Background: Reversible posterior leukoencephalopathy (RPLE) or reversible posterior cerebral edema
syndrome is a syndrome characterized by transient focal or diffused neurological deficits and reversible
neuroimaging changes. RPLE is often associated with hypertension and systemic illness. The classical Magnetic
Resonance Imaging (MRI) feature of RPLE is predominately involvement of bilateral posterior cerebral white
matter. Due to availability of MRI technology, this entity has been reported more frequently.

Material and Method: The clinical recordings were searched from data bases at King Chulalongkorn Memorial
Hospital from 2003 to 2005. Keywords were “leukoencephalopathy” and “hypertensive encephalopathy”.
Neuroimaging criteria for the diagnosis of RPLE were bilateral symmetrical cortical-subcortical white matter
lesions predominantly affecting the occipital lobe. The data were reviewed. Cases with RPLE were recruited
and analyzed.

Results: Nine patients (female:male, 8:1), ranged in age from 17 to 39 years (average, 26 years) were analyzed.
Five patients had acute hypertension associated with renal failure, 1 had acute hypertension without renal
impairment, 2 had eclampsia and 1 was associated with cyclosporine therapy. Most common clinical symptoms
were seizure and cortical blindness. MRI revealed bilateral occipital white matter edema in 7/8 patients while
computerized tomography demonstrated this feature in 3/9 patients. Other MRI abnormalities were detected
in frontal lobes, parietal lobes, deep grey nuclei, brainstem and cerebellum. The patients were treated with
antihypertensive drugs, antiepileptics and withdrawal from immunosuppressive therapy. In 8 patients, the
neurological deficits recovered within 2 weeks. The case with cyclosporine therapy had residuals in the form
of limb weakness and spasticity.

Conclusion: RPLE is associated with hypertension, systemic autoimmune diseases, renal impairment, immunosuppressive
therapy or eclampsia. The neuroimaging findings reveal characteristic white matter vasogenic
edema in occipital lobes as well as other cortical areas and deep grey matter. Good clinical outcomes occur
after prompt symptomatic treatment with antihypertensive drugs, antiepileptics or withdrawal from immunosuppressive
therapy and repeated neuroimaging may not be necessary.

Keywords: Reversible posterior leukoencephalopathy syndrome