Soler Riera Cristina, Haddad Leila, Scocco Darío, Fischer Gabriela, Saubidet Christian Lopez, Alvarez Paulino A
Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Av Las Heras 2900 (C1425ASS), Buenos Aires, Argentina.
Cases J. 2009;2:145. doi: 10.1186/1757-1626-2-145. Epub 2009 Sep 30.
Atypical clinical and imaging findings in Reversible Posterior Leukoencephalopathy Syndrome are recognized with increasing frequency.
We report a case of an adult in his 5(th )decade immunosupressed with methilprednisolone, tacrolimus and micophenolate who two months after renal transplantation, multiple infections and an episode of humoral rejection became hypertensive with severe headaches, visual field abnormalities, seizures, left hemiparesis and hemineglect. Computed Tomography scan of the brain showed a hypo dense lesion in the left occipital lobe. Ischemic stroke was diagnosed and aspirin and permissive hypertension were indicated. Twelve hours later he developed left sided motor seizures and cortical blindness. Magnetic Resonance Image showed hyper intensity in T2 and FLAIR in both occipital lobes and a small area of cortical restricted diffusion in Diffuson Weighted Images in the left occipital lobe. With a diagnosis of Reversible Posterior Leukoencephalopathy Syndrome his blood pressure was controlled with intravenous labetalol, and two days later the neurologic findings returned to baseline and most Computed tomography findings resolved.
This case underscores that in the appropriate setting Reversible Posterior Leukoencephalopathy Syndrome should be suspected and the clinician should not be misled by atypical clinical or imaging findings. In contrast to other pathologies that resemble Reversible Posterior Leukoencephalopathy Syndrome, with the right and timely treatment, signs, symptoms and images can be completely reversible.
可逆性后部白质脑病综合征的非典型临床和影像学表现越来越常见。
我们报告一例50多岁的成年男性，因甲基强的松龙、他克莫司和霉酚酸酯免疫抑制，肾移植两个月后，多次感染和一次体液排斥反应后出现高血压，伴有严重头痛、视野异常、癫痫发作、左侧偏瘫和偏侧忽视。脑部计算机断层扫描显示左侧枕叶有低密度病变。诊断为缺血性中风，给予阿司匹林和允许性高血压治疗。12小时后，他出现左侧运动性癫痫发作和皮质盲。磁共振成像显示双侧枕叶T2和液体衰减反转恢复序列呈高信号，左侧枕叶扩散加权成像中有一小片皮质受限扩散区域。诊断为可逆性后部白质脑病综合征后，用静脉注射拉贝洛尔控制血压，两天后神经学表现恢复至基线，大多数计算机断层扫描结果消失。
该病例强调，在适当情况下应怀疑可逆性后部白质脑病综合征，临床医生不应被非典型临床或影像学表现误导。与其他类似可逆性后部白质脑病综合征的疾病不同，通过正确及时的治疗，体征、症状和影像学表现可完全可逆。
