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Tarhan G, Karabulut EGT, Karacı R, Sönmez Güngör E, Kaya GK, Ülker M, Domaç SF. Multiorgan dysfunction precipitated by disulfiram use and posterior reversible encephalopathy syndrome with atypical presentation: a case report. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2153758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Güllü Tarhan
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Elif Gözde Türedi Karabulut
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Rahşan Karacı
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ekin Sönmez Güngör
- Department of Psychiatry, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Gökçe Keskin Kaya
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ülker
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Saime Füsun Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
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Watanabe E, Ido N, Saito T, Kato H, Terashi H, Aizawa H. [Posterior reversible encephalopathy syndrome during intravenous immunoglobulin therapy in Guillain-Barré syndrome]. Rinsho Shinkeigaku 2021; 61:12-17. [PMID: 33328417 DOI: 10.5692/clinicalneurol.cn-001461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 63-year-old woman was diagnosed with Guillain-Barré syndrome (GBS), and intravenous immunoglobulin (IVIg) therapy was initiated. On the second day of IVIg therapy, she became less alert (JCS III-200) and had hyponatremia. Brain MRI showed vasogenic edema in bilateral occipital lobes, which disappeared afterwards. Her clinical course and MRI findings were consistent with those of posterior reversible encephalopathy syndrome (PRES). As a result of considering the timing of the onset of GBS and PRES and the degree of hyponatremia and hypertension in some documented patients, the cause of PRES onset in this case is considered to be IVIg therapy itself and IVIg therapy-induced hyponatremia.
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Affiliation(s)
- Eri Watanabe
- Department of Neurology, Tokyo Medical University
| | - Nobuhiro Ido
- Department of Neurology, Tokyo Medical University
| | - Tomoko Saito
- Department of Neurology, Tokyo Medical University
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Garrido D, Martins J, Jordão M, Raimundo P, Jacinto R, Estevens R, Taveira I, Macedo A, Nzwalo H. Triggers of posterior reversible encephalopathy in Guillain-Barre syndrome. Clin Neurol Neurosurg 2020; 198:106250. [DOI: 10.1016/j.clineuro.2020.106250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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Xiromerisiou G, Kalampokini S, Rikos D, Provatas A, Tsouris Z, Markou K, Ralli S, Dardiotis E. Posterior reversible encephalopathy in a GT1a positive oculopharyngeal variant of Guillain-Barré syndrome: A case-report and review of the literature. Clin Neurol Neurosurg 2020; 196:106037. [DOI: 10.1016/j.clineuro.2020.106037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
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Posterior reversible encephalopathy and Guillain-Barré syndrome: which came first, the chicken or the egg? A review of literature. Neurol Sci 2020; 41:3663-3666. [PMID: 32506357 DOI: 10.1007/s10072-020-04496-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
Posterior reversible encephalopathy (PRES) is a rare occurrence in patients with Guillain-Barré syndrome (GBS) with only nine adult cases reported to date. We conducted a review of the literature and compared previous cases with a novel case admitted to our clinic. In light of the timing of the symptoms, it is assumable that arterial hypertension can develop acutely during a phase of GBS-related autonomic dysfunction and subsequently precipitates PRES. According to this, dysautonomia caused by GBS could precede motor weakness; thus, PRES in the absence of any strong alternative etiology may suggest an underlying GBS.
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Smets GJ, Loyson T, Van Paesschen W, Demaerel P, Nackaerts K. Posterior reversible encephalopathy syndrome possibly induced by pemetrexed maintenance therapy for lung cancer: a case report and literature review. Acta Clin Belg 2018; 73:382-388. [PMID: 29173113 DOI: 10.1080/17843286.2017.1403103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Advances in systemic chemotherapy, molecular targeted therapy and immunotherapy have extended and improved the quality of life of patients with cancer. However, the central nervous system is very susceptible to complications of systemic cancer and its treatment. Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and neuroradiologic entity which has garnered increasing recognition in the past two decades. Cancer patients are generally treated with cytotoxic agents, immunotherapy, molecular targeted therapies or glucosteroids which are more frequently associated with PRES. Case presentation A 59-year old female, known with a relapse of her lung adenocarcinoma, had been treated with 4 cycles of cisplatin (75 mg/m²) and pemetrexed (500 mg/m²). Six weeks after this combination chemotherapy and within 28 h after the administration of pemetrexed maintenance therapy, she developed a generalised epileptic insult. Magnetic resonance imaging (MRI) of the brain showed bilateral areas of increased signal intensity in the subcortical parietal and frontal white matter. She was treated with a broad spectrum antiseizure drug, levetiracetam 750 mg twice daily and strict control of blood pressure. Discussion Diagnosis of PRES should be considered in all patients with neurologic symptoms who are at risk to develop PRES. It is crucial to establish the diagnosis as soon as possible since there is no specific treatment of PRES other than correction of the underlying risk factors and preventing seizure recurrence. Administration of pemetrexed is a possible risk factor for the development of PRES.
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Affiliation(s)
- Gert-Jan Smets
- Clinical Department of Pneumology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Tine Loyson
- Clinical Department of Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Clinical Department of Neurology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Clinical Department of Radiology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Clinical Department of Pneumology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
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Yokoi K, Ando T, Kawakami O. [Case of posterior reversible encephalopathy syndrome caused by Fisher syndrome]. Rinsho Shinkeigaku 2018; 58:45-48. [PMID: 29269696 DOI: 10.5692/clinicalneurol.cn-001089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This report presents a case of a 71-year-old woman with Fisher syndrome who had posterior reversible encephalopathy syndrome (PRES) before the initiation of intravenous immunoglobulin (IVIg) treatment. She had symptoms of common cold 2 weeks before the onset of PRES. On the day of the onset, she began to stagger while walking. On day 2, she developed hypertension, vision impairment, and limb weakness and was admitted to the hospital. On day 3, she was provided steroid pulse therapy. On day 4, she developed convulsions and right imperfection single paralysis and was transferred to the our hospital. During the transfer, the patient was conscious. Her blood pressure was high at 198/107 mmHg. She had mild weakness in her limbs and face, light perception in both eyes, dilation of both pupils, total external ophthalmoplegia, no tendon reflexes, and limb and trunk ataxia. We diagnosed PRES because of the high signal intensities observed on T2-weighted MRI on both sides of the parietal and occipital lobes. We also diagnosed Fisher syndrome because of a positive anti-GQ1b immunoglobulin G antibody test and albuminocytologic dissociation in the cerebrospinal fluid. PRES showed prompt improvement with antihypertensive therapy, whereas Fisher syndrome slowly improved over a course of 2 months. This case is the first report of PRES without IVIg suggesting that Fisher syndrome induces hypertension and causes PRES.
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Affiliation(s)
| | - Tetsuo Ando
- Department of Neurology, Anjo Kosei Hospital
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Nabi S, Rajput HM, Badshah M, Ahmed S. Posterior reversible encephalopathy syndrome (PRES) as a complication of Guillain-Barre' syndrome (GBS). BMJ Case Rep 2016; 2016:bcr-2016-216757. [PMID: 27489061 DOI: 10.1136/bcr-2016-216757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 17-year-old Pakistani female patient presented with acute onset flaccid quadriparesis with nerve conduction studies showing demyelinating polyneuropathy consistent with Guillain-Barre' syndrome. She was treated with 4 plasmapheresis sessions. She developed raised blood pressure, headache, visual loss and generalised seizures on the 13th day of admission. MRI of the brain on contrast showed findings of altered signals low on T1-weighted image, high on T2-weighted image and fluid-attenuated inversion recovery in the white matter of bilateral occipital, parietal and right frontal lobe consistent with posterior reversible encephalopathy syndrome. The patient was administered antiepileptic and antihypertensive drugs to control seizures and blood pressure. She was discharged in a stable state. On follow-up her visual loss had recovered completely and she had regained full motor strength in all four extremities after 6 weeks. Fresh MRI of the brain revealed complete resolution of lesions. Antihypertensive and antiepileptic medication was discontinued. She is independent in all her daily activities.
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Affiliation(s)
| | - Haris Majid Rajput
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | - Shahzad Ahmed
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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Pichler G, Martinez F, Fernandez C, Redon J. Unusual Case of Severe Hypertension in a 20-Year-Old Woman. Hypertension 2015; 66:1093-7. [DOI: 10.1161/hypertensionaha.115.06271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gernot Pichler
- From the Hypertension Clinic, Department of Internal Medicine, Clinical Hospital of Valencia, INCLIVA, University of Valencia, Valencia, Spain (G.P., F.M., C.F., J.R.); and CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERObn), Carlos III Health Institute, Madrid, Spain (F.M., J.R.)
| | - Fernando Martinez
- From the Hypertension Clinic, Department of Internal Medicine, Clinical Hospital of Valencia, INCLIVA, University of Valencia, Valencia, Spain (G.P., F.M., C.F., J.R.); and CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERObn), Carlos III Health Institute, Madrid, Spain (F.M., J.R.)
| | - Conrado Fernandez
- From the Hypertension Clinic, Department of Internal Medicine, Clinical Hospital of Valencia, INCLIVA, University of Valencia, Valencia, Spain (G.P., F.M., C.F., J.R.); and CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERObn), Carlos III Health Institute, Madrid, Spain (F.M., J.R.)
| | - Josep Redon
- From the Hypertension Clinic, Department of Internal Medicine, Clinical Hospital of Valencia, INCLIVA, University of Valencia, Valencia, Spain (G.P., F.M., C.F., J.R.); and CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERObn), Carlos III Health Institute, Madrid, Spain (F.M., J.R.)
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Guillain Barré syndrome-related posterior reversible encephalopathy syndrome. Neuroradiology 2015; 57:755-6. [DOI: 10.1007/s00234-015-1499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
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Chen A, Kim J, Henderson G, Berkowitz A. Posterior reversible encephalopathy syndrome in Guillain-Barré syndrome. J Clin Neurosci 2015; 22:914-6. [PMID: 25800144 DOI: 10.1016/j.jocn.2014.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 10/23/2022]
Abstract
Autonomic dysfunction is a well-known complication of Guillain-Barré syndrome (GBS) and may manifest as hemodynamic fluctuations. Posterior reversible encephalopathy syndrome (PRES) is commonly associated with acute hypertension, but is rarely reported to occur in association with GBS. We describe a patient with GBS who developed PRES in the setting of autonomic dysfunction and review the clinical features of all 12 previously reported patients with co-occurrence of GBS and PRES. Almost all cases have occurred in women over the age of 55, raising the possibility of increased sensitivity to dysautonomia in this patient group.
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Affiliation(s)
- Adam Chen
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Jennifer Kim
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Galen Henderson
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Aaron Berkowitz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Stetefeld HR, Lehmann HC, Fink GR, Burghaus L. Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome/Bickerstaff brain stem encephalitis overlap syndrome. J Stroke Cerebrovasc Dis 2014; 23:e423-5. [PMID: 25149206 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 04/30/2014] [Accepted: 05/08/2014] [Indexed: 10/24/2022] Open
Abstract
The association of a posterior reversible encephalopathy syndrome (PRES) without arterial hypertension with autoimmune-mediated inflammatory neuropathies such as Guillain-Barré syndrome (GBS) is a rare and poorly understood phenomenon. To date, PRES has been described as initial manifestation, coincidental finding, or adverse event subsequent to immunomodulatory treatment with intravenous immunoglobulin (IVIG) in cases of axonal and demyelinating GBS as well as in Miller-Fisher syndrome (MFS). We here report a case of MFS/Bickerstaff brain stem encephalitis (BBE)-overlap syndrome and nonhypertensive PRES that occurred in close temporal association with IVIG treatment and caused stroke. Immunoadsorption ameliorated the disease course. Our case supports the notion that in severe cases, immunoadsorption should be considered as first-line therapy instead of IVIG for rapid removal of IgG and thus to hasten recovery and improve functional outcome.
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Affiliation(s)
| | - Helmar C Lehmann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Department of Cognitive Neuroscience, Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Rigamonti A, Basso F, Scaccabarozzi C, Lauria G. Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain-Barré syndrome: case report and review of the literature. J Peripher Nerv Syst 2012; 17:356-60. [DOI: 10.1111/j.1529-8027.2012.00416.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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