Bakshi R, Bates V E, Mechtler L L, Kinkel P R, Kinkel W R
Dent Neurologic Institute, Department of Neurology, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, USA.
Epilepsia. 1998 Mar;39(3):295-9. doi: 10.1111/j.1528-1157.1998.tb01376.x.
Reversible posterior leukoencephalopathy syndrome (RPLS) is an increasingly recognized brain disorder most commonly associated with malignant hypertension, toxemia of pregnancy, or the use of immunosuppressive agents. When associated with acute hypertension, RPLS typically occurs concurrently with the fulminant clinical syndrome of hypertensive encephalopathy. We describe occipital lobe seizures, in the setting of only moderate elevations of blood pressure, as the major clinical manifestation of RPLS.
Two patients from the Dent Neurologic Institute are presented with clinical and magnetic resonance imaging (MRI) correlation.
New onset secondarily generalized occipital seizures were noted, with MRI findings consistent with RPLS. Both of the patients had chronic renal failure and a moderate acute exacerbation of chronic hypertension. Other features of hypertensive encephalopathy were lacking, such as headache, nausea, papilledema, and an altered sensorium. Magnetic resonance imaging (MRI) showed edematous lesions primarily involving the posterior supratentorial white matter and corticomedullary junction, consistent with RPLS. With lowered blood pressure, the MRI lesions resolved and the patients became seizure-free without requiring chronic anticonvulsant therapy.
Occipital seizures may represent the only major neurologic manifestation of RPLS due to acute hypertension, especially in patients with renal failure. Other evidence of hypertensive encephalopathy, such as cerebral signs and symptoms, need not be present. Blood pressure elevations may be only moderate. Early recognition of this readily treatable cause of occipital seizures may obviate the need for extensive, invasive investigations. Despite the impressive lesions on MRI, prompt treatment of this disorder carries a favorable prognosis.
可逆性后部白质脑病综合征（RPLS）是一种越来越受到认可的脑部疾病，最常与恶性高血压、妊娠中毒症或免疫抑制剂的使用相关。当与急性高血压相关时，RPLS通常与高血压脑病的暴发性临床综合征同时发生。我们描述了在血压仅中度升高的情况下，枕叶癫痫发作是RPLS的主要临床表现。
介绍了来自牙科学院神经研究所的两名患者的临床情况及磁共振成像（MRI）相关性。
注意到新发的继发性全身性枕叶癫痫发作，MRI表现与RPLS一致。两名患者均患有慢性肾衰竭和慢性高血压的中度急性加重。缺乏高血压脑病的其他特征，如头痛、恶心、视乳头水肿和意识改变。磁共振成像（MRI）显示水肿性病变主要累及幕上后白质和皮质髓质交界处，与RPLS一致。随着血压降低，MRI病变消退，患者无需长期抗惊厥治疗即可无癫痫发作。
枕叶癫痫发作可能是急性高血压所致RPLS的唯一主要神经学表现，尤其是在肾衰竭患者中。高血压脑病的其他证据，如脑部体征和症状，可能并不存在。血压升高可能仅为中度。早期识别这种易于治疗的枕叶癫痫发作原因可避免进行广泛的侵入性检查。尽管MRI上的病变令人印象深刻，但及时治疗这种疾病预后良好。
