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November 2008

Irreversible Posterior Leukoencephalopathy

Arch Neurol. 2008;65(11):1545. doi:10.1001/archneur.65.11.1545-a

I read with interest the article by Lee et al.1 They described 38 episodes of reversible posterior leukoencephalopathy syndrome (RPLS) in 36 patients. They defined permanent injury on follow-up magnetic resonance imaging (MRI) as persistent lesions at least 2 weeks after the initial MRI. They found that 10 episodes (26%) resulted in permanent injury on MRI.

They also stated that “clinical recovery” occurred within a mean of 5.3 days. Did they find any evidence of permanent clinical deficits? Did they do any visual acuity or visual field testing among the patients with radiologic injury? Although the figures are small, some of the follow-up MRIs appear to show occipital gray and white matter lesions. Conceivably, these may manifest as permanent visual field deficits with formal perimetry.

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