Emergency Management of Posterior Leukoencephalopathy Syndrome

Year 2014, , 35 - 38, 01.03.2014

Yücel Yavuz Serdar Oruç Yusuf Yürümez Gülşen Çığşar Fatma Fidan Kamil Tünay Oya Akpınar Oruç

https://doi.org/10.5505/sakaryamj.2014.50480

Abstract

Posterior Leukoencephalopathy Syndrome (PLS) is an acute neurologic emergency which is characterized by altered mental functions, headaches, epileptic seizures, visual impairment and often associated with high blood pressure. Exact pathophysiological mechanism is unknown but it is proposed that hypertension originated vasospasm affects the blood brain barrier and consequently leads to cerebral edema. PLS can be diagnosed by clinical and neuroradiological imaging methods. However, inaccurate or delayed diagnosis causes inadequate medical treatment and may result in cerebral hemorrhage, coma and death. This case study is aimed to draw attention to the subject by presenting a patient who has PLS.

Keywords

PLES, Altered Mental Functions. Hypertension

Posteriyor Lökolensefalopati Sendromunda Acil Yaklaşım

Abstract

Posteriyor Lökoensefalopati Sendromu (PLES) mental bozukluk, baş ağrısı, epileptik nöbet ve görme bozukluğu ile karakterize, sıklıkla artmış kan basıncı ile birliktelik gösteren akut nörolojik bir acildir. Fizyopatolojik mekanizması kesin olarak bilinmemekte, ancak hipertansiyona yanıt olarak ortaya çıkan vazospazma bağlı olarak kan beyin bariyerinin etkilendiği ve sonuçta serebral ödemin oluştuğu ileri sürülmektedir. Tanı klinik ve nöroradyolojik görüntüleme yöntemleri ile sıklıkla konulabilmektedir. Ancak yanlış tanı veya tanıdaki gecikme nedeni ile tedavinin yapılamadığı durumlarda sendrom serebral hemoraji, koma ve ölümle sonuçlanabilmektedir. Bu yazıda PLES'li bir olgu sunularak konuya dikkat çekilmek istenmiştir.

Keywords

PLES, Mental Durum Değişikliği, Hipertansiyon

References

• Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;8:494–500.
• Yasuda Y, Akiguchi I, Imai T, Sonobe M, Kage M. Hypertensive brainstem encephalopathy. Intern Med. 2003;42(11):1131-4.
• Henderson RD, Rajah T, Nicol AJ, Read SJ. Posterior leukoencephalopathy following intrathecal chemotherapy with MRA-documented vasospasm. Neurology. 2003;60(2):326-328.
• Pizon AF, Wolfson AB. Postpartum focal neurologic deficits: posterior leukoencephalopathy syndrome. J Emerg Med. 2005;29(2):163-6.
• Ringelstein EB, Knecht S. Cerebral Small Vessel Diseases: Manifestations In Young Women. Current Oppinion in Neurology 2006;19:55-62.
• Yano Y, Kario K, Fukunaga T, et al. A Case Reversibl Posterior Leukoensephalopathy Syndrome Caused by Ttansient Hypercoagulable State Induced By Infection. Hypertens Res 2005;28:619-623.
• Ergün T, Lakadamyali H, Yilmaz A. Recurrent posterior reversible encephalopathy syndrome in a hypertensive patient with end-stage renal disease Diagn Interv Radiol. 2008 Dec;14(4):182-5.
• Weidauer S, Gaa J, Sitzer M, Hefner R, Lanfermann H, Zanella FE. Posterior encephalopathy with vasospasm: MRI and angiography. Neuroradiology. 2003 Dec;45(12):869-76.
• Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible leukoencephalopathy syndrome: utility of fluidattenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. Am J Neuroradiol 2000; 21:1199-1206.
• Sundgren PC, Edvardsson B, Holtas S. Serial investigation of perfusion disturbances and vasogenic oedema in hypertensive encephalopathy by diffusion and perfusion weighted imaging. Neuroradiology. 2002;44(4):299-304.
• Ay H, Buonanno FS, Schaefer PW, et al. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology 1998; 51: 1369-1376.
• Mukherjee P, Mckinstry RC. Reversible posterior leukoencephalopathy syndrome: evaluation with diffusiontensor imaging. Radiology 2001; 219: 756-765.