Reversible Posterior Leukoencephalopathy Syndrome

Author: Robert Adams OMSIII and Wayne Lindsay OMSIII
Campbell University School of Osteopathic Medicine

A 24-year-old African American female with a history of polysubstance abuse presented to the emergency department in status epilepticus. The patient was given Midazolam by EMS. She arrived unable to protect her airway and was therefore intubated and sent for a non-contrast head CT. The patient’s mother denied a history of seizures, but reported her daughter complained of a headache earlier that afternoon. Past medical history was significant for SLE, depression, fibromyalgia, and medication non-compliance. Initial vitals revealed she was afebrile, pulse of 87, blood pressure of 150/96, and respiratory rate of 30. Within the first hour, her blood pressure climbed to 167/120 and her pulse to 153. Her initial CT scan is shown below:

Image: Radiopedia

Which of the following treatments will most likely improve the clinical outcome in this patient?

A. Tissue plasminogen activator

B. 325 mg Aspirin and physical therapy consult when stable

C. Immediate blood pressure lowering

D. Broad spectrum IV antibiotics with lumbar puncture

Resident Journal Review: Subarachnoid Hemorrhage

Photo: Wikimedia Commons

Originally Published: Common Sense, Jan/Feb 2012

Original Authors: Samantha Wood, MD; Michael Allison, MD; Adam Brenner, MD; Michael Scott, MD; Daniel Boutsikaris, MD; Chris Doty, MD FAAEM; and Michael Bond, MD FAAEM

Headache is a common symptom encountered in the emergency department (ED), representing about 2% of all presenting complaints.(1) Subarachnoid hemorrhage (SAH) is a neurosurgical emergency and is diagnosed in about 1-3% of such ED patients. Guidelines for evaluation and diagnosis of subarachnoid hemorrhage published in 2009 emphasize the need to maintain a high level of suspicion for SAH in patients with an acute severe headache and recommend evaluation with head computed tomography (CT) scan followed by lumbar puncture (LP) if the CT scan is negative.(2)