions, including hypertensive encephalopathy, eclampsia, and immunosuppressive treatment. The rapid resolution of clinical and neuroradiologic abnormalities suggests cerebral oedema, which is thought to result from impaired cerebrovascular autoregulation and endothelial injury. We report a patient presenting with acute onset progressively worsening headache and confusion associated with uncontrolled hypertension. CT and MRI revealed acute non-communicating hydrocephalus secondary to cerebellar and pontine oedema. The patient became drowsy, so an external ventricular drain was inserted for decompression of the acute hydrocephalus, and his blood pressure was aggressively managed. The patient recovered well with complete clinical and radiological resolution. This case illustrates the reversibility of RPLS if it is diagnosed early and appropriate treatment is instituted.