Reversible posterior leucoencephalopathy (RPLS) describes a syndrome of headaches, confusion, seizures, and visual disturbances associated with transient characteristic lesions on neuroimaging, predominantly affecting the posterior region of the brain.¹ RPLS affects patients with hypertension, eclampsia, renal failure, and those on immunosuppressants and chemotherapeutic agents. We discuss a case of RPLS that presented primarily with visual symptoms.

Case report

A 10 year old boy with B cell acute lymphoblastic leukaemia affecting his maxilla was commenced on chemotherapy with intravenous vincristine and cyclophosphamide, oral prednisolone and folinic acid, together with intrathecal methotrexate, cytarabine, and hydrocortisone for central nervous system extension.

Ten days after the onset of chemotherapy he complained of sudden bilateral visual loss. On examination his visual acuity was perception of light in both eyes. His pupils were equal and reactive to light and funduscopy was normal; there was no other neurological deficit. His blood pressure was elevated …