Reversible bilateral pyramidal tract lesions after hypertensive crisis and cerebral seizures

Abstract This is a rare case of reversible high signal-intensity changes along the pyramidal tracts in a patient with reversible posterior leukoencephalopathy syndrome (RPLS). A 38-year-old man was admitted to hospital for loss of consciousness and generalized seizures. His systolic blood pressure w...

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Bibliographic Details
Published in:Journal of neuroradiology 2007-12, Vol.34 (5), p.340-343
Main Authors: Bink, A, Weidauer, S, Hermans, M, Kell, C, Lanfermann, H
Format: Article
Language:English
Subjects:
Adult
Convulsion
Crise hypertensive
Epilepsy, Tonic-Clonic - etiology
Epilepsy, Tonic-Clonic - pathology
Epilepsy, Tonic-Clonic - therapy
Faisceaux pyramidaux
Humans
Hypertension, Malignant - etiology
Hypertension, Malignant - pathology
Hypertension, Malignant - therapy
Hypertensive crisis
Leucoencéphalopathie postérieure réversible
Magnetic Resonance Imaging
Male
Posterior Leukoencephalopathy Syndrome - complications
Posterior Leukoencephalopathy Syndrome - pathology
Posterior Leukoencephalopathy Syndrome - therapy
Pyramidal tracts
Pyramidal Tracts - pathology
Radiology
Reversible posterior leukoencephalopathy syndrome
Seizures
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Summary:Abstract This is a rare case of reversible high signal-intensity changes along the pyramidal tracts in a patient with reversible posterior leukoencephalopathy syndrome (RPLS). A 38-year-old man was admitted to hospital for loss of consciousness and generalized seizures. His systolic blood pressure was 220 mmHg. Neurological examination revealed bilateral pyramidal-tract signs, and paresis of the right arm. Initial MRI showed increased signal intensities on T2-weighted, FLAIR and diffusion-weighted imaging in the following regions: bilateral temporo-occipital white matter and cortex, dorsal parts of the lentiform nuclei, bilateral caudate nuclei and external capsule. High signal intensities were observed in the pyramidal tracts as well. On patient follow-up, MRI signal abnormalities and clinical symptoms were completely resolved after antihypertensive treatment.
ISSN:0150-9861
DOI:10.1016/j.neurad.2007.09.002