High Blood Pressure and "Reversible" Strokes

A man describing his headache to his doctor

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Reversible posterior leukoencephalopathy syndrome, or RPLS, is a rare, stroke-like condition caused by swelling in the brain. It may also be called posterior reversible encephalopathy syndrome, or PRES.

RPLS is usually associated with an episode of extremely high blood pressure or with the use of some drugs. It's called "reversible" because, in many cases, it's not permanent. However, it can still occasionally be a very serious, even fatal condition, and the syndrome may develop in an unpredictable way before it resolves. In addition, because it is never guaranteed that a stroke or a stroke-like episode will eventually resolve, it is always important to get medical attention for neurological symptoms.

About RPLS

If you have been told that you or a loved one has RPLS, you probably have a few questions about it.

This condition is considered a syndrome, or a constellation of symptoms that typically occur together and have one or more etiologies (origins of illness or disease). The areas of the brain affected by this syndrome are generally located in the back of the brain (the posterior region), although it can affect other regions as well. In the case of RPLS, it is the brain's white matter that is most affected: leukoencephalopathy means disorders involving the brain's white matter. One of the characteristics of RPLS is that it resolves in the majority of cases, which means its symptoms and MRI findings are transient.

Variability of RPLS

As it turns out, the symptoms observed with this condition are not as clearly defined as its acronym implies. RPLS has been shown to cause a variety of symptoms, all of which have a wide spectrum of severity and duration. The most common of these, as reported by one study, include encephalopathy (92%), seizures (87%), headaches (54%), and visual problems (39%). However, other symptoms may also be present.

Diagnosis

The diagnosis of RPLS is made through a careful medical workup, which includes a careful history of the symptoms experienced by the patient, a neurological physical examination, and an MRI of the brain. The presence of high blood pressure around the time of the event is also an important sign: while your blood pressure may be normal during your exam, it is generally a sudden, significant change in blood pressure that can cause this condition.

Some research also shows that some people might suffer from RPLS in the presence of normal blood pressure. This may occur in a condition called eclampsia, which is most often associated with late pregnancy or labor and delivery. Leukoencephalopathy can also occur in people who use certain medications.

Typically, the MRI of the brain of patients with RPLS shows an appearance of swelling in the white matter of the posterior region on both the left and right sides. However, in some cases, RPLS can involve areas in the front or other areas of the brain, and it may even affect the gray matter. Furthermore, many cases of RPLS have left survivors with permanent brain damage, although in most cases a resolution of the swelling does occur. Improvement can typically be confirmed by a follow-up MRI of the brain.

Treatment

The treatment for RPLS is focused on closely controlling blood pressure and fluid levels in the body. For cases associated with certain medications, discontinuation of the offending drug is required. In addition, preventing and treating seizures is an important component of the acute management of this condition. Closely watching symptoms, such as headaches, is an important component of determining urgent changes in your condition.

Prognosis

Typically, symptoms resolve within a few days to weeks after the initial onset of RPLS. However, as with all episodes of stroke or mini-stroke, there may be residual symptoms from brain damage.

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