The Investigation To Clinical Manifestation Of The Reversible Posterior Leukoencephalopathy Syndrome (RPLS)

Objectives:To analysis the clinical manifestation of the reversible posterior leukoencephalopathy syndrome (RPLS), and to improve the awareness, diagnosis and treatment of RPLS.Methods:In a retrospective analysis, we analyzed 29 patients with RPLS in the First Affiliated Hospital of Guangxi Medical University from January 1996 to March 2016, analyzing the etiology, clinical manifestations, laboratory tests, imaging characteristics, treatment and prognosis, and analyzing these between the eclampsia/pre-eclampsia wtih RPLS and non-eclampsia/pre-eclampsia wtih RPLS.Results:(1) In this study, there were 21 cases (21/29) with acute onset, eight cases (8/29) with subacute,11 males (11/29) and 18 females (18/29).And their age were from 3.5 to 72 years.(2) In our study, the common causes or risk factors of RPLS in number one to five were:hypertension 23 cases (23/29), eclampsia/pre-eclampsia 10 cases (10/29), using methylprednisolone 7 cases (7/29), using immunosuppressants 5 cases (5/29), kidney disease 4 cases (4/29), and including single etiology (≤1 factor) with RPLS 11 cases(11/29), multiple etiologies (≥2 factors) 18 (18/29). (3) In this study, the the common clinical symptoms were:headache 17 cases (17/29), seizures 16 cases (16/29), visual impairment 14 cases (14/29), disturbance of consciousness 14 cases (14/29), mental disorders 5 cases (5/29), nausea and vomiting 14 cases (14/29), positive signs of nervous system 14 cases (14/29). It was consistent with the all in the clinical symptoms between the eclampsia/pre-eclampsia group and non-eclampsia/pre-eclampsia, but no psychiatric symptoms in eclampsia/pre-eclampsia group (P>0.05). (4) There were 6 cases with EEG examination and all being abnormal. There were 17 cases with Lumbar puncture, and 10 cases with abnormalities, mainly for high intracranial pressure and high protein. It was high in lactate dehydrogenase and low in albumin. The lactate dehydrogenase, uric acid and magnesium of eclampsia/pre-eclampsia group were higher than non-eclampsia/pre-eclampsia, but lower serum albumin in eclampsia/pre-eclampsia group.(5) The top five of involved brain regions were: occipital lobe 20 cases (20/29), parietal lobe 19 cases(19/20), temporal lobe 16 cases(16/20), basal ganglia 16 cases (16/29), frontal lobe 15 cases (15/29), and the number of involved brain regions were from 0 to 8, with an average 4.16 ± 1.60. On the MRI, it mainly showed low signal in T1, hyperintensity in T2 and FLAIR. It was consistent with the all in the involved brain regions between the eclampsia/pre-eclampsia group and non-eclampsia/pre-eclampsia, but the frontal lobe was involved more in the eclampsia/pre-eclampsia group(P<0.05), and without the brain stem and periventricular impaired.(6) In this study, the main treatments for the RPLS were symptomatic and supportive treatment. There were 10 cases (10/29) with complete remission at discharge, partial remission 18 cases (18/29),and 1 case(1/29) died.Conclusions:(1) The specific imaging of RPLS were symmetry vasogenic edema mainly on the white matter of occipital and parietal. (2) It suggested that eclampsia/pre-eclampsia may be impact on the clinical manifestations of RPLS. (3)It was whit favorable prognosis to RPLS.