Balasubramanya*, Suresh**, Pranathi ***
Department of Pediatrics.*, Department of Pediatrics.**, Department of Pediatrics.***
Reversible Posterior Leukoencephalopathy Syndrome/Posterior Reversible encephalopathy Syndrome is a clinico-radiological entity described recently. It is an Acute Reversible Encephalopathy usually seen in Hypertensive encephalopathy, Acute Phases of Acute-immune diseases, patients on Immunosupressives and Post-organ & bone marrow transplants. Typical white matter low density symmetrical areas are seen in the parieto-occipital lobes with associated clinical findings which on treatment disappear.
A 12 year old girl presented to us with a short history of high grade fever, facial and limb edema, altered sensorium, seizures and limb weakness and transient visual loss.
She was found to have
acute Glomerulonephritis & Hypertensive encephalopathy Secondry to systemic infection, with features of raised ICT, CT Scan at this stage showed. Bilateral subtle wedge-shaped hypodensities involving posterior parietal & adjacent occipital region. Suggestive of focal perfusion defects involving posterior high parietal lobes.
Blood and Urine investigations correlated with clinical findings. The patient was treated for the above and recovery was uneventful with return of Normal Visual function. Repeat CT Scan showed a disappearance of the parieto-occipital lesions.
Pathophysiology postulated is loss of predominant posterior Cerebral autoregulation with Vasodilatation causing extravasation. RPLS is an acute encephalopathy where neuroimaging is diagnostic. Awareness of this rare entity and the setting in which it occurs is important as it is reversible.
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