REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY OR BRAIN TUMOR – CASE REPORT

Sindrom reverzibilne posteriorne leukoencefalopatije klinički se prezentira glavoboljom, konfuzijom, epileptičkim napadajima i smetnjama vida. Na magnetskoj rezonanciji (MR) mozga vidljiv je edem koji zahvaća bijelu tvar parijetookcipitalnih regija. U početku je taj sindrom etiološki bio povezan uz arterijsku hipertenziju, bubrežne bolesti i imunosupresivnu terapiju. U posljednje vrijeme prepoznati su i drugi uzroci poput eklampsije, hemolitičko-uremičkog sindroma, bolesti vezivnog tkiva, malignih bolesti itd. Autori opisuju slučaj 72-godišnje bolesnice s anamnezom dugogodišnje oscilatorne arterijske hipertenzije koja je naglo izazvala smeteno stanje popraćeno glavoboljom, lijevom homonimnom hemianopsijom i lijevom hemiparezom, povezano s naglim povišenjem vrijednosti krvnog tlaka. Na MR-u mozga opisana je opsežna lezija bijele tvari, koja je zahvaćala desni parijetalni i okcipitalni režanj, splenijum korpusa kalozuma i lijevi okcipitalni režanj, poglavito suspektna na ekspanzivni proces. Međutim, nakon opsežne dijagnostičke obrade postavljena je dijagnoza reverzibilne posteriorne leukoencefalopatije, etiološki povezane s arterijskom hipertenzijom. Bolesnica je trenutačno uredna neurološkog statusa, kontrolni MR mozga pokazao je potpunu regresiju opisane lezije bijele tvari.Reversible posterior leukoencephalopathy (RPLE) syndrome is clinically associated with headache, altered consciousness, seizures and visual symptoms. On brain magnetic resonance imaging (MRI) there is edema predominantly affecting white matter of the parietooccipital brain regions. Initially, this syndrome was believed to be secondary to hypertension, renal disease, or immunosuppressive therapy. However, it has recently been identified in a wide variety of conditions, including eclampsia, hemolytic-uremic syndrome, connective tissue diseases, malignancies, etc. Authors describe a case of a 72-year-old woman with a history of arterial hypertension, who suddenly developed headache, confusion, left homonymous hemianopsia, and left hemiparesis, associated with high blood pressure. Brain MRI revealed extensive white matter lesion in the right parietal and occipital lobe, splenium corpus callosum and left occipital lobe, suggestive of expansive process. However, after extensive diagnostic work-up, diagnosis of reversible posterior leukoencephalopathy was established, connected with arterial hypertension. At the moment the patient is without neurological symptoms, follow-up brain MRI revealed resolution of white matter lesion