Reversible posterior leukoencephalopathy in a patient with autonomic dysreflexia: a case report

STUDY DESIGN: Case report.

OBJECTIVES: To report a case of reversible posterior leukoencephalopathy (RPL) in a patient with traumatic cervical spinal cord injury.

SETTING: Neurologic inpatient Unit, Lahey Clinic, Burlington, MA, USA.

METHODS: A 55-year-old woman with a residual spastic quadriparesis from a traumatic C5-C6 fracture developed, during an assisted cough maneuver, sudden severe headache followed by cortical blindness in the setting of high blood pressure. Magnetic resonance imaging (MRI) showed T2 hyperintensities in the subcortical white matter of both medial occipital lobes and left post-central gyrus.

RESULTS: Elevation of the head of the bed during subsequent cough maneuvers with occasional use of sublingual nifedipine prevented further episodes of acute arterial hypertension and development of new symptoms. Repeat MRI of the head done one month later was normal.

CONCLUSION: RPL can occur in the setting of autonomic dysreflexia in patients with traumatic cervical cord injury. The prompt recognition of this syndrome is of importance to prevent further morbidity and mortality in patients with spinal cord injury.