Reversible Leukoencephalopathy—A Differential Diagnosis Beyond Posterior Reversible Encephalopathy Syndrome

Abstract

Prodromic or acute visual symptoms are characteristic of many reversible white matter syndromes, which may motivate consultation with an ophthalmologist or neuro-ophthalmologist. The imaging differential diagnosis of reversible leukoencephalopathy of unknown aetiology has a broad differential diagnosis, including posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome, toxic leukoencephalopathy, migraine, postictal reversible oedema, neuromyelitis optica, and acute disseminated encephalomyelitis. This report presents a case study of a patient presenting with visual dysfunction associated with transient white matter lesions, with a review of the current literature regarding reversible leukoencephalopathy.

KEYWORDS::

• Encephalitis
• Loss of consciousness
• PRES
• Scotoma

ACKNOWLEDGEMENTS

The author is grateful for the CADASIL skin biopsy by Johann Gudjonsson, MD, PhD, and John Voorhees, MD, of the University of Michigan, Department of Dermatology, and Mila Blaivas, MD, PhD, of the University of Michigan, Department of Pathology, for electron microscopy of the biopsy.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. Eric Tkaczyk, MD, PhD, was supported by National Institutes of Health grant T32 GM007863 during this work at the University of Michigan. He is now an Associate Professor at the University of Tartu, in Estonia.

Note: Supplementary Material is available online at www.informahealthcare.com/oph