High Blood Pressure and Reversible Strokes

A man describing his headache to his doctor

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A syndrome that is known as reversible posterior leukoencephalopathy syndrome, or RPLS, is a rare, stroke-like condition caused by swelling in the brain. Reversible posterior leukoencephalopathy is usually associated with an episode of extremely high blood pressure or with the use of some drugs. However, the syndrome may develop in an unpredictable way before it resolves. And, because it is never guaranteed that a stroke or a stroke-like episode will eventually resolve, it is important to get medical attention for neurological symptoms. If you have been told that you or a loved one has had RPLS, you probably have a few questions about it.

About RPLS

This condition is considered a syndrome, or a constellation of symptoms that typically occur together and are caused by one or more etiologies (origins of illness or disease). The regions of the brain affected by this syndrome are located mostly in the back of the brain. In the case of RPLS, it is the white matter of the brain that is most predominantly affected. One of the characteristics of RPLS is that it is reversible in the majority of cases, which means that this condition is temporary and that its symptoms and MRI findings are transient.

Leukoencephalopathy is defined as a clouding of consciousness, confusion, or an altered mental state due to a condition that affects a large region of the brain.

Variability of RPLS

As it turns out, the symptoms observed with this condition are not as clearly defined as its acronym implies, as 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%). But not all cases of RPLS are reversible, posterior, or related to swelling in the white matter. So almost any area of the brain can be affected by RPLS, and other stroke symptoms might 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, an MRI of the brain, and the presence of high blood pressure around the time of the event. One research study, however, shows that some people might suffer from RPLS in the presence of normal blood pressure. This may occur in a condition called eclampsia, which most often is associated with late pregnancy or labor and delivery. Encephalopathy and 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 of the brain on both the left and right sides. However, in some cases, RPLS can involve areas in the front of the brain or other regions of the brain, and it may even involve 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. Additionally, 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 the 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 might be residual symptoms from brain damage.

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