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Neuroradiology
Published in: Neuroradiology 12/2003

01-12-2003 | Diagnostic Neuroradiology

Posterior encephalopathy with vasospasm: MRI and angiography

Authors: S. Weidauer, J. Gaa, M. Sitzer, R. Hefner, H. Lanfermann, F. E. Zanella

Published in: Neuroradiology | Issue 12/2003

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Abstract

Posterior encephalopathy is characterised by headache, impairment of consciousness, seizures and progressive visual loss. MRI shows bilateral, predominantly posterior, cortical and subcortical lesions with a distribution. Our aim was to analyse the MRI lesion pattern and angiographic findings because the pathophysiology of posterior encephalopathy is incompletely understood. We report three patients with clinical and imaging findings consistent with posterior encephalopathy who underwent serial MRI including diffusion-weighted imaging (DWI) and construction of apparent diffusion coefficient (ADC) maps, and four-vessel digital subtraction angiography (DSA). DWI revealed symmetrical subcortical and cortical parieto-occipital high signal. High and also low ADCs indicated probable vasogenic and cytotoxic oedema. On follow-up there was focal cortical laminar necrosis, while the white-matter lesions resolved almost completely, except in the arterial border zones. DSA revealed diffuse arterial narrowing, slightly more marked in the posterior circulation. These findings suggest that posterior encephalopathy may in some cases be due to diffuse, severe vasospasm affecting especially in the parieto-occipital grey matter, with its higher vulnerability to ischemia. Cerebral vasospasm due to digitoxin intoxication, resulting in posterior encephalopathy, has not yet been described previously.
Literature
1.
Casey S, Sampaio RC, Michel E, Truwit CL (2000) Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR 21: 1199–1206
2.
Schwartz RB, Feske SK, Polak JF, et al (2000) Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology 217: 371–376PubMed
3.
Hinchey J, Chaves C, Appignani B, et al (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334: 494–500PubMed
4.
Schaefer PW, Buonanno FS, Gonzalez RG, Schwamm LH (1997) Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke 28: 1082–1085PubMed
5.
Pavlakis SG, Frank Y, Chusid R (1999) Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathy: three names for an old syndrome. J Child Neurol 14: 277–281
6.
Ay H, Buonanno FS, Schäfer PW, Le DA, Wang B, Gonzales RG, Koroshetz WJ (1998) Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology 53: 1372–1373
7.
Antunes NL, Small TN, George D, Boulad F, Lis E (1999) Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol 20: 241–243CrossRefPubMed
8.
Covarrubias DJ, Luetmer PH, Campeau NG (2002) Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR 23: 1038–1048
9.
Sengar AR, Gupta RA, Dhanuka AK, Roy R, Das K (1997) MR imaging, MR angiography, and MR spectroscopy of the brain in eclampsia. AJNR 18: 1485–1490
10.
Schwartz RB, Bravo SM, Klufas RA, et al (1995) Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. Am J Roentgenol 165: 627–631PubMed
11.
Gijtenbeek JM, van den Bent MJ, Vecht CJ (1999) Cyclosporine neurotoxicity: a review. J Neurol 246: 339–346PubMed
12.
Lewis MB (1999) Cyclosporine neurotoxicity after chemotherapy: cyclosporine causes reversible posterior leukoencephalopathy syndrome. Br Med J 319: 54–55
13.
Lin JT, Wang SJ, Fuh JL, Hsiao LT, Lirng JF, Chen PM (2003) Prolonged reversible vasospasm in cyclosporine A-induced encephalopathy. AJNR 24: 102–104
14.
Kastrup O, Maschke M, Wanke I, Diener HC (2002) Posterior reversible encephalopathy syndrome due to severe hypercalcemia. J. Neurol 249: 1563–1566PubMed
15.
Utz N, Kinkel B, Hedde JP, Bewermeyer H (2001) MR imaging of acute intermittent porphyria mimicking reversible posterior leukoencephalopathy syndrome. Neuroradiology 43: 1059–1062PubMed
16.
Celik M, Forta H, Dalkilic T, Babacan G (2002) MRI reveals reversible lesions resembling posterior reversible encephalopathy in porphyria. Neuroradiology 44: 839–841CrossRefPubMed
17.
Russell MT, Nassif AS, Cacyorin ED, Awwad E, Perman W, Dunphy F (2001) Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings. Magn Reson Imaging 19: 129–132CrossRefPubMed
18.
Ito Y, Arahata Y, Goto Y, Hirayama M (1998) Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome. AJNR 19: 415–417
19.
Raps EC, Galetta SL, Broderick M, Atlas SW (1993) Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol 33: 222–225PubMed
20.
Lewis LK, Hinshaw DB, Will AD, Hasso AN, Thompson JR (1988) CT and angiographic correlation of severe neurological disease in toxemia of pregnancy. Neuroradiology 30: 59–64PubMed
21.
Ito T, Sakai T, Inagawa S, Utsu M, Bun T (1995) MR angiography of cerebral vasospasm in preeclampsia. AJNR 16: 1344–1346
22.
Coughlin WF, McMurdo K, Reeves T (1989) MR imaging of postpartum cortical blindness. J Comput Assist Tomogr 13: 572–576PubMed
23.
Zunker P, Golombeck K, Brossmann J, Georgiadis D, Deuschl G (2002) Post-partum cerebral angiopathy: repetitive TCD, MRI, MRA and EEG examinations. Neurol Res 24: 570–572PubMed
24.
Schäfer PW, Gonzales RG, Hunter G, Wang B, Koroshetz WJ, Schwamm LH (2001) Diagnostic value of apparent diffusion coefficient hyperintensity in selected patients with acute neurologic deficits. J Neuroimaging 11: 369–380PubMed
25.
Engelter ST, Provenzale JM, Petrella JR (2000) Assessment of vasogenic edema in eclampsia using diffusion imaging. Neuroradiology 42: 818–820
26.
Provenzale JM, Petrella JR, Cruz LCH, Wong JC, Engelter S, Barboriak DB (2001) Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome. AJNR 22: 1455–1461
27.
Manfredi M, Beltramello A, Bongiovanni LG, Polo A, Pistoia L, Rizzuto N (1997) Eclamptic encephalopathy: imaging and pathogenetic considerations. Acta Neurol Scand 96: 277–282PubMed
28.
Port JD, Beauchamp NJ (1998) Reversible intracerebral pathologic entities mediated by vascular autoregulatory dysfunction. Radiographics 18: 353–367PubMed
29.
Higman MA, Port JD, Beauchamp NJ, Chen AR (2000) Reversible leukoencephalopathy associated with re-infusion of DMSO preserved stem cells. Bone Marrow Transplant 26: 797–800CrossRefPubMed
30.
Giminez-Mesa E, Martinez-Salio A, Porta-Etessam J, Berbel Garcia A, Cedena Romero T, Salam Bendoyan P (2001) Reversible posterior leukoencephalopathy in a patient with non-Hodgkin lymphoma after treatment with CHOP. Ann Med Intern 18: 591–593
31.
Dillon WP, Rowley H (1998) The reversible posterior cerebral edema syndrome. AJNR 19: 591
32.
Sundgren PC, Edvardsson B, Holtås S (2002) Serial investigation of perfusion disturbances and vasogenic oedema in hypertensive encephalopathy by diffusion and perfusion weighted imaging. Neuroradiology 44: 299–304CrossRefPubMed
33.
Henderson RD, Rajah T, Nicol AJ, Read SJ (2003) Posterior leukoencephalopathy following intrathecal chemotherapy with MRA-documented vasospasm. Neurology 60: 326–328
34.
Heo K, Park SA, Lee JY, Lee BI, Lee SK (2003) Post-transfusion posterior leukoencephalopathy with cytotoxic and vasogenic edema precipitated by vasospasm. Cerebrovasc Dis 15: 230–233CrossRefPubMed
35.
Cunningham FG, Fernandez CO, Hernandez C (1995) Blindness associated with preeclampsia and eclampsia. Am J Obstet Gynecol 172: 1291–1298PubMed
36.
Trommer BL, Homer D, Mikhael MA (1988) Cerebral vasospasm and eclampsia. Stroke 19: 326–329PubMed
37.
Coley SC, Porter DA, Calamante F, Chong WK, Connelly A (1999) Quantitative MR diffusion mapping and cyclosporine-induced neurotoxicity. AJNR 20: 1507–1510
38.
Mukherjee P, McKinstry RC (2001) Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging. Radiology 219: 756–765PubMed
39.
Sticherling C, Berkefeld J, Auch-Schwelk W, Lanfermann H (1998) Transient bilateral cortical blindness after coronary angiography. Lancet 351: 570
40.
Zwicker JC, Sila CA (2002) MRI findings in a case of transient cortical blindness after cardiac catheterisation. Cathet Cardiovasc Intervent 57: 47–49CrossRef
41.
Tuxhorn I, Holthausen H, Ebener A, Noachtar S (1994) Reversible cortical edema mimicking cortical dysplasia in mitochondrial disorder. J Neurol Neurosurg Psychiatry 57: 1439
42.
Yaffe K, Ferriero D, Barkovich AJ, Rowley H (1995) Reversible MRI abnormalities following seizures. Neurology 45: 104–108PubMed
43.
de Bruijn SFTM, de Haan RJ, Stam J (2001) Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. J Neurol Neurosurg Psychiatry 70: 105–108CrossRefPubMed
44.
Caplan LR (1980) “Top of the basilar” syndrome. Neurology 30: 72–79PubMed
45.
Uson-Martin M, Gracia-Naya M (1999) Top of the basilar artery syndrome: clinico-radiological aspects of 25 patients. Rev Neurol 28: 698–701
46.
Osborn AG (1994) Diagnostic neuroradiology. Mosby, St Louis, pp 373–378
47.
Harris KG, Tran DD, Sickels WJ, Cornell SH, Yuh WTC (1994) Diagnosing intracranial vasculitis: the roles of MR and angiography. AJNR 15: 317–330
48.
Moore PM, Richardson B (1998) Neurology of the vasculitides and connective tissue diseases. J Neurol Neurosurg Psychiatry 65: 10–22
49.
Pomper MG, Miller TJ, Stone HJ, Tidmore WC, Hellmann DB (1999) CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. AJNR Neuroradiol 20: 75–85
50.
Ohkuma H, Suzuki S, Shimamura N, Nakano T (2003) Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features. Neuroradiology 45: 143–148PubMed
Metadata
Title
Posterior encephalopathy with vasospasm: MRI and angiography
Authors
S. Weidauer
J. Gaa
M. Sitzer
R. Hefner
H. Lanfermann
F. E. Zanella
Publication date
01-12-2003
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 12/2003
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-003-1059-0

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