Acute posterior leukoencephalopathy in a patient with nephrotic syndrome

Abstract

Reversible posterior leukoencephalopathy syndrome is one of the most serious complications of immunosuppressive therapy. The clinical features include headache, altered mental functioning, seizures, cortical blindness and other visual disturbances, with hypertension. The neuroimaging studies reveal predominant posterior leukoencephalopathy. Usually, antihypertensive therapy and reduction or withdrawal of immunosuppressive agents have been reported to resolve the neurological deficits and imaging abnormalities within a few weeks. We discuss here a 51-year-old woman with nephrotic syndrome who developed acute leukoencephalopathy during combination therapy with prednisolone and cyclosporine. She developed severe headache, visual disturbance, consciousness disturbance, and generalized tonic clonic convulsion. A computed tomography scan (CT) revealed low-density areas in the subcortices of the parietal and occipital lobes. Magnetic resonance imaging (MRI) disclosed a high signal intensity area on T2-weighted images and a low signal intensity area on T1-weighted images in the same lesions. Follow-up brain CT and MRI were performed several times. Three weeks after the first study, these lesions had completely resolved, but she had persistent altered consciousness for more than 1 year.

Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

“…PRES is the result of multitude of factors and has been associated with numerous medical conditions. Hypertension and immunosuppressive or cytotoxic drugs have been reported to be the most significant causes of PRES (4).…”

Posterior reversible encephalopathy syndrome in a patient with hepatitis B induced type 1 membranoproliferative glomerulonephritis

“…A number of etiologies have been identified, namely hypertensive encephalopathy, eclampsia, immunosuppressive therapy, SLE and nephrotic syndrome [1][2][3].…”

“…With regard to the pathophysiology of the disease, the final common pathway must be a brain capillary leak due to altered fluid and vascular hemodynamics secondary to the possible etiologies alone or in combination [1][2][3][4].…”

Apparent diffusion coefficient map based on diffusion-weighted magnetic resonance imaging is useful in diagnosing the brainstem variant of reversible posterior leukoencephalopathy syndrome with uremia

“…Its major symptoms are headache, vomiting, confusion, seizures, visual disturbances, and motor signs [1]. It is often seen in patients with renal disease [1,2]. Meanwhile, a brainstem variant of RPLS is also reported [3,4].…”