reversible posterior leukoencephalopathy syndrome (RPLS)
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Etiology
- cytotoxic drugs: bevacizumab, cyclosporine, tacrolimus
- severe hypertension
- eclampsia
- risk factors/comorbid conditions
- hypertension (53%)
- renal disease (45%)
- malignancy (32%)
- bone marrow or solid organ transplantation (24%)
Pathology
- cytotoxic effects of immunosuppressive drugs on the vascular endothelium
Clinical manifestations
- may present with: headache (53%), seizure (87%), lethargy, confusion, blindness & other visual & neurologic disturbances (40%)
- most patients have encephalopathy (92%)
- may occur 16 hours to 1 year after administration of bevacizumab
- hypertension generally present
- fluid retention
Radiology
- magnetic resonance imaging of brain
- abnormalities in posterior regions of the brain consistent with subcortical white matter vasogenic edema
- anterior involvement or cortical lesions observed in > 50% of cases
- follow-up MRI after resolution of symptoms shows resolution of imaging abnormalities, with permanent injury noted in ~25% of cases
More general terms
References
- ↑ Hinchey J et al, A reversible posterior leukoencephalopathy syndrome NEJM 1996, 334:494 PMID: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/18268188
- ↑ PubMed Search PubMed search: reversible+posterior+leukoencephalopathy+syndrome