Document Detail


Occipital lobe seizures as the major clinical manifestation of reversible posterior leukoencephalopathy syndrome: magnetic resonance imaging findings.
MedLine Citation:
PMID:  9578048     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Reversible posterior leukoencephalopathy syndrome (RPLS) is an increasingly recognized brain disorder most commonly associated with malignant hypertension, toxemia of pregnancy, or the use of immunosuppressive agents. When associated with acute hypertension, RPLS typically occurs concurrently with the fulminant clinical syndrome of hypertensive encephalopathy. We describe occipital lobe seizures, in the setting of only moderate elevations of blood pressure, as the major clinical manifestation of RPLS. METHODS: Two patients from the Dent Neurologic Institute are presented with clinical and magnetic resonance imaging (MRI) correlation. RESULTS: New onset secondarily generalized occipital seizures were noted, with MRI findings consistent with RPLS. Both of the patients had chronic renal failure and a moderate acute exacerbation of chronic hypertension. Other features of hypertensive encephalopathy were lacking, such as headache, nausea, papilledema, and an altered sensorium. Magnetic resonance imaging (MRI) showed edematous lesions primarily involving the posterior supratentorial white matter and corticomedullary junction, consistent with RPLS. With lowered blood pressure, the MRI lesions resolved and the patients became seizure-free without requiring chronic anticonvulsant therapy. CONCLUSIONS: Occipital seizures may represent the only major neurologic manifestation of RPLS due to acute hypertension, especially in patients with renal failure. Other evidence of hypertensive encephalopathy, such as cerebral signs and symptoms, need not be present. Blood pressure elevations may be only moderate. Early recognition of this readily treatable cause of occipital seizures may obviate the need for extensive, invasive investigations. Despite the impressive lesions on MRI, prompt treatment of this disorder carries a favorable prognosis.
Authors:
R Bakshi; V E Bates; L L Mechtler; P R Kinkel; W R Kinkel
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Epilepsia     Volume:  39     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-05-22     Completed Date:  1998-05-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  295-9     Citation Subset:  IM    
Affiliation:
Dent Neurologic Institute, Department of Neurology, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain / pathology
Brain Diseases / diagnosis*,  pathology,  physiopathology
Epilepsy, Generalized / diagnosis,  physiopathology
Female
Humans
Hypertension, Malignant / diagnosis*,  physiopathology
Magnetic Resonance Imaging*
Middle Aged
Occipital Lobe / pathology,  physiopathology*
Syndrome
Comments/Corrections
Comment In:
Epilepsia. 1998 Dec;39(12):1381-3   [PMID:  9860079 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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