Korean J Hematol.  2009 Sep;44(3):177-181. 10.5045/kjh.2009.44.3.177.

Reversible Posterior Leukoencephalopathy Syndrome in a Patient with Relapsed Hodgkin's Disease: A Case Report

• Kim JW
• Moon JM
• Kang EJ
• Choi YJ
• Kim JS
• Choi JG
• Seo HY
• Sung HJ
• Choi CW
• Kim BS
• Kim JS
• Seo WK

• KMID: 2252139
• DOI: http://doi.org/10.5045/kjh.2009.44.3.177

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is a distinctive clinicoradiological entity that's characterized by headache, confusion, seizure and frequent visual disturbances. It is associated with certain neuro-radiological findings, and predominantly white matter abnormalities of the parieto-occipital lobes. RPLS has been identified mostly in patients with malignant hypertension, pre-eclampsia and renal insufficiency and in those patients who are using immunosuppressive agents or cytotoxic drugs. We report here on a case of RPLS in a patient who was undergoing chemotherapy. A 49-year-old woman presented with abrupt mental changes and visual disturbances five days after the administration of a chemotherapeutic agent. MRI showed hyper-intense signals on the magnetic resonance (MR) diffusion images in the bilateral temporal, parietal and occipital lobes. The clinical manifestations completely resolved after one week of treatment that consisted of blood pressure control, a negative intake-output balance and the best supportive care. These radiological changes and the reversible clinical manifestations were consistent with RPLS.

Keyword

Posterior leukoencephalopathy syndrome; Hodgkin disease; ESHAP regimen

MeSH Terms

Antineoplastic Combined Chemotherapy Protocols
Blood Pressure
Cisplatin
Cytarabine
Diffusion
Etoposide
Female
Headache
Hodgkin Disease
Humans
Hypertension, Malignant
Immunosuppressive Agents
Magnetic Resonance Spectroscopy
Middle Aged
Occipital Lobe
Posterior Leukoencephalopathy Syndrome
Pre-Eclampsia
Prednisone
Renal Insufficiency
Seizures
Antineoplastic Combined Chemotherapy Protocols
Cisplatin
Cytarabine
Etoposide
Immunosuppressive Agents
Prednisone

Figure

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  Fig. 1. MR diffusion. (A) TRACE map, diffusion high signal intensity on temporal, parietal, and some occipital gyruses. (B) Apparent diffusion coefficient (ADC) map, focal restricted diffusion on area of left parietal occipital and right parietal.

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  Fig. 2. MRI. (A) Fluid-attenuated inversion-recovery (FLAIR), white hyperintensity in the occipital white matter. (B) Gadolinium enhanced image, no enhanced area on same area.

Reference

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