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Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, seizure, altered mental status and visual impairment. Neuroimaging shows reversible white matter edema predominantly in the parietal and occipital lobes. RPLS has been associated with a variety of conditions, including hypertensive encephalopathy, renal failure, immuno- supressive therapy, and autoimmune diseases such as systemic lupus erythematosus (SLE). We report a young woman of SLE presented with headache, generalized tonic-clonic seizure and altered mental status, after taking azathioprine and cyclosporine. The brain magnetic resonance images showed bilateral hyperintensitiy in the posterior parietal, occipital, temporal lobes and cerebellum on T2-weighted images and fluid attenuated inversion recovery images, whereas diffusion-weighted images showed isointensity in the same distribution. The patient was improved clinically and radiologically one week after the control of hypertension and discontinuation of cyclosporine.
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Fig. 1.
At admission, axial T2-weighted image, (A) showed bilaterally high signal intensity in the occipital and temporal lobes, and coronal FLAIR image, (B) showed high signal intensity in the cerebellum, parietal and temporal lobes of both side. Axial diffusion-weighted images, (C,D) showed isointensity in the cerebellum, occipital and temporal lobes. One week later, axial T2-weighted image, (E) and coronal FLAIR image, (F) showed almost complete resolution of previous lesions.
Table 1.
Summary of presenting characteristics in 17 cases of SLE with RPLS
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