BACKGROUND: Reversible posterior leukoencephalopathy syndrome (RPLS) is radiologically characterized by symmetrical subcortical areas of vasogenic edema that are preferentially parieto-occipital, and it typically resolves after appropriate treatment. CASE REPORT: We present a patient with strikingly unilateral RPLS that developed 21 days after coiling of an anterior communicating artery aneurysm and several days of triple-H therapy. Cortical and subcortical vasogenic edema and enhancement developed only in the left hemisphere, with a pattern suggesting RPLS. After 7 months the lesions had nearly completely resolved. CONCLUSIONS: The pathophysiological mechanism underlying RPLS is still not well understood, which makes it difficult to explain the unilateral appearance in this case. Since the imaging findings may be confused with other conditions such as ischemia, recognition of RPLS after coiling is necessary in order to avoid inadequate treatment.
BACKGROUND: Reversible posterior leukoencephalopathy syndrome (RPLS) is radiologically characterized by symmetrical subcortical areas of vasogenic edema that are preferentially parieto-occipital, and it typically resolves after appropriate treatment. CASE REPORT: We present a patient with strikingly unilateral RPLS that developed 21 days after coiling of an anterior communicating artery aneurysm and several days of triple-H therapy. Cortical and subcortical vasogenic edema and enhancement developed only in the left hemisphere, with a pattern suggesting RPLS. After 7 months the lesions had nearly completely resolved. CONCLUSIONS: The pathophysiological mechanism underlying RPLS is still not well understood, which makes it difficult to explain the unilateral appearance in this case. Since the imaging findings may be confused with other conditions such as ischemia, recognition of RPLS after coiling is necessary in order to avoid inadequate treatment.
Authors: Jennifer E Fugate; Daniel O Claassen; Harry J Cloft; David F Kallmes; Osman S Kozak; Alejandro A Rabinstein Journal: Mayo Clin Proc Date: 2010-05 Impact factor: 7.616
Authors: Barbara Voetsch; Nicholas Tarlov; Thanh N Nguyen; Christina DeFusco; Glenn D Barest; Alexander Norbash; Deborah M Green; Joseph D Burns Journal: Neurocrit Care Date: 2011-12 Impact factor: 3.210
Authors: Elias A Giraldo; Jennifer E Fugate; Alejandro A Rabinstein; Giuseppe Lanzino; Eelco F M Wijdicks Journal: Neurocrit Care Date: 2011-06 Impact factor: 3.210
Authors: Alexander M McKinney; James Short; Charles L Truwit; Zeke J McKinney; Osman S Kozak; Karen S SantaCruz; Mehmet Teksam Journal: AJR Am J Roentgenol Date: 2007-10 Impact factor: 3.959