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Meenakshi-Sundaram et al. Neuroimmunol Neuroinflammation 2017;4:28-32 Neuroimmunology and
DOI: 10.20517/2347-8659.2016.12
Neuroinflammation

www.nnjournal.net
Case Report Open Access

Reversible posterior leukoencephalopathy

syndrome: single photon emission

computerized tomography observations

Salvadeeswaran Meenakshi-Sundaram , Sathyam Senthilnathan , Kaliappan Gurusamy Srinivasan ,
2
1
3
Somalinga Nagendran Karthik , Pandi Suresh , Somasundaram Palanirajan 4
1
1
1 Department of Neurosciences, Apollo Speciality Hospitals, Madurai 625020, Tamil Nadu, India.
2 Department of Nuclear Medicine, Meenakshi Mission Hospital and Research Centre, Madurai 625020, Tamil Nadu, India.
3 KGS Advanced MR and CT Scan Centre, Madurai 625020, Tamil Nadu, India.
4 Department of Nephrology, Apollo Speciality Hospitals, Madurai 625020, Tamil Nadu, India.
Correspondence to: Dr. Salvadeeswaran Meenakshi-Sundaram, Department of Neurosciences, Apollo Speciality Hospitals, Lake View Road, KK
Nagar, Madurai 625020, Tamil Nadu, India. E-mail: drsundarsms@yahoo.com
How to cite this article: Meenakshi-Sundaram S, Senthilnathan S, Srinivasan KG, Karthik SN, Suresh P, Palanirajan S. Reversible posterior
leukoencephalopathy syndrome: single photon emission computerized tomography observations. Neuroimmunol Neuroinflammation 2017;4:28-32.
ABSTRACT
Article history: The authors report clinical correlations of single photon emission computerized tomography
Received: 04-03-2016 (SPECT) findings in reversible posterior leukoencephalopathy (RPL). These are observations
Accepted: 22-12-2016 that have not received wide attention in literature. A 31-year-old hypertensive gentleman, on
Published: 20-02-2017 discontinuing antihypertensive medications, presented with vomiting, headache, focal motor
to bilateral tonic-clonic seizures, altered sensorium, right gaze palsy and right hemiparesis.
Key words: Accelerated hypertension was noted and he improved well with antihypertensive and
Reversible posterior anticonvulsant therapy. While cranial magnetic resonance imaging (MRI) revealed extensive
leukoencephalopathy, bilateral lesions, SPECT imaging revealed perfusion defects involving bilateral basal ganglia,
single photon emission left parieto-occipital, right cerebellar and right occipital regions, which corresponded with
computerized tomography clinical deficits on examination. While MRI is the standard of care for the evaluation of RPL,
imaging, this case suggests that SPECT abnormalities may be better localized to the pathogenic lesions.
accelerated hypertension, Furthermore, this may begin to explain the pathophysiology of injury in RPL.
crossed cerebellar diaschisis

INTRODUCTION included headache, vomiting, confusion, seizures,
cortical blindness and other visual abnormalities.
[1]
The syndrome of reversible posterior Computerized tomography (CT) and magnetic
leukoencephalopathy (RPL) was first described resonance imaging (MRI) studies in these patients
by Hinchey et al. who reported the clinical and revealed extensive bilateral white matter abnormalities
[1]
radiological features in 15 patients. The clinical findings suggestive of subcortical and cortical edema without

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