A Case of Reversible Posterior Leukoencephalopathy Syndrome Resulted from Malignant Hypertension

概要

論文の詳細を見る
This is a case of reversible posterior leukoencephalopathy syndrome that was caused by malignant hypertension. A 47-year-old man was admitted to our hospital because of somnolence. He had no neurological focal signs except anisocoria on admission. His blood pressure was 260/170mmHg, and he had bilateral retinal hemorrhage. Plain brain computed tomography (CT) and flair magnetic resonance imaging (MRI) on admission showed diffuse edema in the white matter of bilateral parieto-occipital lesion. By contrast, no abnormalities were found on diffusion weighted MRI. He was diagnosed as hypertensive encephalopathy, and treated with vasodilating agents. He became alert two weeks after admission, and the abnormal findings on CT and MRI disappeared two months after admission. The biopsy findings of the kidney showed proliferative arteriosclerosis compatible with malignant hypertension. Thus, we concluded that he developed a reversible posterior leukoencephalopathy due to malignant hypertension. Combilation of diffusion weighted MRI and Flair MRI could make it possible to distinguish cytotoxic edema from vasogenic edema. Vasogenic edema is reversible and has good prognosis. Diffusion weighted MRI on admission may help early diagnosis of vasogenic edema, and be useful for decision making in an emergency department.
一般社団法人日本救急医学会の論文