What is reversible posterior leukoencephalopathy (RPLE) during pregnancy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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RPLE [8] is also known as reversible posterior leukoencephalopathy syndrome (RPLS) and posterior reversible (leuko-) encephalopathy syndrome (PRES). The 2 most common clinical presentations of RPLE in pregnant women are seizures and postpartum blindness.

RPLE is probably best understood as a condition in which cerebral autoregulation of blood pressure is overwhelmed, usually because of a rapid rise in blood pressure. [10] Vasogenic edema occurs in vulnerable regions. The posterior circulation territory is thought to be most vulnerable because it has a relatively poor ability to autoregulate. [11] Other regions may be involved, and RPLE occasionally affects gray matter.

RPLE is usually identified in settings of hypertensive encephalopathy. Patients with renal failure, those with eclampsia or peripartum seizures, and those taking immunosuppressant or cytotoxic medications are especially susceptible. Metabolic imbalances (eg, hypomagnesemia) and fluid overload may lower the threshold for precipitation of RPLE by rapidly elevating the patient’s blood pressure.

With appropriate treatment to control blood pressure, clinical and imaging abnormalities usually resolve fairly rapidly. If left untreated, RPLE may progress to permanent infarct or intraparenchymal bleeding.

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