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A study on clinical characteristics and the causes of missed diagnosis of reversible posterior leukoencephalopathy syndrome in eclampsia

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Abstract

Purpose

To explore the clinical and imaging characteristics and summarize the causes of missed diagnosis of reversible posterior leukoencephalopathy syndrome (RPLS) in eclampsia.

Methods

We collected the data of a total of 45 patients with RPLS who were misdiagnosed initially (27 cases were confirmed and 18 cases were suspicious) out of 804 patients with severe eclampsia who had presented themselves to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2016. We summarized the clinical and imaging characteristics of the patients and analyzed the possible causes of the misdiagnosis.

Results

Among the 804 patients with eclampsia, 45 were misdiagnosed the first time. Their clinical manifestations included headache (20 cases), epilepsy (13 cases), blurred vision (11 cases), disturbance of consciousness (2 cases), and drowsiness (3 cases). The parietal lobe was involved in 22 cases, the occipital lobe in 15 cases, the frontal lobe in 20 cases, basal ganglia in 9 cases, and the temporal lobe in 8 cases. Low-density lesions were observed on computed tomography (CT) scans. Head magnetic resonance (MR) scans showed hypo-intense lesions on T1-weighted image (T1WI), hyper-intense lesions on the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR), iso-intense or slightly hyper-intense lesion on diffusion-weighted imaging (DWI), and slightly hyper-intense or hypo-intense lesion on apparent diffusion coefficient (ADC).

Conclusion

The incidence of reversible posterior leukoencephalopathy syndrome is extremely high. The clinical features include headache, mental disturbance, seizures, blurred vision, and other neurological symptoms. The lesion area is mainly limited to the parietal and occipital lobes; however, the frontal lobe, basal ganglia, temporal lobe, corpus callosum, and cerebellum can also be involved. The prognosis is good with timely and appropriate treatments.

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Funding

This paper was supported by the National Natural Science Foundation of China (Grant No. 81271268).

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Author notes

  1. Tong Shen and Hao Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China

    Tong Shen, Hao Chen, Hafiz Khuram Raza, Zuozhui Zhang, Lei Bao, Su Zhou, Shenyang Zhang & Guiyun Cui

  2. Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, China

    Hao Chen & Guiyun Cui

  3. Department of Biology, Georgia State University, Atlanta, GA, USA

    Jia Jing

  4. School of International Education, Xuzhou Medical University, Xuzhou, 221002, China

    Hafiz Khuram Raza

Authors
  1. Tong Shen
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  2. Hao Chen
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  3. Jia Jing
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  4. Hafiz Khuram Raza
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  5. Zuozhui Zhang
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  7. Su Zhou
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  8. Shenyang Zhang
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  9. Guiyun Cui
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Corresponding authors

Correspondence to Hao Chen or Guiyun Cui.

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Shen, T., Chen, H., Jing, J. et al. A study on clinical characteristics and the causes of missed diagnosis of reversible posterior leukoencephalopathy syndrome in eclampsia. Neurol Sci 40, 1873–1876 (2019). https://doi.org/10.1007/s10072-019-03914-3

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  • DOI: https://doi.org/10.1007/s10072-019-03914-3

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