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Neuroradiology

, Volume 46, Issue 12, pp 978–983 | Cite as

Atypical manifestations of reversible posterior leukoencephalopathy syndrome: findings on diffusion imaging and ADC mapping

  • K. J. Ahn
  • W. J. You
  • S. L. Jeong
  • J. W. Lee
  • B. S. Kim
  • J. H. Lee
  • D. W. Yang
  • Y. M. Son
  • S. T. Hahn
Diagnostic Neuroradiology

Abstract

Typically, reversible posterior leukoencephalopathy syndrome (RPLS) involves the parieto-occipital lobes. When regions of the brain other than the parieto-occipital lobes are predominantly involved, the syndrome can be called atypical RPLS. The purpose of this study is to find radiological and pathophysiological features of atypical RPLS by using diffusion-weighted imaging (D-WI). We retrospectively reviewed seven patients (two with eclampsia, one with cyclosporine neurotoxicity, and four with hypertensive encephalopathy) with atypical MR manifestations of RPLS. Changes in signal intensity on T2-weighted imaging (T2-WI) and D-WI, and ADC ratio, were analyzed. In patients with atypical manifestation of RPLS, high signal intensities on T2-WI were noted in the frontal lobe, basal ganglia, thalamus, brainstem, and subcortical white matter in regions other than the parieto-occipital lobes. These areas of increased signal intensities on T2-WI showed increased ADC values, representing vasogenic edema in all seven patients. This result should be very useful in differentiating atypical RPLS from other metabolic brain disorders that affect the same sites with cytotoxic edema.

Keywords

Atypical reversible posterior leukoencephalopathy Diffusion-weighted imaging ADC mapping 

References

  1. 1.
    Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas J-L, Caplan LR (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 22:494–500CrossRefGoogle Scholar
  2. 2.
    Ay H, Buonanno FS, Schaefer PW, Le DA, Wang B, Gonzalez RG, Koroshetz WJ (1998) Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology 51:1369–1376PubMedGoogle Scholar
  3. 3.
    Tajima Y, Isonishi K, Kashiwaba T, Tashiro K (1999) Two similar cases of encephalopathy, possibly a reversible posterior leukoencephalopathy syndrome: serial findings of magnetic resonance imaging, SPECT and angiography. Intern Med 38:54–58PubMedGoogle Scholar
  4. 4.
    Phal P, Molan M, Clare I (2002) Hypertensive encephalopathy. Australas Radiol 46:319–324CrossRefPubMedGoogle Scholar
  5. 5.
    Thambisetty M, Biousse V, Newman NJ (2003) Hypertensive brainstem encephalopathy: clinical and radiographic features. J Neurol Sci 208:93–99Google Scholar
  6. 6.
    Covarrubias DJ, Luetmer PH, Campeau NG (2002) Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR 23:1038–1048PubMedGoogle Scholar
  7. 7.
    Sawada H, Udaka F, Seriu N, Shindou K, Kameyama M, Tsujimura M (1990) MRI demonstration of cortical laminar necrosis and delayed white matter injury in anoxic encephalopathy. Neuroradiology 32:319–321PubMedGoogle Scholar
  8. 8.
    Takahashi S, Higano S, Ishii K, Matsumoto K, Sakamoto K, Iwasaki Y, Suzuki M (1993) Hypoxic brain damage: cortical laminar necrosis and delayed changes in white matter at sequential MR imaging. Radiology 189:449–456PubMedGoogle Scholar
  9. 9.
    Koci TM, Chiang F, Chow P, Wang A, Chiu LC, Itabashi H, Mehringer CM (1990) Thalamic extrapontine lesions in central pontine myelinolysis. AJNR 11:1229–1233PubMedGoogle Scholar
  10. 10.
    Chu K, Kang DW, Ko SB, Kim M (2001) Diffusion-weighted MR findings of central pontine and extrapontine myelinolysis. Acta Neurol Scand 104:385–388CrossRefPubMedGoogle Scholar
  11. 11.
    Chan R, Erbay S, Oljeski S, Thaler D, Bhadelia R (2003) Hypoglycemia and diffusion-weighted imaging. J Comput Assist Tomogr 27:420–423CrossRefPubMedGoogle Scholar
  12. 12.
    Finelli PF (2001) Diffusion-weighted MR in hypoglycemic coma. Neurology 57:933Google Scholar
  13. 13.
    Thompson AJ, Brown MM, Swash M, Thakkar C, Scholtz C (1988) Autopsy validation of MRI in central pontine myelinolysis. Neuroradiology 30:175–177PubMedGoogle Scholar
  14. 14.
    Miller GM, Baker HL Jr, Okazaki H, Whisnant JP (1988) Central pontine myelinolysis and its imitators: MR findings. Radiology 168:795–802PubMedGoogle Scholar
  15. 15.
    Schaefer PW, Buonanno FS, Gonzalez RG, Schwamm LH (1997) Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke 28:1082–1085PubMedGoogle Scholar
  16. 16.
    Provenzale JM, Petrella JR, Cruz LC Jr, Wong JC, Engelter S, Barboriak DP (2001) Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome. AJNR 22:1455–1461PubMedGoogle Scholar
  17. 17.
    Schwartz RB, Mulkern RV, Gudbjartsson H, Jolesz F (1998) Diffusion-weighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. AJNR 19:859–862PubMedGoogle Scholar
  18. 18.
    Mukherjee P, McKinstry RC (2001) Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging. Radiology 219:756–765PubMedGoogle Scholar
  19. 19.
    Arbelaez A, Castillo M, Mukherji SK (1999) Diffusion-weighted MR imaging of global cerebral anoxia. AJNR 20:999–1007PubMedGoogle Scholar
  20. 20.
    Singhal AB, Topcuoglu MA, Koroshetz WJ (2002) Diffusion MRI in three types of anoxic encephalopathy. J Neurol Sci 196:37–40CrossRefPubMedGoogle Scholar
  21. 21.
    Kim JH, Chang KH, Song IC, Kim KH, Kwon BJ, Kim HC, Kim JH, Han MH (2003) Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions. AJNR 24:1592–1597PubMedGoogle Scholar
  22. 22.
    Cramer SC, Stegbauer KC, Schneider A, Mukai J, Maravilla KR (2001) Decreased diffusion in central pontine myelinolysis. AJNR 22:1476–1479PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • K. J. Ahn
    • 1
  • W. J. You
    • 1
  • S. L. Jeong
    • 1
  • J. W. Lee
    • 1
  • B. S. Kim
    • 1
  • J. H. Lee
    • 1
  • D. W. Yang
    • 2
  • Y. M. Son
    • 2
  • S. T. Hahn
    • 1
  1. 1.Department of Radiology, College of Medicine, The Catholic University of KoreaSt. Mary’s HospitalSeoulKorea
  2. 2.Department of Neurology, College of Medicine, The Catholic University of KoreaSt. Mary’s HospitalSeoulKorea

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