Headache, Confusion, and Seizures in Patient With SLE

Answer

C. Distribution of abnormalities confined to a single vascular territory

A typical finding in RPLS is symmetric white matter edema in the posterior cerebral hemispheres, particularly the parieto-occipital regions.¹ The calcarine and paramedian parts of the occipital lobe are usually spared, helping to distinguish RPLS from bilateral posterior cerebral infarction.¹ Involvement of the cerebellum and brainstem is common, and the distribution of abnormalities usually is not confined to a single vascular territory.

Because neuroradiographic findings after seizure or other neurologic conditions can be similar to those seen in RPLS, repeat neuroimaging may be necessary. With treatment, resolution of abnormal neuroimaging findings usually occurs within days to weeks.²

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References

1. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427-432.

2. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494-500.

3. Staykov D, Schwab S. Posterior reversible encephalopathy syndrome. J Intensive Care Med. 2012;27(1):11-24.

4. Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol. 2002;23(6):1038-1048.

5. Leroux G, Sellam J, Costedoat-Chalumeau N, et al. Posterior reversible encephalopathy syndrome during systemic lupus erythematosus: four new cases and review of the literature. Lupus. 2008;17(2):139-147.

6. Mak A, Chan BP, Yeh IB, et al. Neuropsychiatric lupus and reversible posterior leucoencephalopathy syndrome: a challenging clinical dilemma. Rheumatology (Oxford). 2008;47(3):256-262.

7. Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2(2):161-192.

8. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356(9227):411-417.

9. Arnoldus EP, Van Laar T. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(26):1745; author reply 1746.

10. Datar S, Singh T, Rabinstein AA, Fugate JE, Hocker S. Long-term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome. Epilepsia. 2015;56(4):564-568.

11. Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159(2):379-383.

12. Roth C, Ferbert A. Posterior reversible encephalopathy syndrome: long-term follow-up. J Neurol Neurosurg Psychiatry. 2010;81(7):773-777.

This article originally appeared on Neurology Advisor