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reversible posterior leukoencephalopathy syndrome (RPLS)
Etiology:
- cytotoxic drugs: bevacizumab, cyclosporine, tacrolimus
- severe hypertension
- eclampsia
- risk factors/comorbid conditions
a) hypertension (53%)
b) renal disease (45%)
c) malignancy (32%)
b) bone marrow or solid organ transplantation (24%)
Pathology:
- cytotoxic effects of immunosuppressive drugs on the vascular endothelium
Clinical manifestations:
1) may present with: headache (53%), seizure (87%), lethargy, confusion, blindness & other visual & neurologic disturbances (40%)
2) most patients have encephalopathy (92%)
3) may occur 16 hours to 1 year after administration of bevacizumab
4) hypertension generally present
5) fluid retention
Radiology:
- magnetic resonance imaging of brain
a) abnormalities in posterior regions of the brain consistent with subcortical white matter vasogenic edema
b) anterior involvement or cortical lesions observed in > 50% of cases
c) follow-up MRI after resolution of symptoms shows resolution of imaging abnormalities, with permanent injury noted in ~25% of cases
General
leukoencephalopathy
syndrome
References
- Hinchey J et al,
A reversible posterior leukoencephalopathy syndrome
NEJM 1996, 334:494
PMID: 8559202
- FDA MedWatch
http://www.fda.gov/medwatch/safety/2006/safety06.htm#Avastin
- Lee VH et al,
Clinical spectrum of reverible posterior leukoencephalopathy
syndrome.
Arch Neurol 2008, 65:205
PMID: 18268188
- PubMed Search
PubMed search: reversible+posterior+leukoencephalopathy+syndrome