Table 1

Common differential diagnoses of posterior leukoencephalopathy syndrome

Posterior leukoencephalopathy Cerebral venous thrombosis Top of basilar syndrome
Predisposing factorsEclampsia, renal failure, cytotoxic and   immuno-suppresive agents, hypertensionPregnancy, puerperium, dehydrationRisk factors for stroke, cardiac disorders
Onset and progressionAcute, evolves in daysAcute, evolves in daysSudden, evolves in hours
Clinical featuresSeizures precede all other manifestations,   visual aura, cortical blindness, confusion, headache, rarely focal deficitHeadaches, seizures, stupor or coma, focal   neurological deficits (monoporesis or hemiparesis), papilloedema, evidence of venous thrombosis elsewhere, infrequently hypertensiveCortical blindness, hemianopia,   confusional state, brain stem signs, cerebral signs, rarely seizures
Imaging featuresPredominantly white matter oedema in   bilateral occipital and posterior parietal regions, usually spares paramedian brain parenchymaHaemorrhagic and ischaemic infarcts, small   ventricles, “cord sign” caused by hyperdense thrombosed vein, evidence of major venous sinus thrombosis on MRIInfarcts of bilateral paracalcarine   cortex, thalamus, inferior medial temporal lobe, and brain stem
PrognosisCompletely resolves after rapid control of BP and removal of offending drugIntensive management is needed; mortality high in severe casesNo recovery or only partial eventual recovery
  • BP, blood pressure; MRI, magnetic resonance imaging.