Two cases of reversible posterior leukoencephalopathy syndrome, one with and the other without pre‐eclampsia

Abstract

Two cases of reversible posterior leukoencephalopathy syndrome (RPLS) are reported. One was a 26-year-old woman, who had pre-eclampsia and developed cortical blindness and subsequent eclampsia at 28 weeks' gestation. The other was a 27-year-old woman, who had no pre-eclampsia and developed loss of consciousness and subsequent systemic convulsion at 36 weeks' gestation. On brain magnetic resonance imaging, they both had high signal intensity on T2-weighted and fluid-attenuated inversion recovery images, and normal signal intensity on diffusion-weighted image of the posterior lobe, which almost disappeared with the amelioration of clinical symptoms thereafter. RPLS is considered to be the result of vasogenic brain edema caused by hypertension. Two hypotheses are conceived to explain the emergence of RPLS without hypertension. The first suggests that an immunotolerant condition such as pregnancy can easily cause vasogenic edema without the elevation of blood pressure. The second suggests that hypertension exists but cannot be detected because it is extremely acute and transient.

Reversible Posterior Leukoencephalopathy Syndrome Accompanying Eclampsia: Correct Diagnosis Using Preoperative MRI

“…Eclampsia is often associated with hypertension, and some believe that eclampsia is also one of the pathological conditions predisposing to RPLS/PRES (Mabie 1999). There have been many case reports of RPLS/PRES occurring after eclampsia (Hinchey et al 1996;Celik and Hascalik 2003;Finocchi et al 2005;Parisaei et al 2005;Fujiwara et al 2005), and McKinney et al (2007) reported on 76 patients with RPLS/PRES, of whom 5 (6.6%) had eclampsia.…”

Cerebral Vasospasm in Cortical Blindness Associated with Preeclamsia/ Eclampsia Syndrome

“…Another presentation of bilateral blindness with agnosia of the visual deficit associated with PRES is Anton´s syndrome, denial of blindness. The finding of gaze palsies in the patient 3, indicated a low midbrain/high pontine lesion [65]. Cortical blindness is usually reversible.…”

“…Other authors have reported CVS with cortical blindness: PRES-cortical blindness associated with eclampsia [63][64][65][66][67][68]. PREScortical blindness associated with preeclampsia without seizures [54][55][56][57].…”

“…RCVS-cortical blindness associated with preeclampsia [36,59] and the coexistence of PRES/RCVS-cortical blindness associated with eclampsia [37]. Cortical blindness can be the primary clinical manifestation and be preceded seizures [9,[65][66][67]. The mechanism is unclear whether it results from vasogenic edema or vasospasm and ischemic injury, TCD had demonstrated findings of vasospasm in temporary blindness associated with preeclampsia.…”

Posterior Reversible Encephalopathy Syndrome due to Eclampsia in Term Pregnancy

“…However, it is uncertain whether a cause and effect relationship truly exists between the two or if these represent independent processes with some element of clinical overlap. 5 Fujiwara et al 6 and Mackinney et al 7 have reported that the cause of PRES was eclampsia in 5.5% of patients.…”