[Posterior reversible encephalopathy syndrome: some case reports]. / Sindrome de encefalopatía posterior reversible: presentación de casos clínicos.

INTRODUCTION: In 1996, Hinchey et al described a clinico-radiological picture they called posterior reversible leukoencephalopathy syndrome (PRLS), which is characterized by visual disorders, seizures, altered mental states and changes in the subcortical white matter of the temporoparietooccipital lobes that are shown up in the neuroimages. These clinical manifestations are associated with arterial hypertension. Later, other triggering elements, such as cytostatic drugs, were described without being linked to hypertension. Other authors have suggested the name of posterior reversible encephalopathy, since magnetic resonance imaging (MRI) reveals a high percentage of cortical compromise. CASE REPORTS: We present three cases of posterior reversible encephalopathy with different origins. Two of the cases involved females, one of whom was a 19-year-old hypertensive with lupus nephropathy and the other was a 33-year-old with eclampsia. The third case was an 11-year-old male child with post streptococcal glomerulonephritis and hypertension. The most relevant signs and symptoms included seizures, visual disorders, arterial hypertension and sensory deterioration. MR played a decisive role in diagnosis and it revealed an alteration of the signal in the supra and infratentorial white matter of the cortex and the subcortex, which was predominant in the posterior areas of the encephalon. The three cases presented a significant radiological and clinical improvement in a short time. CONCLUSION: Failure of the self regulation of cerebral vascular circulation, with development of oedema, is the most widely accepted hypothesis to explain the pathophysiological mechanism at work in this entity.

Síndrome de encefalopatía posterior reversible: presentación de casos clínicos / Posterior reversible encephalopathy syndrome: some case reports

Introducción. En 1996, Hinchey et al describieron un cuadro clinicorradiológico al que denominaron síndrome de leucoencefalopatía posterior reversible (SLPR), que se caracterizaba por trastornos visuales, convulsiones, alteraciones del estado mental y cambios de la sustancia blanca subcortical de los lóbulos temporoparietooccipitales en las neuroimágenes. Estas manifestaciones clínicas se asociaban a la hipertensión arterial. Posteriormente, se describieron otros desencadenantes, como medicamentos citostáticos, sin que se asociaran a un cuadro hipertensivo. Otros autores propusieron el nombre de encefalopatía posterior reversible, tras detectar un elevado porcentaje de afectación cortical en imágenes de resonancia magnética (RM). Casos clínicos. Presentamos tres casos de encefalopatía posterior reversible de diferentes etiologías: dos mujeres, una hipertensa con nefropatía lúpica de 19 años de edad, y la otra de 33 años con eclampsia; el tercer caso es un niño varón de 11 años de edad con glomerulonefritis postestreptocócica e hipertensión. Las convulsiones, las alteraciones visuales, la hipertensión arterial y el deterioro del sensorio fueron los síntomas y signos relevantes. La RM fue decisiva en el diagnóstico; mostró una alteración de la señal de la sustancia blanca, subcortical y cortical, supratentorial e infratentorial, que predominaba en las áreas posteriores del encéfalo. Los tres casos presentaron una mejoría significativa clínica y radiológica en poco tiempo. Conclusión. La hipótesis más aceptada como mecanismo fisiopatológico en esta entidad es la ruptura de la autorregulación vascular cerebral, con desarrollo de edema (AU)

Introduction. In 1996, Hinchey et al described a clinico-radiological picture they called posterior reversible leukoencephalopathy syndrome (PRLS), which is characterized by visual disorders, seizures, altered mental states and changes in the subcortical white matter of the temporoparietooccipital lobes that are shown up in the neuroimages. These clinical manifestations are associated with arterial hypertension. Later, other triggering elements, such as cytostatic drugs, were described without being linked to hypertension. Other authors have suggested the name of posterior reversible encephalopathy, since magnetic resonance imaging (MRI) reveals a high percentage of cortical compromise. Case reports. We present three cases of posterior reversible encephalopathy with different origins. Two of the cases involved females, one of whom was a 19-year-old hypertensive with lupus nephropathy and the other was a 33 year old with eclampsia. The third case was an 11-year-old male child with post-streptococcal glomerulonephritis and hypertension. The most relevant signs and symptoms included seizures, visual disorders, arterial hypertension and sensory deterioration. MR played a decisive role in diagnosis and it revealed an alteration of the signal in the supra and infratentorial white matter of the cortex and the subcortex, which was predominant in the posterior areas of the encephalon. The three cases presented a significant radiological and clinical improvement in a short time. Conclusion. Failure of the selfregulation of cerebral vascular circulation, with development of oedema, is the most widely accepted hypothesis to explain the pathophysiological mechanism at work in this entity (AU)