Clinical spectrum of reversible posterior leukoencephalopathy syndrome

Pediatr Neurol. 2001 May;24(5):361-4. doi: 10.1016/s0887-8994(01)00265-x.


Reversible posterior leukoencephalopathy syndrome is a recently recognized disorder with characteristic radiologic findings that mainly involve the white/gray matter of the parieto-occipital lobes. This complex syndrome is associated with cyclosporine A therapy or a variety of other conditions in which blood pressure rises acutely. Twelve patients from a variety of conditions who met the diagnostic criteria for this syndrome were studied. Interestingly, three of these patients had intra-abdominal neurogenic tumors, which have rarely been reported. Initial cranial magnetic resonance imaging scans revealed fairly symmetric areas of increased T(2) signal involving both white and gray matter of parieto-occipital lobes in the majority of the patients. However, the lesions were often located outside the parieto-occipital regions. Four patients had occipital region magnetic resonance spectroscopy during the acute phase, which revealed high lactate peak and normal N-acetyl aspartate/creatine and choline peaks. With appropriate treatment, most patients recovered from this syndrome and experienced almost complete resolution of brain lesions on follow-up magnetic resonance imaging. One patient, however, continued to have small residual hemosiderin deposits on a follow-up magnetic resonance imaging with neurologic sequellae. In conclusion, a better understanding of this complex syndrome may obviate unnecessary investigations and allow management of the associated problems in prompt and appropriate ways.

MeSH terms

  • Adolescent
  • Adult
  • Blood-Brain Barrier / physiology*
  • Brain Edema / diagnosis*
  • Brain Edema / etiology
  • Child
  • Child, Preschool
  • Cyclosporine / adverse effects
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Hemosiderin / metabolism
  • Humans
  • Lactic Acid / metabolism
  • Magnetic Resonance Imaging*
  • Magnetic Resonance Spectroscopy*
  • Male
  • Neurologic Examination
  • Occipital Lobe / pathology*
  • Parietal Lobe / pathology*
  • Remission, Spontaneous
  • Risk Factors
  • Syndrome


  • Lactic Acid
  • Cyclosporine
  • Hemosiderin