Syed Ali Abbas, S Salkeen, Salahuddin Afsar.
Posterior Leukoencephalopathy Syndrome.
J Coll Physicians Surg Pak Jan ;12(4):253-4.

We report a case of posterior leukoencephalopathy in a 23 years old pregnant female who presented with eclampsia and later developed right hemiparesis with upper motor neuron type facial weakness on same side. With control of her blood pressure, her neurological signs started improving after three days and repeat CT scan after ten days showed complete resolution of white matter changes which were noticed earlier.

Case Report: A 23 years old pregnant female was brought at full term with history of multiple episodes of generalized tonic clonic seizures and unconsciousness for more than 20 hours. She had no antenatal medical checkup and had three prior uneventful deliveries at home, the last one was six years back which followed two abortions in first trimester. Rest of the history was unremarkable. On examination she had a blood pressure of 220/110 mmHg, pulse rate 114/min, respiratory rate 24/min and temperature of 99°F. She also had mild volume depletion, pallor and bilateral pitting edema. She was deeply unconscious with minimal response to maximal painful stimulus. Her complete blood count showed microcytic hypochromic anemia with 6.5 gm% hemoglobin, normal white cell and platelet counts. Urine examination revealed moderate albuminurea. Renal function test, coagulation screen and chest x-ray were normal. A provisional diagnosis of eclampsia was made, she was treated accordingly. Urgent delivery of an alive fetus was planned. After few episodes of uncontrolled seizures the fetus died in uterus and was later delivered through forceps application. Six hours postdelivery she regained consciousness, was still hypertensive and a review examination revealed right-sided hemiplegia with upper motor neuron type facial nerve involvement on the same side. Both fundi were normal. A CT scan of brain was done which showed areas of white matter low attenuation in left parietal and both occipital regions without any postcontrast enhancement. Her antihypertensive medications were optimized to control blood pressure to acceptable range. Later on she had no convulsive fits and had good control of her blood pressure. By third day there was improvement in power on right side. Ten days later she had regained full power on right side and facial weakness had disappeared. A follow-up CT scan at this time showed almost complete reversal of changes in areas of white matter which were seen in prior scan (Figure 2).

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