Abstract
While conditions associated with reversible posterior leukoencephalopathy syndrome (RPLS) are reported to have underlying biological features similar to T-cell activation and inflammatory cytokine production, it is also reported that diabetic ketoacidosis (DKA) or its treatment increase inflammatory cytokines and could develop systemic inflammatory responce syndrome (SIRS). A 63-year-old woman admitted for appetite loss, a 3-day headache, and consciousness disturbance of Japan coma scale II-10 showed no neurological deficit. She had diabetes mellitus since the age of 39 and poor glycemic control with oral hypoglycemic agents. On admission, laboratory tests showed elevated plasma glucose of 543 mg/dl and metabolic acidosis. Diagnosed as having DKA, she was administered saline drip infusion and continuous intravenous insulin. Her consciousness disturbance remained despite improved laboratory results. Head magnetic resonance imaging (MRI) showed hyperintensive bilateral posterior lobes and left thalamus on fluid-attenuated inversion recovery imaging and an apparent diffusion coefficient map. Corresponding diffusion weighted imaging showed isointensive signals in these regions, suggesting vasogenic brain edema. Her condition became normal on hospitalization day 3, and lesion improvement on MRI. In our case, SIRS accompanied with DKA and its treatment may have caused RPLS.
