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• Vol.45 No.4
• CLINICA NEUROL, 45: 317−320, 2005
• Vol.45 No.4 contents

Brief Clinical Note

31-year-old gravid woman of reversible posterior leukoencephalopathy syndrome associated with HELLP syndrome after labor

Yu Kono, M.D.¹⁾²⁾, Tomoki Nakamori, M.D.¹⁾, Ichiro Imafuku, M.D.¹⁾, Masanari Kunimoto, M.D.¹⁾³⁾, Miki Takei, M.D.⁴⁾⁵⁾ and Tokuo Kusaba, M.D.⁴⁾⁶⁾

¹⁾Department of Neurology, Yokohama Rosai Hospital
²⁾Department of Neurology, The Jikei University School of Medicine
³⁾Department of Neurology, International Medical Center of Japan
⁴⁾Department of Gynecology and Obstetrics, Yokohama Rosai Hospital
⁵⁾Department of Obstetrics, Kanagawa Children's Medical Center
⁶⁾Department of Gynecology and Obstetrics, Kanagawa Clinic

We report on a 31-year-old gravid woman with reversible posterior leukoencephalopathy syndrome (RPLS) associated with HELLP syndrome. The patient was hospitalized and underwent an emergency cesarean section at the 34th week of pregnancy due to severe toxemia. After labor her blood pressure acutely increased to 180/100 mmHg and a generalized convulsion occurred. Laboratory data revealed hemolysis, elevated liver enzymes, and low platelets, consistent with HELLP syndrome. FLAIR and Apparent Diffusion Coefficient images on MRI showed hyperintense lesions bilaterally in the posterior white matter, however Diffusion-Weighted images revealed slightly hyperintense changes in the same locations. With the use of diltiazem for blood pressure control, and anticonvulsants, convulsions disappeared and consciousness level improved. Moreover the MRI abnormalities also improved after therapy. This case was diagnosed as RPLS associated with HELLP syndrome and is the first case of an investigation utilizing Diffusion-Weighted and Apparent Diffusion Coefficient images to establish this diagnosis. Based on these results, possible mechanisms of RPLS may be vasogenic edema mediated by a cerebrovascular endothelial disturbance of cerebral vessels and a rapid blood-pressure increase due to HELLP syndrome.

(CLINICA NEUROL, 45: 317−320, 2005)
key words: HELLP syndrome, reversible posterior leukoencephalopathy syndrome, Apparent Diffusion Coefficient images, Diffusion-Weighted images, vasogenic edema

(Received: 1-Mar-04)