INTRODUCTION: In 1996, Hinchey et al described a clinico-radiological picture they called posterior reversible leukoencephalopathy syndrome (PRLS), which is characterized by visual disorders, seizures, altered mental states and changes in the subcortical white matter of the temporoparietooccipital lobes that are shown up in the neuroimages. These clinical manifestations are associated with arterial hypertension. Later, other triggering elements, such as cytostatic drugs, were described without being linked to hypertension. Other authors have suggested the name of posterior reversible encephalopathy, since magnetic resonance imaging (MRI) reveals a high percentage of cortical compromise. CASE REPORTS: We present three cases of posterior reversible encephalopathy with different origins. Two of the cases involved females, one of whom was a 19-year-old hypertensive with lupus nephropathy and the other was a 33-year-old with eclampsia. The third case was an 11-year-old male child with post streptococcal glomerulonephritis and hypertension. The most relevant signs and symptoms included seizures, visual disorders, arterial hypertension and sensory deterioration. MR played a decisive role in diagnosis and it revealed an alteration of the signal in the supra and infratentorial white matter of the cortex and the subcortex, which was predominant in the posterior areas of the encephalon. The three cases presented a significant radiological and clinical improvement in a short time. CONCLUSION: Failure of the self regulation of cerebral vascular circulation, with development of oedema, is the most widely accepted hypothesis to explain the pathophysiological mechanism at work in this entity.
INTRODUCTION: In 1996, Hinchey et al described a clinico-radiological picture they called posterior reversible leukoencephalopathy syndrome (PRLS), which is characterized by visual disorders, seizures, altered mental states and changes in the subcortical white matter of the temporoparietooccipital lobes that are shown up in the neuroimages. These clinical manifestations are associated with arterial hypertension. Later, other triggering elements, such as cytostatic drugs, were described without being linked to hypertension. Other authors have suggested the name of posterior reversible encephalopathy, since magnetic resonance imaging (MRI) reveals a high percentage of cortical compromise. CASE REPORTS: We present three cases of posterior reversible encephalopathy with different origins. Two of the cases involved females, one of whom was a 19-year-old hypertensive with lupus nephropathy and the other was a 33-year-old with eclampsia. The third case was an 11-year-old male child with post streptococcal glomerulonephritis and hypertension. The most relevant signs and symptoms included seizures, visual disorders, arterial hypertension and sensory deterioration. MR played a decisive role in diagnosis and it revealed an alteration of the signal in the supra and infratentorial white matter of the cortex and the subcortex, which was predominant in the posterior areas of the encephalon. The three cases presented a significant radiological and clinical improvement in a short time. CONCLUSION: Failure of the self regulation of cerebral vascular circulation, with development of oedema, is the most widely accepted hypothesis to explain the pathophysiological mechanism at work in this entity.
Authors: Corinne Orlando; Gregorio P Milani; Giacomo D Simonetti; Barbara Goeggel Simonetti; Sebastiano A G Lava; Rolf Wyttenbach; Mario G Bianchetti; Marirosa Cristallo Lacalamita Journal: Pediatr Nephrol Date: 2021-09-21 Impact factor: 3.651