Reversible posterior leukoencephalopathy syndrome: a review with two illustrative cases

To shed more light on the newly recognized neurological disorder, reversible posterior leuko-encephalopathy syndrome [RPLS] Medical Department, Al-Adan Hospital, Kuwait. In two patients who were hospitalized for acute illness, we had noted a syndrome of altered mental functioning, seizures and motor signs with findings indicating predominantly posterior leukoencephalopathy on neuroimaging studies. The findings on neuroimaging studies were characteristic of subcortical edema without infarction and reversible. To elucidate this syndrome, we searched the literature for the differential diagnoses of reversible radiological shadows on neuroimaging of the brain [CT scan and MRI]. Hinchey and colleagues reported the syndrome of RPLS for the first time in 1996. Thereafter, the syndrome was reported with increasing frequency both in pediatric and adult populations. In this study, we report two cases of RPLS due to acute hypertensive encephalopathy. The patients were treated with antihypertensive medications and the neurological deficits abated completely within two weeks. Essentially the diagnosis of RPLS is retrospective; significant reversal of neuroradiological abnormalities coupled with complete clinical recovery suggests the diagnosis. Clinicians must be aware of this syndrome as its recognition obviates unnecessary diagnostic procedures. Moreover, the syndrome is reversible with prompt treatment and has a good outcome

Profound hyperkalemia and the electrocardiogram. Lack of correlation: a case report

We report a case of severe hyperkalemia as a result of treatment with potassium sparing diuretics, digoxin and angiotensin receptor antagonist valsartan in the presence of renal insufficiency. Inspite of a maximal serum potassium concentration of 10.3 mmol/l, only non-specific ECG changes were found. The patient survived after an uneventful dialysis. Thus severe hyperkalemia may present without typical ECG changes, and values exceeding 10.3 mmol/l may not necessarily be fatal