1
|
Li J, Huang Y, Lao Q. Paclitaxel combined with trastuzumab chemotherapy-related posterior reversible encephalopathy syndrome: A case report and literature review. Radiol Case Rep 2024; 19:2188-2191. [PMID: 38515774 PMCID: PMC10950567 DOI: 10.1016/j.radcr.2024.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) in breast carcinoma is a rare disease in clinical practice that is often misdiagnosed and ignored. This study reported a case of a patient admitted to our hospital and discussed the clinical, imaging, and pathogenesis properties of the disease. We retrospectively analyzed the clinical data of this patient and reviewed the relevant literature. Imaging was used to diagnose PRES based on clinical findings, and clinical symptoms improved after discontinuation of the relevant drugs.
Collapse
Affiliation(s)
- Jing Li
- Department of Neurology, Guangxi medical university cancer hospital, Nanning, Guangxi, China, 530021
| | - Yanlan Huang
- Department of Neurology, Guangxi medical university cancer hospital, Nanning, Guangxi, China, 530021
| | - Qifang Lao
- Department of Intensive Care Medicine, Guangxi medical university cancer hospital, Nanning, Guangxi, China, 530021
| |
Collapse
|
2
|
Kawashima Y, Ariji S, Aoyagi R, Noda M, Oba K, Ogasawara M. Pediatric Reversible Cerebral Vasoconstriction Syndrome/Posterior Encephalopathy Syndrome/Poststreptococcal Glomerulonephritis. Pediatr Neurol 2024; 155:33-35. [PMID: 38579434 DOI: 10.1016/j.pediatrneurol.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/16/2024] [Accepted: 03/12/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Yuki Kawashima
- Department of Pediatrics, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Shohei Ariji
- Department of Pediatrics, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Rui Aoyagi
- Department of Pediatrics, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Masahiro Noda
- Department of Pediatrics, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Masashi Ogasawara
- Department of Pediatrics, Showa General Hospital, Kodaira, Tokyo, Japan; Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.
| |
Collapse
|
3
|
Wang H, Xie Y. Premenstrual abdominal pain and posterior reversible encephalopathy syndrome in a woman with acute intermittent porphyria: A case report. Asian J Surg 2024; 47:1501-1502. [PMID: 38061950 DOI: 10.1016/j.asjsur.2023.11.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Haixia Wang
- Department of Gynecology and Obstetrics, Affiliated Hospital of Jining Medical University, No. 79, Guhuai Road, Jining, 272000, Shandong Province, PR China
| | - Yuan Xie
- Department of Gynecology and Obstetrics, Affiliated Hospital of Jining Medical University, No. 79, Guhuai Road, Jining, 272000, Shandong Province, PR China.
| |
Collapse
|
4
|
Suzuki H, Ohkuchi A, Horie K, Ogoyama M, Usui R, Takahashi H, Fujiwara H. Clinical relevance of reversible cerebral vasoconstriction syndrome in pregnant women with posterior reversible encephalopathy syndrome: review of case reports in Japan. Hypertens Res 2024:10.1038/s41440-024-01619-5. [PMID: 38383893 DOI: 10.1038/s41440-024-01619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/12/2024] [Accepted: 01/27/2024] [Indexed: 02/23/2024]
Abstract
We systematically reviewed case reports of posterior reversible encephalopathy syndrome (PRES), and investigated the characteristics of PRES in pregnant Japanese women and the clinical relevance of reversible cerebral vasoconstriction syndrome (RCVS) in pregnant women with PRES. Articles were collected using the PubMed/Medline and Ichushi-Web databases. This review was ultimately conducted on 121 articles (162 patients). The clinical characteristics of PRES, individual sites of PRES lesions, edema types, and clinical characteristics of RCVS in PRES cases were examined. The most common individual site of PRES lesion was the occipital lobe (83.3%), followed by the basal ganglia, parietal lobe, frontal lobe, brain stem, cerebellum, temporal lobe, thalamus, and splenium corpus callosum (47.5, 42.6, 24.7, 16.1, 9.3, 5.6, 4.3, and 0.0%, respectively). Edema types in 79 cases with PRES were mainly the vasogenic edema type (91.1%), with very few cases of the cytotoxic edema type (3.8%) and mixed type (5.1%). Among 25 PRES cases with RCVS, RCVS was not strongly suspected in 17 (68.0%) before magnetic resonance angiography. RCVS was observed at the same time as PRES in 13 cases (approximately 50%), and between days 1 and 14 after the onset of PRES in the other 12. These results suggest that the basal ganglia is a frequent site of PRES lesions in pregnant women. RCVS may occur at or after the onset of PRES, even if there are no symptoms to suggest RCVS.
Collapse
Affiliation(s)
- Hirotada Suzuki
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Akihide Ohkuchi
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Kenji Horie
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Manabu Ogoyama
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Rie Usui
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Hironori Takahashi
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Hiroyuki Fujiwara
- Departments of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3111-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| |
Collapse
|
5
|
Ikeda S, Inoue Y, Suzuyama K, Ide T, Eriguchi M. Haemorrhagic and ischemic stroke following posterior reversible encephalopathy syndrome and thrombotic microangiopathy in a patient with malignant hypertension. Acta Neurol Belg 2024; 124:339-341. [PMID: 37407871 DOI: 10.1007/s13760-023-02328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Shuhei Ikeda
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
- Department of Neurology, Kansai Medical University, Osaka, 573-1191, Japan.
| | - Yukako Inoue
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Kohei Suzuyama
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| |
Collapse
|
6
|
Liu Y, Li Q, Liu Y, Qiao P, Liu S, Xu K. The challenging clinical dilemma of posterior reversible encephalopathy syndrome in systemic lupus erythematosus. Z Rheumatol 2024; 83:124-131. [PMID: 37405426 DOI: 10.1007/s00393-023-01385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE) is a challenging clinical dilemma. A retrospective single-center study was performed to investigate the clinical features, risk factors, outcomes, and clinical determinants of the prognosis of PRES in SLE. METHODS A retrospective study was performed from January 2015 to December 2020. 19 episodes of lupus PRES and 19 episodes of non-lupus PRES were identified. 38 cases of patients presenting with neuropsychiatric lupus (NPSLE) hospitalized during the same period were selected as controls. Survival status was acquired via outpatient and telephone follow-up in December 2022. RESULTS The clinical neurological presentation of PRES in lupus patients was similar to that of the non-SLE-related PRES and NPSLE populations. Nephritis-induced hypertension is the predominant trigger of PRES in SLE. Disease flare and renal failure-triggered PRES were identified in half of the patients with SLE. The mortality rate of lupus-related PRES during the 2‑year follow-up was 15.8%, the same as that of NPSLE. For patients with lupus-related PRES, multivariate analysis indicated that high diastolic blood pressure (OR =1.762, 95% CI: 1.031 ~ 3.012, p = 0.038), renal involvement (OR = 3.456, 95% CI: 0.894 ~ 14.012, p = 0.049), and positive proteinuria (OR = 1.231, 95% CI: 1.003 ~ 1.511, p = 0.047) were independent risk factors compared to NPSLE. A strong connection between the absolute counts of T and/or B cells and prognosis in lupus patients with neurological manifestations was found (p < 0.05). The lower the counts of T and/or B cells, the worse the prognosis. CONCLUSION Lupus patients with renal involvement and disease activity are more likely to develop PRES. The mortality rate of lupus-related PRES is similar to that of NPSLE. Focusing on immune balance might reduce mortality.
Collapse
Affiliation(s)
- Yang Liu
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Qian Li
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Ying Liu
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Pengyan Qiao
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Sumiao Liu
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Ke Xu
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.
| |
Collapse
|
7
|
Heo MH, Choi HY, Lee K, Kim JY. A complex case of posterior reversible encephalopathy syndrome after combined spinal epidural of preeclampsia parturient: A case report. Saudi J Anaesth 2024; 18:134-136. [PMID: 38313718 PMCID: PMC10833034 DOI: 10.4103/sja.sja_646_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a disorder characterized by vasogenic edema affecting the posterior brain region. We report a case of PRES in a 36-year-old woman with preeclampsia who underwent an emergency cesarean section with spinal anesthesia. After surgery, she developed right leg weakness, headache, and seizures. Imaging showed white matter edema consistent with PRES. The exact cause of PRES is unclear, but elevated blood pressure and endothelial dysfunction are implicated. Tight blood pressure control in PRES is crucial for management, and prompt recognition and treatment are essential for favorable outcomes.
Collapse
Affiliation(s)
- Min Hee Heo
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South Korea
| | - Hwan Yong Choi
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South Korea
| | - Kwanghyuk Lee
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South Korea
| |
Collapse
|
8
|
Dai Y, Liu W, Hong F. Post reversible encephalopathy syndrome attributed to mycophenolate mofetil used in the treatment of SLE: A case report and review of literature. J Int Med Res 2024; 52:3000605231218620. [PMID: 38156668 PMCID: PMC10757442 DOI: 10.1177/03000605231218620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare clinical disease, which has been seen in patients with systemic lupus erythematosus (SLE). Its main manifestations are seizure, headache and other neurological symptoms. While the condition is reversible, if not treated in time, there can be risks of cerebral haemorrhage. We report here the case of a young patient with SLE who developed PRES after receiving the immunosuppressant, mycophenolate mofetil. Neurological symptoms, signs, or changes in a patient's condition that cannot be explained by lupus, should alert physicians to the possibility of the drug causing PRES, and prompt discontinuation should ensue.
Collapse
Affiliation(s)
- Yiping Dai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Weihua Liu
- Department of Nephrology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Fuyuan Hong
- Department of Nephrology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| |
Collapse
|
9
|
Ghanem R, Glaisner S, Bobin A, Ronchetti AM, Cereja S, Joly B, Salanoubat C, Fouquet G. Posterior reversible encephalopathy syndrome (PRES) and myeloma. Leuk Res Rep 2023; 21:100407. [PMID: 38260821 PMCID: PMC10801201 DOI: 10.1016/j.lrr.2023.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) has rarely been described in myeloma, but chemotherapy is a known risk factor. We report 3 patients with myeloma who developed PRES, and analyzed them with 13 published cases, mostly women. The most frequent causative agents were proteasome inhibitors and autologous stem cell transplantation. Risk factors were frequently associated: hypertension, infection or renal failure. Symptoms included headache, blurred vision, altered mental status, seizures. Most patients experienced rapid clinical recovery, without relapse even after resuming treatment. Although rare, we must remain vigilant about PRES in myeloma patients. Stricter control of blood pressure could limit its occurrence.
Collapse
Affiliation(s)
- Ricardos Ghanem
- Centre Hospitalier Sud Francilien, Hématologie clinique, Corbeil-Essonnes, France
| | - Sylvie Glaisner
- Département d'oncologie médicale, Institut Curie, Paris, France
| | - Arthur Bobin
- Service d'Hématologie et Thérapie Cellulaire, Pôle Régional de Cancérologie, CHU de Poitiers, France
| | - Anne-Marie Ronchetti
- Centre Hospitalier Sud Francilien, Hématologie clinique, Corbeil-Essonnes, France
| | - Sophie Cereja
- Centre Hospitalier Sud Francilien, Hématologie clinique, Corbeil-Essonnes, France
| | - Bertrand Joly
- Centre Hospitalier Sud Francilien, Hématologie clinique, Corbeil-Essonnes, France
| | - Célia Salanoubat
- Centre Hospitalier Sud Francilien, Hématologie clinique, Corbeil-Essonnes, France
| | - Guillemette Fouquet
- Centre Hospitalier Sud Francilien, Hématologie clinique, Corbeil-Essonnes, France
- Université de Paris, INSERM U1016, Institut Cochin, CNRS UMR8104, Faculté de médecine Cochin-Port Royal, Paris, France
| |
Collapse
|
10
|
Katwal S, Ghimire A, Bhusal A, Bajracharya A. Posterior reversible encephalopathy syndrome in postpartum patients with gestational hypertension: A case report emphasizing early recognition and management. Radiol Case Rep 2023; 18:4564-4568. [PMID: 37886729 PMCID: PMC10597782 DOI: 10.1016/j.radcr.2023.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare neuroradiological condition causing headaches, altered mental status, seizures, visual disturbances, and focal deficits. It is often associated with preeclampsia and eclampsia in pregnancy, but can also occur in patients with other medical conditions, such as hypertension, autoimmune diseases, renal dysfunction etc. This case report highlights the importance of recognizing PRES in postpartum patients with hypertension and the need for prompt diagnosis and management to prevent potential complications. A 30-year-old woman with gestational hypertension underwent scheduled induction of labor. After a successful delivery, she experienced a sudden headache but no other neurological symptoms. Imaging showed bilateral frontoparietal white matter edema, consistent with PRES. She was closely monitored, treated with analgesics, and improved within a week. The case highlights the rarity of PRES in postpartum patients without preeclampsia or eclampsia. It underscores the importance of considering PRES as a possible diagnosis in postpartum patients with hypertension, even in the absence of typical risk factors. Prompt control of blood pressure and careful monitoring are essential to ensure a positive outcome, as PRES can lead to life-threatening complications if not managed appropriately. The study highlights the importance of heightened awareness of PRES in postpartum patients with gestational hypertension. Early detection and timely management can improve prognosis, even in atypical cases. Healthcare professionals should be vigilant in assessing hypertension patients to diagnose and manage PRES, preventing neurological sequelae. Further research is needed to better understand PRES pathophysiology and risk factors in postpartum patients.
Collapse
Affiliation(s)
- Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Aastha Ghimire
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Amrit Bhusal
- BP Koirala Institute of Health Sciences, Dharan, Koshi Province, Nepal
| | | |
Collapse
|
11
|
Çimen Güneş E, Çolak S, Tekgöz E, Çınar M, Yılmaz S. Golimumab-induced posterior reversible encephalopathy syndrome (PRES): a case-based review. Clin Rheumatol 2023; 42:3407-3410. [PMID: 37715081 DOI: 10.1007/s10067-023-06771-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/27/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state which is characterized by seizures, headache, visual disturbances, paresis, and altered mental status. Golimumab is anti-tumor necrosis factor-α inhibitor (anti-TNF-α) that can be used in the treatment of rheumatologic diseases. Here, we present a patient who had developed PRES after golimumab treatment for ankylosing spondylitis (AS). A 45-year-old female patient was admitted to the emergency service with a newly onset severe headache, loss of vision in both eyes, and two generalized tonic-clonic seizures that lasted for 3 to 4 min. The patient had the diagnoses of AS for 12 years and hypertension for 3 years and receiving golimumab and carvedilol. The patient was diagnosed with PRES based on the current clinical and diffusion cranial magnetic resonance imaging (MRI) findings. On suspicion of being the trigger of this situation, golimumab was stopped. After starting anti-convulsant therapy and controlling blood pressure, the neurological findings recovered rapidly and no seizures were seen. Control MRI images, in the first month's visit, were normal. Although chemotherapeutic agents are well-known causes of PRES, there are few reported cases with anti-TNF-α agents in the literature. To our knowledge, this is the first case that developed PRES after golimumab. Demyelinating diseases are the most frightening neurologic complication of anti-TNF-α treatment; however, PRES should come to mind in patients presenting with neurological symptoms.
Collapse
Affiliation(s)
- Ezgi Çimen Güneş
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Seda Çolak
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Emre Tekgöz
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Muhammet Çınar
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sedat Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
12
|
Raval M, Trivedi J, Curry I, Sanghvi L, Patel S, Alexandrov P, Saber W, Aumentado D, Al-Yacoub M, Elgabry I. Transient Cortical Blindness After Cardiac Catheterization: A Case Report and Review of Possible Neurological Etiologies. J Community Hosp Intern Med Perspect 2023; 13:24-28. [PMID: 38596558 PMCID: PMC11000839 DOI: 10.55729/2000-9666.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 04/11/2024] Open
Abstract
Cardiac catheterization is a standard procedure performed approximately 1 million times per year. Transient cortical blindness is a rare complication of this procedure. Herein we report a case of complete bilateral vision loss after cardiac catheterization through right radial access, which, to our knowledge, has only been reported once before. Prompt identification of this complication is crucial for patient care. This report provides insight into the diagnostic difficulties, differential diagnosis, imaging findings, and management of transient cortical blindness.
Collapse
Affiliation(s)
- Maharshi Raval
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Jaahnavee Trivedi
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Ishbel Curry
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Labdhi Sanghvi
- Department of Pediatrics, Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad,
India
| | - Sagar Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Paul Alexandrov
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Walid Saber
- Department of Cardiology, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Dennis Aumentado
- Department of Neurology, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Motasem Al-Yacoub
- Department of Neurology, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| | - Ibrahim Elgabry
- Department of Cardiology, New York Medical College/Landmark Medical Center, Woonsocket, RI,
USA
| |
Collapse
|
13
|
Srichawla BS, Quast J. Magnesium deficiency: An overlooked key to the puzzle of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS)? J Neurol Sci 2023; 453:120796. [PMID: 37708589 DOI: 10.1016/j.jns.2023.120796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Jared Quast
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| |
Collapse
|
14
|
Azin N, Hajihashemi A, Geravandi M. Rare central nervous system manifestation of granulomatosis with polyangiitis in a 12-year-old child: A case report. Radiol Case Rep 2023; 18:3704-3709. [PMID: 37636535 PMCID: PMC10447933 DOI: 10.1016/j.radcr.2023.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/22/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
To share a unique case of granulomatosis with polyangiitis (GPA) identified in a child with CNS involvement, specifically PRES (posterior reversible encephalopathy syndrome). Discuss this uncommon manifestation's clinical characteristics, diagnostic process, and treatment. We are currently discussing a 12-year-old female patient who presented with a chronic cough, shortness of breath, and a new-onset fever. Upon further examination, the patient was diagnosed with GPA, confirmed through positive cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA), a renal biopsy, and multiple lung cavitary lesions. During her hospitalization, the patient also experienced neurological symptoms, including a severe headache, blurred vision, loss of consciousness, and an abnormal neurological exam, which led to brain MR imaging. The imaging revealed evidence of small vessel vasculitis with confluent T2 hyper signal intensity of gray-white matter junctions in both parietooccipital and frontal lobes containing hemorrhagic components, suggesting Posterior reversible encephalopathy syndrome. This case of Wegener's granulomatosis is noteworthy due to its occurrence in a pediatric patient with CNS involvement, specifically (posterior reversible encephalopathy syndrome). This event highlights the importance of recognizing that autoimmune disorders can present infrequently in young patients. Diagnosing Wegener's granulomatosis can be challenging, particularly when the CNS is affected. However, when appropriate treatment is initiated promptly, favorable outcomes can be achieved, as evidenced by the patient's improved condition with the prednisolone, captopril, and Rituximab treatment plan. Further research is necessary to understand better the underlying pathophysiology and optimal management of CNS involvement in GPA, particularly in the pediatric population.
Collapse
Affiliation(s)
- Neda Azin
- Department of Radiology, Imam Hussein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Hajihashemi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Geravandi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
15
|
Fujii N, Fujii H, Matsuki M, Doi S, Isozaki T, Watanabe Y, Nakamata A, Fujita A, Mori H. Optic pathway involvement in the posterior reversible encephalopathy syndrome: A case report and review of the literature. Radiol Case Rep 2023; 18:3769-3772. [PMID: 37649724 PMCID: PMC10462788 DOI: 10.1016/j.radcr.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological condition characterized by reversible vasogenic edema of the white matter and acute neurological symptoms. PRES typically affects the parieto-occipital regions but rarely affects the optic pathway. Herein, we describe a case of central-variant PRES in a 57-year-old man with abnormal signal intensities in the optic pathway on magnetic resonance imaging (MRI). The patient underwent hemodialysis, initiated diuretics and antihypertensive medications, and the abnormal signal intensities of the brainstem and optic pathway on MRI improved. Although rare, PRES can affect the optic pathway, thus suggesting the possibility of fragility of the optic pathway itself to hyperperfusion.
Collapse
Affiliation(s)
- Nana Fujii
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Mitsuru Matsuki
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Shugo Doi
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takenori Isozaki
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Yuriko Watanabe
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Akihiro Nakamata
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Akifumi Fujita
- Department of Radiology, Haga Red Cross Hospital, Tochigi, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
16
|
Shimamoto Y, Sasaki H, Kasuno K, Watanabe Y, Sakashita S, Nishikawa S, Nishimori K, Morita S, Nishikawa Y, Kobayashi M, Fukushima S, Enomoto S, Takahashi N, Hamano T, Sakamaki I, Iwasaki H, Iwano M. Posterior reversible encephalopathy syndrome (PRES) associated with SARS-CoV-2 infection in a patient under maintenance haemodialysis: a case report. BMC Nephrol 2023; 24:286. [PMID: 37773103 PMCID: PMC10542676 DOI: 10.1186/s12882-023-03319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Endothelial dysfunction is common in patients undergoing chronic haemodialysis, and is a major cause of posterior reversible encephalopathy syndrome (PRES). Recently, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to cause endothelial dysfunction by infecting vascular endothelial cells. Several cases of neurological complications in patients without kidney dysfunction, and only a few cases in patients with chronic kidney disease, have been reported in the literature. However, no previous report has yet described PRES associated with SARS-CoV-2 infection among patients undergoing maintenance dialysis. CASE PRESENTATION A 54-year-old woman undergoing maintenance haemodialysis was admitted to our hospital for status epilepticus. She had developed end-stage kidney disease (ESKD) secondary to diabetic nephropathy. Seven days prior to admission, she had developed fever and was diagnosed with COVID-19. Subsequently her blood pressure increased from 160/90 mmHg to 190/100 mmHg. On admission, she presented with severe hypertension (> 220/150 mmHg), unconsciousness, and epilepticus. CT tomography revealed no signs of brain haemorrhage. Cranio-spinal fluid (CSF) examination revealed no signs of encephalitis, and CSF polymerase chain reaction (PCR) for SARS-CoV-2 was negative. MRI findings revealed focal T2/FLAIR hyperintensity in the bilateral parietooccipital regions, leading to the diagnosis of PRES. Deep sedation and strict blood pressure control resulted in a rapid improvement of her symptoms, and she was discharged without sequelae. CONCLUSIONS We report the first case of PRES associated with SARS-CoV-2 infection in a patient undergoing maintenance haemodialysis. Patients undergoing maintenance haemodialysis are at high risk of PRES because of several risk factors. SARS-CoV-2 infection causes direct invasion of endothelial cells by binding to angiotensin-converting enzyme 2 (ACE2), initiating cytokine release, and hypercoagulation, leading to vascular endothelial cell injury and increased vascular leakage. In the present case, SARS-CoV-2 infection possibly be associated with the development of PRES.
Collapse
Affiliation(s)
- Yuki Shimamoto
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Hirohito Sasaki
- Division of Neurology, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenji Kasuno
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan.
| | - Yuki Watanabe
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sayumi Sakashita
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sho Nishikawa
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Kazuhisa Nishimori
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sayu Morita
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Yudai Nishikawa
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Mamiko Kobayashi
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sachiko Fukushima
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Soichi Enomoto
- Division of Neurology, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Naoki Takahashi
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Tadanori Hamano
- Division of Neurology, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ippei Sakamaki
- Department of Infectious Diseases, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Masayuki Iwano
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| |
Collapse
|
17
|
Xie L. Posterior reversible encephalopathy syndrome triggered by FLOT (5-fluorouracil, oxaliplatin, docetaxel, and calcium levofolinate) chemotherapy and thrombocytopenia (docetaxel and cisplatin) chemotherapy. J Oncol Pharm Pract 2023; 29:1503-1509. [PMID: 37218162 DOI: 10.1177/10781552231177597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome is a clinical and imaging syndrome characterized by endothelial dysfunction, blood-brain barrier disruption, and vasogenic edema. The common clinical symptoms of posterior reversible encephalopathy syndrome include headache, altered consciousness, visual disturbances, and seizures, among which headache and seizures are the most common. The classic imaging patterns usually reveal vasogenic edema. CASE REPORT We describe the case of a middle-aged woman with gastric cancer. She was under treatment by fluorouracil, leucovorin, oxaliplatin, and docetaxel regimen and thrombocytopenia regimen after tumor progression, but developed unconsciousness, irritability, and headache shortly after initiation of treatment. Her magnetic resonance imaging in our hospital shows abnormal signals in bilateral frontal parietal occipital lobes with hyperintensities on T2-weighted magnetic resonance imaging and fluid-attenuated inversion recovery imaging, accompanied by the increased value of apparent diffusion coefficient. And T1-weighted images illustrate hypointense foci, with increased diffusion-weighted imaging signals. MANAGEMENT AND OUTCOME After admission, she was treated to control blood pressure, reduce brain edema, expand blood vessels, improve consciousness, and symptomatic support treatment. 3 days after the onset of the disease, her headache symptoms and state of consciousness gradually improved, and her blood pressure can be controlled at about 130/80 mmHg. DISCUSSION This is the first report that posterior reversible encephalopathy syndrome is caused by a thrombocytopenia regimen, and our case highlights the pathogenic role of a thrombocytopenia regimen in posterior reversible encephalopathy syndrome. However, the association between the thrombocytopenia regimen and previous fluorouracil, leucovorin, oxaliplatin, and docetaxel regimens needs further study.
Collapse
Affiliation(s)
- LinLin Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Shandong, China
| |
Collapse
|
18
|
Hwang J, Cho WH, Cha SH, Ko JK. Posterior reversible encephalopathy syndrome following uneventful clipping of an unruptured intracranial aneurysm: A case report. World J Clin Cases 2023; 11:4723-4728. [PMID: 37469736 PMCID: PMC10353519 DOI: 10.12998/wjcc.v11.i19.4723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is characterized mainly by occipital and parietal lobe involvement, which can be reversible within a few days. Herein, we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm (UIA).
CASE SUMMARY A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery. Clipping surgery was performed uneventfully, and he regained consciousness quickly immediately after the surgery. At the 4th hour after surgery, he developed a disorder of consciousness and aphasia. Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal, occipital, and frontal lobes ipsilaterally, without restricted diffusion, consistent with unilateral PRES. With conservative treatment, his symptoms and radiological findings almost completely disappeared within weeks. In our case, the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.
CONCLUSION Our unique case highlights that, to our knowledge, this is the second report of PRES developing after craniotomy for the treatment of UIA. Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.
Collapse
Affiliation(s)
- Joseph Hwang
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Won-Ho Cho
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Seung-Heon Cha
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Jun-Kyueng Ko
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| |
Collapse
|
19
|
Ghaderi Yazdi B, Hadei SJ, Malekian N. Brainstem and upper cervical cord involvement in a patient with posterior reversible encephalopathy syndrome: Neuro-images. Neurol Sci 2023; 44:2217-2219. [PMID: 36840855 DOI: 10.1007/s10072-023-06708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome with acute heterogeneous neurological symptoms. It is usually preceded by hypertension or chemotherapy. Brain magnetic resonance imaging (MRI) shows vasogenic edema over the cortex and subcortex of parieto-occipital lobes. Involvement of the brainstem, basal ganglia, and spinal cord is rare. MATERIAL Here we described an 18 years old woman with a history of systemic lupus erythematosus who was admitted due seizure and impaired consciousness. She had a mean arterial pressure of 160 and previously received cyclophosphamide. RESULTS She had a unique involvement of diffuse bilateral asymmetric brain edema over the upper cervical cord, brainstem, cerebellum, thalami, basal ganglia, frontotemporal, and parieto-occipital lobes. She was diagnosed with PRES and after the treatment vasogenic edema vanished completely. CONCLUSION When it is clinically applicable, physicians should consider PRES as the differential diagnosis of vasogenic edema over the upper cervical cord, cerebellum, and brainstem.
Collapse
Affiliation(s)
- Bardiya Ghaderi Yazdi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal E Al Ahmad, Tehran, 1411713135, Iran
| | - Seyed Jalaleddin Hadei
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal E Al Ahmad, Tehran, 1411713135, Iran
| | - Nazila Malekian
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal E Al Ahmad, Tehran, 1411713135, Iran.
| |
Collapse
|
20
|
Osteraas ND, Dafer RM. Advances in Management of the Stroke Etiology One-Percenters. Curr Neurol Neurosci Rep 2023:10.1007/s11910-023-01269-z. [PMID: 37247169 DOI: 10.1007/s11910-023-01269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE OF REVIEW Uncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from "standard" care. RECENT FINDINGS Randomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in "high-risk" patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of L-arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance. Less commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.
Collapse
Affiliation(s)
| | - Rima M Dafer
- Rush University Medical Center, Chicago, IL, USA.
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison St., Suite 1118, Chicago, IL, 60612, USA.
| |
Collapse
|
21
|
Yin X, Duan Y, Zhang L, Feng Z, Yin C, Zhu S, Chen J, Peng X. Eclampsia with hypothyroidism complicated with posterior reversible encephalopathy syndrome-a case report. BMC Neurol 2023; 23:63. [PMID: 36765280 PMCID: PMC9911940 DOI: 10.1186/s12883-023-03068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/11/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder with complex physiopathological mechanisms that have not been fully understood. Early identification is of great prognostic significance, of which the symptoms and radiological abnormalities can be completely reversed. If the diagnosis and treatment are delayed, ischemia and massive infarction may be developed in some patients. Posterior reversible encephalopathy syndrome (PRES) has been reported mainly in association with postpartum eclampsia, which have been rarely reported, while the association with hypothyroidism has not been reported at home or abroad. CASE PRESENTATION Here we report on a pregnant 29-year-old with multipara and a chief complication of hypothyroidism. She presented in the emergency department with frequent attacks of severe headache symptoms resulting from reversible cerebral vasoconstriction syndrome (RCVS), accompanied with prenatal eclampsia. PRES was determined by radiological examination. CONCLUSION To the best of our knowledge, this is the first case of PRES complicated by hypothyroidism and prepartum eclampsia.Clinicians should be alert for the co-occurence of eclampsia, PRES, and RCVS when patients have convulsions after a typical throbbing headache. Moreover, regular monitoring of thyroid function during pregnancy should also occupy certain special attention.
Collapse
Affiliation(s)
- Xuejing Yin
- grid.254020.10000 0004 1798 4253Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| | - Yu Duan
- grid.263452.40000 0004 1798 4018Department of Emergency Medicine, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province 046000 China
| | - Lifang Zhang
- grid.263452.40000 0004 1798 4018Department of Neurology, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province 046000 China
| | - Zhichao Feng
- grid.254020.10000 0004 1798 4253Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| | - Caixia Yin
- grid.263452.40000 0004 1798 4018Department of Neurology, Shanxi Medical University, Taiyuan, Shanxi Province 030000 China
| | - Sujie Zhu
- grid.254020.10000 0004 1798 4253Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| | - Jinhua Chen
- Department of Emergency Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province, 046000, China. .,Department of Neurology, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province, 046000, China. .,Department of Emergency Medicine and Neurology, The Affiliated Hospital of Shanxi Medical University, No. 502 Changxing Middle Road, Changzhi, Shanxi Province, 046000, China.
| | - Xinsen Peng
- grid.254020.10000 0004 1798 4253Department of Cardiovascular Medicine, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| |
Collapse
|
22
|
Chou LT, Abazari A. Hindsight is 20/20, an unexpected ocular telltale sign of bilateral renal artery dissection. Am J Ophthalmol Case Rep 2023; 29:101815. [PMID: 36846487 PMCID: PMC9945706 DOI: 10.1016/j.ajoc.2023.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
|
23
|
Hai PD, Duc VA, Hung VQ, Thang NVV. Posterior reversible encephalopathy syndrome following septicemia in patient with myasthenia gravis. Radiol Case Rep 2023; 18:1549-1551. [PMID: 36815144 PMCID: PMC9939535 DOI: 10.1016/j.radcr.2023.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinicoradiologic entity characterized by seizure, headaches, visual symptoms, impaired consciousness, and vasogenic cerebral edema of occipital and parietal lobes of the brain. Magnetic resonance imaging (MRI) is the diagnostic gold standard. The pathophysiology of posterior reversible encephalopathy syndrome is still unknown, but it is thought to be closely related to several medical conditions including hypertension, preeclampsia, eclampsia, immunosuppressive agents, transplantation, and sepsis. We report a rare case of posterior reversible encephalopathy syndrome in patient with myasthenia gravis and sepsis. A 22-year-old male was diagnosed with myasthenia gravis combined with sepsis due to pneumonia. During his recovery, the patient suffered multiple generalized convulsions and subsequent loss of consciousness. On cranial MRI, the abnormalities were observed with hyperintense within the subcortical white matter of the temporal, parietal, and bilateral occipital lobes on T2-weighted and T2 FLAIR. Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of posterior reversible encephalopathy syndrome. Early recognition and management of posterior reversible encephalopathy syndrome as a cause of encephalopathy in patients with septicemia and myasthenia gravis is necessary to prevent secondary complications in this condition.
Collapse
Affiliation(s)
- Pham Dang Hai
- Medical Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
- Corresponding author.
| | - Vu Anh Duc
- Medical Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Quang Hung
- Medical Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
| | | |
Collapse
|
24
|
Chang S, Schecht M, Jain R, Belani P. Acute Neurological Complications of Coronavirus Disease. Neuroimaging Clin N Am 2023; 33:57-68. [PMID: 36404047 PMCID: PMC9288970 DOI: 10.1016/j.nic.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The coronavirus disease (COVID-19) pandemic has impacted many lives globally. Neurologic manifestations have been observed among individuals at various stages and severity of the disease, the most common being stroke. Prompt identification of these neurologic diagnoses can affect patient management and prognosis. This article discusses the acute neuroradiological features typical of COVID-19, including cerebrovascular disease, intracerebral hemorrhage, leukoencephalopathy, and sensory neuropathies.
Collapse
Affiliation(s)
- Sanders Chang
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA
| | - Michael Schecht
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, 1st Floor, New York, NY 10016, USA,Department of Neurosurgery, NYU Grossman School of Medicine, 660 1st Avenue, 1st Floor, New York, NY 10016, USA
| | - Puneet Belani
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA,Corresponding author. 1176 5th Avenue MC Level, New York, NY 10029
| |
Collapse
|
25
|
Balcerac A, Bihan K, Psimaras D, Lebrun-Vignes B, Salem JE, Weiss N. Drugs associated with posterior reversible encephalopathy syndrome, a worldwide signal detection study. J Neurol 2023; 270:975-985. [PMID: 36329183 DOI: 10.1007/s00415-022-11450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) can occur in a variety of clinical conditions, such as severe hypertension, pregnancy, inflammatory diseases, hematopoietic stem cells or solid organ transplantation. Apart increased blood pressure levels and altered renal function, several drugs have been reported as potential triggering factor. These descriptions are nevertheless limited to case reports or small case series. Systematic analysis of drugs associated with PRES using global pharmacovigilance database is lacking and can be useful. METHODS We performed a disproportionality analysis using VigiBase, the World Health Organization pharmacovigilance database, using the information component (IC). The IC compares observed and expected values to find associations between drugs and PRES using disproportionate Bayesian reporting. An IC0.25 (lower end of the IC 95% credibility interval) > 0 is considered statistically significant. RESULTS Here we present an analysis of 3278 cases of PRES reported in VigiBase. These results identified 73 molecules statistically associated with PRES using full database as background with an IC0.25 > 0. Only 34% (N = 25/73) of them had this information written in the summary of product characteristics. The main drug classes involved were antineoplastic and immunomodulating agents and the drugs with the greatest number of cases were tacrolimus, cyclosporin, bevacizumab, methotrexate, and vincristine. An overall mortality of 8.1% (N = 267/3278) was identified in cases of drug-associated PRES. CONCLUSION These results will help clinicians identify potential suspected drugs associated with PRES and decide which drug to discontinue and eventually lead to a re-evaluation of drug labels for some molecules.
Collapse
Affiliation(s)
- Alexander Balcerac
- département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France. .,Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, 47-83, boulevard de l'hôpital, 75013, Paris, France.
| | - Kevin Bihan
- Department of Pharmacology, Regional Pharmacovigilance Center, Sorbonne Université, AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, INSERM, CIC-1901, Sorbonne Universités, Paris, France
| | - Dimitri Psimaras
- service de neuro-oncologie, DMU Neurosciences, Groupe OncoNeuro Tox, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bénédicte Lebrun-Vignes
- Department of Pharmacology, Regional Pharmacovigilance Center, Sorbonne Université, AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, INSERM, CIC-1901, Sorbonne Universités, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, Regional Pharmacovigilance Center, Sorbonne Université, AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, INSERM, CIC-1901, Sorbonne Universités, Paris, France
| | - Nicolas Weiss
- département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, 47-83, boulevard de l'hôpital, 75013, Paris, France
| |
Collapse
|
26
|
Li Y, Song J, Huq AM, Timilsina S, Gershwin ME. Posterior reversible encephalopathy syndrome and autoimmunity. Autoimmun Rev 2023; 22:103239. [PMID: 36464226 DOI: 10.1016/j.autrev.2022.103239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by acute or subacute onset of neurological symptoms (e.g., headache, seizure, confusion, vomiting, and diminished eyesight) and impaired endothelial barrier function of the cerebral circulation that leads to bilateral subcortical vasogenic edema, while exhibiting a "reversible" feature in most cases. Clinically, various predisposing or precipitating conditions have been identified, such as hypertension, autoimmune diseases, renal dysfunction/failure, preeclampsia/eclampsia, post-transplantation conditions, and certain therapeutic agents. Among several putative mechanisms, the immune activation hypothesis prevails, as up to 50% of patients with PRES harbor abnormalities related to autoimmunity, such as concurrent systemic lupus erythematosus. In this Review, we summarize the clinical and laboratory evidence that places PRES in the context of autoimmunity.
Collapse
Affiliation(s)
- Yang Li
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China
| | - Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China.
| | - Ahm M Huq
- Department of Pediatrics, Central Michigan University, Detroit, MI 48201, USA
| | - Suraj Timilsina
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
| |
Collapse
|
27
|
Kudo D, Suzuki H, Abe N, Hirai R, Tanimura A, Takeshita M, Miwa A. [ Posterior reversible encephalopathy syndrome during nilotinib treatment for chronic myeloid leukemia]. Rinsho Ketsueki 2023; 64:1514-1518. [PMID: 38220151 DOI: 10.11406/rinketsu.64.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Here we present the case of a 50-year-old woman with chronic myeloid leukemia who received nilotinib as initial treatment. After about 2 years of nilotinib therapy, she developed headache, blurred vision, impaired consciousness, and marked hypertension. Posterior reversible encephalopathy syndrome (PRES) was diagnosed, and was strongly suspected to be a vascular adverse event caused by nilotinib. Nilotinib was withheld and the patient was treated with antihypertensive drugs under ventilator management. Her symptoms resolved quickly. The most likely cause of PRES is systemic arterial hypertension and endothelial dysfunction due to direct injury leading to dysfunction at the level of the blood-brain barrier, along with the resultant vasogenic edema. PRES has been reported with some tyrosine kinase inhibitors, but this is the first case of PRES during nilotinib treatment.
Collapse
Affiliation(s)
- Daisuke Kudo
- Department of Hematology, Tokyo-Kita Medical Center
| | | | - Naomi Abe
- Department of Hematology, Tokyo-Kita Medical Center
| | - Risen Hirai
- Department of Hematology, Tokyo-Kita Medical Center
| | | | - Masataka Takeshita
- Department of Hematology, Tokyo-Kita Medical Center
- International Myeloma Center for Advanced Research and Treatment
| | - Akiyoshi Miwa
- Department of Hematology, Tokyo-Kita Medical Center
- International Myeloma Center for Advanced Research and Treatment
| |
Collapse
|
28
|
Tortajada Soler J, Tauler Redondo M, Garví López M, Lozano Serrano M, López-Torres López J, Sánchez López M. Posterior reversible encephalopathy syndrome in critical COVID-19 patients: Report of 2 cases. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:51-55. [PMID: 36621570 PMCID: PMC9814367 DOI: 10.1016/j.redare.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/29/2021] [Indexed: 01/07/2023]
Abstract
Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema. The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome. SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.
Collapse
|
29
|
Erhart DK, Ludolph AC, Althaus K. RCVS: by clinicians for clinicians-a narrative review. J Neurol 2023; 270:673-88. [PMID: 36305970 DOI: 10.1007/s00415-022-11425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVE Reversible cerebral vasoconstriction syndrome may be underdiagnosed. It can be accompanied by various complications, mainly intracerebral hemorrhage and ischemic stroke. The clinical presentation of this condition varies according to its localization. The aims of this review are to raise awareness of the disease, especially in the presence of corresponding risk factors; to connect its precipitating factors, pathophysiology, and complications; and to compare various differential diagnoses of vasoconstriction. METHODS A review of the literature in PubMed/MEDLINE and Google Scholar was conducted from May 1997 until May 2022. RESULTS Reversible cerebral vasoconstriction syndrome, which is a clinical-radiological syndrome, is mainly characterized by the occurrence of thunderclap headache and widespread vasoconstriction. The most common precipitating factors are the use of vasoactive substances and postpartum status. The pathophysiology is currently assumed to include two mechanisms: sympathetic overactivity and endothelial dysfunction. From these mechanisms, it is possible to derive potential complications as well as the most important differential diagnoses: posterior reversible encephalopathy syndrome, convexity subarachnoid hemorrhage, ischemic and hemorrhagic stroke, and primary angiitis of the central nervous system. CONCLUSION In general, the outcome of reversible cerebral vasoconstriction syndrome is very good. Vasospasm as well as thunderclap headache attacks can be fully reversible, and > 90% of patients are functionally independent at discharge.
Collapse
|
30
|
He X, Shi D, Long C, Yang J, Tian J. Posterior reversible encephalopathy syndrome in a child after burns: A case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231157988. [PMID: 36937809 PMCID: PMC10021091 DOI: 10.1177/2050313x231157988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/31/2023] [Indexed: 03/17/2023] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinical-neuroradiological syndrome with typical neuroimaging features of posterior cerebral white matter changes that are usually reversible. However, there are only few reports of burns with posterior reversible encephalopathy syndrome in the literature. Hence, it is a clinical entity that many burn medicine physicians may be unfamiliar with. We report a case of severe burns complicated by posterior reversible encephalopathy syndrome in a 14-month-old male patient. On the eighth day of hospitalization, the child had persistent fever, occasional convulsions, eyes staring to the right, and high-pitched cry. Magnetic resonance imaging on day 10 showed the diagnosis is posterior reversible encephalopathy syndrome. We used hormone therapy to reduce cerebral oedema, oxcarbazepine to control convulsions, and multiple other drugs and physical measures to treat fever. The symptoms, signs, and imaging abnormalities of his posterior reversible encephalopathy syndrome were rapidly reversed in a short period of time. At the 1-year follow-up, the patient had recovered completely with no residual neurological signs and symptoms. To our knowledge, the patient may be the youngest recorded patient with both burns and posterior reversible encephalopathy syndrome. Careful observation, computed tomography, and magnetic resonance imaging can achieve early detection, early diagnosis, and early treatment of posterior reversible encephalopathy syndrome, which facilitates the achievement of desired therapeutic results. Further investigation is required to determine whether burns can serve as an independent posterior reversible encephalopathy syndrome causative factor and clarify the underlying pathogenesis mechanism.
Collapse
Affiliation(s)
- Xiaoying He
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
| | - Dandan Shi
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
| | - Chenyan Long
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
- Department of Plastic Surgery,
Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jia Yang
- Department of Pediatric Intensive Care
Unit, Zhongshan City People’s Hospital, Zhongshan, China
| | - Ju Tian
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
- Ju Tian, Department of Plastic Surgery,
Zhongshan City People’s Hospital, 2 Sunwen East Road, Zhongshan 528400,
Guangdong, China.
| |
Collapse
|
31
|
Phalak M, Ganeshkumar A, Sharma R, Kale SS. Posterior reversible encephalopathy syndrome following cervical spine surgery: insights from an interesting case. Childs Nerv Syst 2022; 39:1089-1092. [PMID: 36571596 DOI: 10.1007/s00381-022-05726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/25/2022] [Indexed: 12/27/2022]
Abstract
A 14-month child presenting with complaints of spastic paraplegia was diagnosed with C6-D1 intramedullary cyst. A cysto-subarachnoid shunt was performed; the patient was clinically stable in the immediate post-operative period. On post-operative day 2, the patient developed multiple episodes of generalized tonic-clonic seizures (GTCS) with altered sensorium, NCCT head revealed bilateral diffuse parieto-occipital hypodensities. MRI brain showed on T2WI and FLAIR, diffuse hyperintensities in bilateral parieto-occipital region suggestive of posterior reversible encephalopathy syndrome (PRES). The patient never experienced hypertensive episodes and was treated with anti-epileptics. The patient's symptoms improved and repeat MRI after 10 weeks revealed normal signal intensity in bilateral parieto-occipital areas. PRES after spinal surgeries is very rare and more so in pediatric cases, CSF hypotension may contribute to PRES in such cases.
Collapse
Affiliation(s)
- Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, 720, CNC, AIIMS, New Delhi, 110029, India.
| | - Akshay Ganeshkumar
- Department of Neurosurgery, All India Institute of Medical Sciences, 720, CNC, AIIMS, New Delhi, 110029, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, 720, CNC, AIIMS, New Delhi, 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, 720, CNC, AIIMS, New Delhi, 110029, India
| |
Collapse
|
32
|
Yang B, Guo L, Yang X, Yu N. The pathogenesis and treatment of posterior reversible encephalopathy syndrome after neuromyelitis optica spectrum disorder: a case report and literature review. BMC Neurol 2022; 22:493. [PMID: 36539740 PMCID: PMC9764726 DOI: 10.1186/s12883-022-02985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a rare disease characterized by reversible subcortical vasogenic brain edema. Neuromyelitis optica spectrum disorder (NMOSD) is a frequent neurological autoimmune disease that is rarely reported to complicate PRES. CASE PRESENTATION Here, we report a case of neuromyelitis optica (NMO) concurrent with PRES. A 50-year-old woman presented with severe impairment of her health visual acuity, with significantly worsening of the motor weakness in both lower limbs during methylprednisolone therapy after her diagnosis of NMO. MRI showed new-onset brain edematous lesions of the bilateral frontal, occipital, and parietal lobes. PRES was considered. Her vision impairment and weakness of the extremities were alleviated after antihypertensive treatment and dehydration. The edema lesions detected by MRI also completely disappeared. CONCLUSIONS We reviewed 14 cases of NMO with PRES and concluded that the etiology of NMOSD concurrent PRES may be multifactorial, involving pathogenic IgGs against aquaporin-4 (AQP-4) and immunotherapy treatment. Different underlying pathogeneses require different treatment approaches.
Collapse
Affiliation(s)
- Bo Yang
- grid.54549.390000 0004 0369 4060Department of Center for Psychosomatic Medicine, Sichuan Provincial Center for Mental Health,Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Guo
- grid.54549.390000 0004 0369 4060Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xu Yang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Leshan, Leshan, China
| | - Nengwei Yu
- grid.54549.390000 0004 0369 4060Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
33
|
de Souza Andrade T, Mello LGM, Hokazono K, Monteiro MLR. Visual Hallucinations as a Major Manifestation of Posterior Reversible Encephalopathy Syndrome: Case Report and Literature Review. Neuroophthalmology 2022; 47:117-122. [PMID: 36891408 PMCID: PMC9988333 DOI: 10.1080/01658107.2022.2153873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
We evaluated a 48-year-old woman who had visual hallucinations (VHs) as a major presenting sign of posterior reversible encephalopathy syndrome (PRES). Despite her mild loss of vision, she described various hallucinations after awakening from a comatose state days after a motorcycle collision. VHs are usually accompanied by more severe loss of vision, yet our case and literature review indicate that sudden onset of formed VHs should suggest a possible diagnosis of PRES in patients who have large fluctuations in blood pressure, renal failure, or autoimmune dysfunction, as well as in patients taking cytotoxic agents.
Collapse
Affiliation(s)
- Thais de Souza Andrade
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Guilherme Marchesi Mello
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
- Department of Specialized Medicine, Centro de Ciências da Saúde (CCS), Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Kenzo Hokazono
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Mário Luiz Ribeiro Monteiro
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
34
|
Xia C, Lv Y. Cerebral amyloid angiopathy-related inflammation with posterior reversible encephalopathy syndrome-like presentation: a case report. BMC Neurol 2022; 22:449. [PMID: 36463107 PMCID: PMC9719169 DOI: 10.1186/s12883-022-02979-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cerebral amyloid angiopathy-related inflammation (CAA-RI), which presents with acute or subacute cognitive or functional decline, focal or multifocal neurologic deficits, new onset of seizures, or a combination of seizures and neurologic deficits, shares clinical and radiologic similarities with posterior reversible encephalopathy syndrome (PRES). Differential diagnosis is critical because the treatment principle for these 2 conditions differs greatly. Here, we present a case of PRES-like CAA-RI and the strategy used to discriminate between the 2 conditions. CASE PRESENTATION A patient with probable CAA-RI was first thought to suffer from PRES. Initial high-dose methylprednisolone therapy caused rapid improvement of the neurologic symptoms but abrupt discontinuation of corticosteroids resulted in clinical relapse and deterioration. Subsequent reinitiation of high-dose methylprednisolone followed by tapering off of oral prednisone led to clinical and radiologic recovery at the 3-month follow-up. CONCLUSIONS We suggest that in cases where it is difficult to distinguish between CAA-RI and PRES solely based on magnetic resonance imaging, a good response to corticosteroids and an apolipoprotein E (ApoE) ε4/ε4 genotype are critical for establishing a diagnosis of CAA-RI. If there is clinical deterioration, sudden withdrawal of high-dose corticosteroid during the active phase of CAA-RI should be avoided.
Collapse
Affiliation(s)
- Cheng Xia
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan Lv
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| |
Collapse
|
35
|
Murao S, Kiuchi T, Hasegawa M, Yoshikawa R. Pontine lesion in hyperglycemic crises: Relevance to osmotic demyelination syndrome and posterior reversible encephalopathy syndrome. J Diabetes Investig 2022; 14:486-488. [PMID: 36458523 PMCID: PMC9951566 DOI: 10.1111/jdi.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
We herein describe a case of type 1 diabetes that presented with a pontine lesion during two hyperglycemic crises accompanied by marked fluctuations in serum osmotic pressure and blood pressure. Magnetic resonance imaging showed swollen pons with osmotic demyelination syndrome characteristics accompanying cytotoxic edema at the first crisis. The involvement of vasogenic edema was also assumed in the second crisis. Neurological symptoms were milder than magnetic resonance imaging findings. The patient recovered after 7 days without sequelae in both crises. Based on these findings, a pontine lesion needs to be considered in patients with poorly controlled diabetes showing rapid metabolic and blood pressure changes, as observed in hyperglycemic crises. Cytotoxic edema leading to osmotic demyelination syndrome and vasogenic edema caused by vascular endothelial cell damage might both be involved in the pathogenesis of a pontine lesion.
Collapse
Affiliation(s)
- Satoshi Murao
- Department of Metabolism and EndocrinologyTakamatsu HospitalKagawaJapan
| | | | - Momoka Hasegawa
- Department of Metabolism and EndocrinologyTakamatsu HospitalKagawaJapan
| | - Ritsuko Yoshikawa
- Department of Metabolism and EndocrinologyTakamatsu HospitalKagawaJapan
| |
Collapse
|
36
|
Hilal K, Khandwala K, Sajjad N, Kaleemi R, Malik AA, Mohsin S, Ibrahim SH. Paediatric posterior reversible encephalopathy syndrome: is there an association of blood pressure with imaging severity and atypical magnetic resonance characteristics? Pediatr Radiol 2022; 52:2610-2619. [PMID: 35723697 DOI: 10.1007/s00247-022-05400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is relatively uncommon in paediatric patients; however, its pathophysiology remains obscure. OBJECTIVE The aims of this study were to find an association or correlation between (1) blood pressures and (2) imaging severity and the presence of atypical imaging features in children with PRES. MATERIALS AND METHODS We performed a retrospective cross-sectional evaluation in children diagnosed with PRES. We reviewed radiologic findings along with each patient's clinical profile and outcome. We categorised imaging severity into mild, moderate and severe, and assessed the MR imaging pattern, enhancement and diffusion restriction for each child. We assessed both associations and correlations between variables using the chi-square test, Cramer V and Kendall tau b. RESULTS A total of 63 children met the inclusion criteria (31 boys; mean age 9.7 years). A total of 42 children (67%) had an elevated blood pressure. Imaging showed parieto-occipital lobe involvement pattern in 24 (38%) children, frontal lobe pattern in 25 (40%) and cerebellar involvement in 12 (19%). Three (5%) had haemorrhage, 15 (24%) had contrast enhancement and 19 (30%) had positive diffusion restriction (cytotoxic oedema). We found no statistically significant association between imaging severity and blood pressures (P=0.11), nor any association between blood pressure and atypical imaging findings such as diffusion restriction (P=0.1), enhancement (P=0.11) or haemorrhage (P=0.33). CONCLUSION According to our results, there is no statistically significant association or correlation between blood pressure and either imaging severity or atypical imaging features in children with PRES. Further prospective studies are warranted.
Collapse
Affiliation(s)
- Kiran Hilal
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Kumail Khandwala
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Nida Sajjad
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Raima Kaleemi
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Amyn A Malik
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shazia Mohsin
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahnaz H Ibrahim
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
37
|
Dai SJ, Yu QJ, Zhu XY, Shang QZ, Qu JB, Ai QL. Autoimmune encephalitis with posterior reversible encephalopathy syndrome: A case report. World J Clin Cases 2022; 10:11044-11048. [PMID: 36338200 PMCID: PMC9631155 DOI: 10.12998/wjcc.v10.i30.11044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/09/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a neuroimaging-based syndrome and is associated with multifocal vasogenic cerebral edema. Patients with PRES frequently demonstrate headache, seizure, encephalopathy, altered mental function, visual loss and so on. We here report a patient who showed persistent neurologic deficits after PRES and was ultimately diagnosed with autoimmune encephalitis (AE).
CASE SUMMARY This case exhibits a rare imaging manifestation of anti-casper 2 encephalitis which was initially well-matched with PRES and associated vasogenic edema.
CONCLUSION AE should be further considered when the etiology, clinical manifestations, and course of PRES are atypical.
Collapse
Affiliation(s)
- Shu-Juan Dai
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Qiu-Jian Yu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Xiao-Yan Zhu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Qun-Zhu Shang
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Ji-Bo Qu
- Department of Neurology, Hospital of Honghe State Affiliated to Kunming Medical University, Honghe 661000, Yunnan Province, China
| | - Qing-Long Ai
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| |
Collapse
|
38
|
Wang Y, Zhang Q. Postpartum posterior reversible encephalopathy syndrome secondary to preeclampsia and cerebrospinal fluid leakage: A case report and literature review. World J Clin Cases 2022; 10:10332-10338. [PMID: 36246802 PMCID: PMC9561592 DOI: 10.12998/wjcc.v10.i28.10332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postpartum posterior reversible encephalopathy syndrome (PRES) is not uncommon. Its mechanisms and risk factors are not clear.
CASE SUMMARY A 28-year-old woman underwent cesarean section but had inadvertent dural puncture during epidural anesthesia. To manage the symptoms of intracranial hypotension, crystalloid fluid was infused. However, the patient developed postpartum preeclampsia and PRES. The patient was treated with diazepam and dehydration therapy. The signs of cerebral lesions on magnetic resonance imaging disappeared on postpartum day 7.
CONCLUSION Postpartum preeclampsia and PRES can develop concomitantly. Treating postdural puncture headaches with infusion of crystalloid fluid may precipitate the development of PRES.
Collapse
Affiliation(s)
- Yu Wang
- Department of Anesthesiology, Zhabei Central Hospital, Shanghai 200071, China
| | - Qing Zhang
- Department of Anesthesiology, Zhabei Central Hospital, Shanghai 200071, China
| |
Collapse
|
39
|
Pringle C, Portwood K, Viamonte MA, Rajderkar D. Imaging Findings in Neonatal and Pediatric Posterior Reversible Encephalopathy Syndrome (PRES) Differ From Adults. Pediatr Neurol 2022; 135:6-11. [PMID: 35963074 PMCID: PMC9903994 DOI: 10.1016/j.pediatrneurol.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is classically a reversible clinical radiographic syndrome associated with predominantly posterior leukoencephalopathy on neuroimaging. Magnetic resonance imaging (MRI) in adults demonstrates almost universally reversible parietal-occipital disease. We aimed to demonstrate in a cohort of children that "atypical" distribution is expected, acutely and on follow-up. METHODS A retrospective review of children diagnosed with PRES from 2010 to 2018 at our children's hospital was performed. All had MRI at diagnoses, with over half having follow-up MRIs. Images were reviewed by a neuroradiology-trained pediatric radiologist for confirmation of findings consistent with PRES/identification of involved regions. RESULTS Nineteen patients (aged zero to 18 years, 53% female) were included. Notably, two were infants. Nearly all had seizures; all had altered mental status and hypertension. Fifteen (84%) had MRI described as "atypical." Distribution of MRI findings was anatomically widespread, including nine with frontal findings. Twelve (63%) had follow-up imaging, of which approximately half remained abnormal. CONCLUSIONS Pediatric PRES MRI findings were more often atypical at time of diagnosis. Vasogenic edema related to the acute phases of PRES typically resolved; however, follow-up imaging identified new volume loss in the areas affected. Two of our subjects were younger than 13 months, younger than typically described. Our series demonstrates that imaging distribution in children with PRES does not mirror the classical posterior, reversible distribution described in adults and continues the recent trend of identifying PRES in infants.
Collapse
Affiliation(s)
- Charlene Pringle
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.
| | - Katherin Portwood
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Manuel A Viamonte
- Division of Pediatric Critical Care, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Dhanashree Rajderkar
- Division of Pediatric Radiology, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida
| |
Collapse
|
40
|
Sanghan N, Lin S, Tartrakoon G, Setthawatcharawanich S, Amornpojnimman T, Sathirapanya P, Khumtong R, Leelawattana R, Korathanakhun P. Factors associated with acute symptomatic seizure occurrence among patients with posterior reversible encephalopathy syndrome. Epilepsy Behav 2022; 134:108834. [PMID: 35834860 DOI: 10.1016/j.yebeh.2022.108834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We aimed to define the factors associated with acute symptomatic seizure occurrence in posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS We conducted a retrospective cohort study enrolling patients with PRES admitted to the hospital between 2006 and 2019. In addition to seizure characteristics, baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the seizure and non-seizure groups. Factors with p-value <0.05 in the univariate analysis were entered into the first model of multivariate logistic regression analysis to determine the factors associated with seizure occurrence if the p-value <0.05. The interaction of associated factors was also analyzed in the final multiple logistic regression analysis model. RESULTS Acute symptomatic seizure, which is mainly based on the clinical documentation without electroencephalography, occurred in 50.0% of 136 patients with PRES. Of these, early seizures within 14 days of PRES occurred in 98.5% which mostly developed at presentation (82.4%) with a single seizure attack (55.9%). Convulsive seizures (77.9%) were the most common seizure semiology. The seizure group was significantly younger (median [interquartile range: IQR] 36.00 years old (21.75-48.50) vs 46.50 years old (31.25-61.00), p = 0.003). In univariate analysis, the seizure group had a higher prevalence of consciousness impairment (61.76% vs 26.47%, p < 0.001), Glasgow coma scale (GCS) score of 0-13 (42.46% vs 13.23%, p < 0.001), preeclampsia (20.58% vs 4.41%, p = 0.004), autoimmune disease (17.65% vs 5.88%, p = 0.033), and frontal lesions (25.00% vs 11.76%, p = 0.046) than those in the non-seizure group. In contrast, the seizure group had a lower prevalence of headache (27.94% vs 61.76%, p < 0.001). In the final multivariate logistic regression analysis which included the interaction terms, the acute symptomatic seizure occurrence directly associated with preeclampsia (adjusted odds ratio (aOR) 6.426, 95% confidence interval (CI) 1.450-27.031, p = 0.016) and autoimmune disease (aOR 4.962, 95% CI 1.283-18.642, p = 0.025), while headache showed a reverse association (aOR 0.310, 95% CI = 0.158-0.721, p = 0.008). CONCLUSIONS Acute symptomatic seizure occurred in a half of patients with PRES in this cohort. Preeclampsia and autoimmune disease were directly associated with seizure occurrence, while headache showed a reverse association.
Collapse
Affiliation(s)
- Nattha Sanghan
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Siriporn Lin
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Gawinnart Tartrakoon
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Thanyalak Amornpojnimman
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rujimas Khumtong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
| |
Collapse
|
41
|
Kunić S, Ibrahimagić OĆ, Kojić B, Džananović D. Comment on “ Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report”. World J Clin Cases 2022; 10:8805-8807. [PMID: 36157809 PMCID: PMC9453353 DOI: 10.12998/wjcc.v10.i24.8805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/13/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state, manifesting clinical symptoms of headache, altered consciousness, visual disturbances, and seizures. Although several diseases have been identified as causative of PRES, the underlying mechanism remains unclear. Song et al recently published “Posterior reversible encephalopathy syndrome (PRES) in a patient with metastatic breast cancer: A case report“ in the World Journal of Clinical Cases, highlighting and discussing the role of hypercalcemia in PRES as related to uncontrolled hypertension. To build upon this case description, we provide further insight into the possible underlying mechanisms of PRES through this commentary.
Collapse
Affiliation(s)
- Suljo Kunić
- Department of Neurology, Primary Health Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Omer Ć Ibrahimagić
- Department of Neurology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Biljana Kojić
- Department of Neurology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Dževad Džananović
- Department of Physical Medicine and Rehabilitation, Primary Health Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| |
Collapse
|
42
|
Puram VV, Ghazaleh D, Salari A, McCleary K, Moriarty G, Nichols K, Ghannam M, Brown K, Berry B. Mepolizumab-Induced Posterior Reversible Encephalopathy Syndrome (PRES), a new patient report. BMC Neurol 2022; 22:318. [PMID: 36008800 DOI: 10.1186/s12883-022-02849-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior Reversible Encephalopathy Syndrome (PRES) is a neurotoxic state characterized by seizures, headache, vision change, paresis, and altered mental status. PRES has an important place in medicine due to the wide variety of causative diseases, infections, and medications that precipitate its mysterious onset. Although exposure to medications, particularly immunosuppressants, cancer chemotherapy, and biologic drugs, is a common occurrence in patients who develop PRES, Mepolizumab has never before been associated. CASE PRESENTATION This report of a 67-year-old male patient outlines the first reported case of Mepolizumab-induced PRES in the literature. CONCLUSIONS Treatment of severe asthma, asthma-exacerbations, and diseases such as eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss) with Mepolizumab is rapidly gaining popularity ever since the drug's recent FDA-approval. This report aims to raise awareness of this potentially life-threatening and previously unreported side effect of Mepolizumab since early identification of the causative agent is the key to preventing the severe neurologic disability and possible death that may occur from the delayed treatment of PRES.
Collapse
|
43
|
Hill G, Archibald N, Larkin P, Farquhar J, Evans J. Foreign accent syndrome and other neuropsychological sequelae of a parieto-occipital lesion following COVID-19 associated posterior reversible encephalopathy syndrome. Clin Neuropsychol 2022:1-15. [PMID: 36000333 DOI: 10.1080/13854046.2022.2108903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We describe a previously fit and well 54-year-old female who acquired a range of severe and persisting neuropsychological impairments following a posterior reversible encephalopathy syndrome (PRES) complication of COVID-19. The initial presentation included aphasia, a neurogenic foreign accent syndrome (FAS) and a persisting complete cortical blindness from the underpinning parieto-occipital brain injury. METHOD Neuropsychological single clinical case report. RESULTS The patient retained insight and made good early progress with their adjustment to the numerous losses caused by the COVID-19 associated acquired brain injury. Comprehensive neuropsychological investigation characterised an acalculia, along with deficits in focused, sustained and divided attention impacting on verbal memory, working memory and executive functioning, amongst numerous relative strengths. CONCLUSION Similar to PRES from other aetiologies, COVID-19 associated PRES can in some cases cause irreversible acquired brain injury. The diverse neuropsychological effects need to be comprehensively investigated and managed. This case adds to the neuropsychological literature on PRES, FAS and acquired brain injury as a rare complication of SARS-CoV-2.
Collapse
Affiliation(s)
- Geoff Hill
- Neuropsychology, Medical Psychology Service, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Neil Archibald
- Neurology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Poppy Larkin
- Speech and Language Therapy, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Jenny Farquhar
- Neurophysiotherapy, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
44
|
Amornpojnimman T, Suwanwong P, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Predictors of hospital outcomes among patients with posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis 2022; 31:106579. [PMID: 35738219 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES We aimed to identify independent predictors of the clinical outcomes of posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS This retrospective cohort study recruited PRES patients admitted in the hospital between 2006 and 2019. The baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the groups with favourable (modified Rankin scale [mRS] score, 0-2) and unfavourable (mRS score, 3-6) clinical outcomes. Factors presenting with p-values < 0.5 in univariate analysis were analysed in the multiple logistic regression model to determine independent predictors of outcome. RESULTS Among 136 PRES patients, 22.80% experienced unfavourable outcomes (mRS score, 3-6), and the mortality rate was 7.35%. The common presenting symptoms in the unfavourable clinical outcome group were impairment of consciousness (90.32%) and seizures (67.74%). Sepsis as a hospital complication (adjusted odds ratio [aOR], 32.95; 95% confidence interval [CI], 4.44-244.22, p = 0.001), acute kidney injury as a hospital complication (aOR, 9.94; 95% CI, 1.71-57.66; p = 0.010), and impairment of consciousness (aOR, 10.85; 95% CI, 1.72-68.53, p = 0.011) were independent predictors of unfavourable outcomes. On the other hand, headache was an independent protective factor (aOR, 0.164; 95% CI, 0.03-0.91; p = 0.039). CONCLUSIONS Impairment of consciousness, sepsis as a hospital complication, and acute kidney injury were independent predictors of unfavourable clinical outcomes, whereas headache showed a preventive effect.
Collapse
Affiliation(s)
- Thanyalak Amornpojnimman
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pachara Suwanwong
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
| |
Collapse
|
45
|
Bazhu, Shi Y, Ren S, Shu L, Li Q. Posterior reversible encephalopathy syndrome secondary to acute post-streptococcal glomerulonephritis in a child: a case report from the Tibetan plateau. BMC Neurol 2022; 22:225. [PMID: 35717141 PMCID: PMC9206370 DOI: 10.1186/s12883-022-02750-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is a disorder of reversible vasogenic brain oedema with acute neurologic symptoms. It is a rare but serious disease that affects the central nervous system. PRES is a rare complication of acute post-streptococcal glomerulonephritis (APSGN). High altitude can accelerate vasogenic brain oedema by increasing cerebral blood flow (CBF), impairing cerebral autoregulation and promoting vascular inflammation. We report a case of PRES induced by acute post-streptococcal glomerulonephritis in a high-altitude environment. Case presentation A fourteen-year-old Tibetan girl presented with progressive headache with haematuria, facial swelling, dizziness and vomiting for 2 weeks as well as multiple episodes of tonic–clonic seizures for 14 h. She was diagnosed with APSGN based on laboratory tests and clinical symptoms. Brain magnetic resonance imaging (MRI) and computed tomography (CT) revealed bilateral frontal, parietal and occipital lesions that were compatible with the radiological diagnosis of PRES. The treatments included an antibiotic (penicillin), an antiepileptic drug, and hyperbaric oxygen (HBO) therapy. Follow-up MRI obtained 1 week after admission and CT obtained 4 weeks and 6 weeks after admission demonstrated complete resolution of the brain lesions. Conclusions The case illustrates a rare occurrence of PRES following APSGN in a 14-year-old child in the Tibetan Plateau. The hypoxic conditions of a high-altitude setting might lower the cerebral autoregulation threshold and amplify the endothelial inflammatory reaction, thus inducing PRES in patients with APSGN. It is important to recognize the clinical and radiologic features of PRES, and adjuvant HBO therapy can promote rapid recovery from this condition in high-altitude areas.
Collapse
Affiliation(s)
- Bazhu
- Department of Neurosurgery, Shigatse People's Hospital, Tibet, China
| | - Yanhui Shi
- Department of Neurology, Xuhui District Central Hospital, Shanghai, China
| | - Shuang Ren
- Department of Neurosurgery, Shigatse People's Hospital, Tibet, China
| | - Liang Shu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qiang Li
- Department of Neurosurgery, Shigatse People's Hospital, Tibet, China. .,Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| |
Collapse
|
46
|
Ioan P, Ribigan AC, Rusu O, Bratu IF, Badea RS, Antochi F. Posterior reversible encephalopathy syndrome - A pathology that should not be overlooked in the era of COVID-19. Am J Emerg Med 2022; 56:393.e5-393.e8. [PMID: 35346531 PMCID: PMC8918073 DOI: 10.1016/j.ajem.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes Coronavirus Disease 2019 (COVID-19) may determine a series of neurological complications directly, by invasion of the nervous system or indirectly, secondary to systemic organ failure. Posterior reversible encephalopathy syndrome (PRES) represents a clinical and radiological neurological entity involving predominantly the occipital lobes. PRES was observed in patients receiving cytotoxic drugs, patients suffering from infectious diseases and sepsis, hypertensive emergencies and eclampsia, renal or autoimmune diseases. As more infectious SARS-COV-2 variants are now dominant in most of the Europe, an increasing number of patients is presenting to the Emergency Department. MATERIALS AND METHODS Case report of a 38-year-old patient, with previous exposure to SARS-COV-2 presented to the Emergency Department (ED) with generalized tonic-clonic seizures, dyspnea, cortical blindness and aphasia. The patient had been exhibiting fever, cough and shortness of breath in the previous 10 days. He had no relevant medical history and was receiving antibiotics and corticosteroids as prescribed by his general practitioner. RESULTS Laboratory findings together with the thoracic computed tomography scan were consistent with the diagnosis of severe SARS-COV-2 pneumonia. The cerebral MRI scans showed bilateral T2-weighted/FLAIR hyperintensities that were suggestive for PRES. The patient was diagnosed with COVID-19 complicated with PRES. He received adequate treatment and the symptoms resolved in 48 h. CONCLUSIONS This is a rare and interesting case of a patient with PRES and COVID-19 as underlying pathology, in whom rapid diagnosis in the ED and early initiation of appropriate treatment led to full recovery. Immediate extensive work-up in patients with COVID-19 and neurological symptoms proves to be paramount for best outcome. To our knowledge this is the first case of PRES described in a patient with Delta variant of SARS-COV-2.
Collapse
Affiliation(s)
- Patricia Ioan
- Neurology Department, University Emergency Hospital Bucharest, Splaiul Independentei, number 169, district 5, Bucharest ZIP code: 050098, Romania
| | - Athena Cristina Ribigan
- Neurology Department, University Emergency Hospital Bucharest, Splaiul Independentei, number 169, district 5, Bucharest ZIP code: 050098, Romania,,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila Bucharest, Dionisie Lupu street, number 37, district 1, Bucharest ZIP code: 020021, Romania,Corresponding author at: Splaiul Independentei, number 169, district 5, Bucharest, Romania
| | - Octaviana Rusu
- Neurology Department, University Emergency Hospital Bucharest, Splaiul Independentei, number 169, district 5, Bucharest ZIP code: 050098, Romania
| | - Ionut Flavius Bratu
- Neurology Department, University Emergency Hospital Bucharest, Splaiul Independentei, number 169, district 5, Bucharest ZIP code: 050098, Romania
| | - Raluca Stefania Badea
- Neurology Department, University Emergency Hospital Bucharest, Splaiul Independentei, number 169, district 5, Bucharest ZIP code: 050098, Romania,,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila Bucharest, Dionisie Lupu street, number 37, district 1, Bucharest ZIP code: 020021, Romania
| | - Florina Antochi
- Neurology Department, University Emergency Hospital Bucharest, Splaiul Independentei, number 169, district 5, Bucharest ZIP code: 050098, Romania
| |
Collapse
|
47
|
Fazeli S, Noorbakhsh A, Imbesi SG, Bolar DS. Cerebral perfusion in posterior reversible encephalopathy syndrome measured with arterial spin labeling MRI. Neuroimage Clin 2022; 35:103017. [PMID: 35584601 PMCID: PMC9119826 DOI: 10.1016/j.nicl.2022.103017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/12/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The pathophysiologic basis of posterior reversible encephalopathy syndrome (PRES) remains controversial. Hypertension (HTN)-induced autoregulatory failure with subsequent hyperperfusion is the leading hypothesis, whereas alternative theories suggest vasoconstriction-induced hypoperfusion as the underlying mechanism. Studies using contrast-based CT and MR perfusion imaging have yielded contradictory results supporting both ideas. This work represents one of the first applications of arterial spin labeling (ASL) to evaluate cerebral blood flow (CBF) changes in PRES. MATERIALS AND METHODS After obtaining Institutional Review Board approval, MRI reports at our institution from 07/2015 to 09/2020 were retrospectively searched and reviewed for mention of "PRES" and "posterior reversible encephalopathy syndrome." Of the resulting 103 MRIs (performed on GE 1.5 Tesla or 3 Tesla scanners), 20 MRIs in 18 patients who met the inclusion criteria of clinical and imaging diagnosis of PRES and had diagnostic-quality pseudocontinuous ASL scans were included. Patients with a more likely alternative diagnosis, technically non-diagnostic ASL, or other intracranial abnormalities limiting assessment of underlying PRES features were excluded. Perfusion in FLAIR-affected brain regions was qualitatively assessed using ASL and characterized as hyperperfusion, normal, or hypoperfusion. Additional quantitative analysis was performed by measuring average gray matter CBF in abnormal versus normal brain regions. RESULTS HTN was the most common PRES etiology (65%). ASL showed hyperperfusion in 13 cases and normal perfusion in 7 cases. A hypoperfusion pattern was not identified. Quantitative analysis of gray matter CBF among patients with visually apparent hyperperfusion showed statistically higher perfusion in affected versus normal appearing brain regions (median CBF 100.4 ml/100 g-min vs. 61.0 ml/ 100 g-min, p < 0.001). CONCLUSION Elevated ASL CBF was seen in the majority (65%) of patients with PRES, favoring the autoregulatory failure hypothesis as a predominant mechanism. Our data support ASL as a practical way to assess and noninvasively monitor cerebral perfusion in PRES that could potentially alter management strategies.
Collapse
Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, University of California San Diego, 200 W. Arbor Drive, San Diego, CA 92103, United States
| | - Abraham Noorbakhsh
- Department of Radiology, University of California San Diego, 200 W. Arbor Drive, San Diego, CA 92103, United States
| | - Steven G Imbesi
- Department of Radiology, University of California San Diego, 200 W. Arbor Drive, San Diego, CA 92103, United States
| | - Divya S Bolar
- Department of Radiology, University of California San Diego, 200 W. Arbor Drive, San Diego, CA 92103, United States; Center for Functional Magnetic Resonance Imaging, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States.
| |
Collapse
|
48
|
Song CH, Lee SJ, Jeon HR. Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report. World J Clin Cases 2022; 10:2281-2285. [PMID: 35321170 PMCID: PMC8895189 DOI: 10.12998/wjcc.v10.i7.2281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/05/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state with clinical symptoms such as headache, altered consciousness, visual disturbances, and seizures. Vasogenic edema occurs predominantly in the posterior occipital and parietal lobes of the brain. PRES is caused by various diseases, and its mechanism remains unclear. However, it can be easily diagnosed based on characteristic lesions on magnetic resonance imaging.
CASE SUMMARY A 51-year-old woman with unremarkable past medical history presented with progressively worsening back pain since 2 mo. Physical examinations revealed paralumbar muscle tenderness, a large lesion on the right breast and several mass-like lesions on both breasts. The blood pressure (BP) was elevated (150/90 mmHg), and did not respond to antihypertensive medication. On the seventh day of hospitalization, she exhibited a confused mental status and generalized tonic-clonic seizures. On magnetic resonance imaging, bilateral cortical and subcortical edema of the occipital lobes, suggestive of PRES, was observed. The serum calcium was 15.8 mg/dL. After two days of treatment with nicardipine, elcatonin, and zolendronic acid, her BP was 130/91 mmHg and serum calcium was 10.1 mg/dL. The patient regained consciousness and her mental status improved. Fluorodeoxyglucose-positron emission tomography revealed right breast cancer with extensive metastases.
CONCLUSION Although rare, hypercalcemia can lead to PRES by causing uncontrolled hypertension. Prompt diagnosis can help prevent severe mental disturbances and even death.
Collapse
Affiliation(s)
- Chae Hyun Song
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang-si Gyeonggi-do 10444, South Korea
| | - Seung Jun Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang-si Gyeonggi-do 10444, South Korea
| | - Ha Ra Jeon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang-si Gyeonggi-do ASI/KR/KS009/Goyang, South Korea
| |
Collapse
|
49
|
Orhun G, Sencer S, Tüzün E, Bebek N, Ergin Özcan P, Barburoğlu M, Günver MG, Esen F. Posterior Reversible Encephalopathy in Sepsis-Associated Encephalopathy: Experience from a Single Center. Neurocrit Care 2022; 36:372-386. [PMID: 35133605 DOI: 10.1007/s12028-021-01433-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sepsis-associated encephalopathy (SAE) is frequently encountered in sepsis and is often accompanied by neuroimaging findings indicating ischemia, hemorrhage, and edema. Posterior reversible encephalopathy syndrome (PRES) has been vastly underrecognized in previously reported cohorts of patients with sepsis and SAE. Our aim was to determine the prevalence and distinguishing clinical, neuroimaging, and electroencephalography features of PRES in SAE. METHODS In this prospective observational study, patients with radiologically identified PRES were selected from a consecutively enrolled cohort of 156 patients with SAE and assessed for neurological outcome using the extended Glasgow Outcome Scale for 12 months. Patients with SAE and PRES and other types of brain lesions were compared in terms of clinical and diagnostic workup features. RESULTS Fourteen of 156 patients (8.9%) were determined to be radiologically compatible with PRES, whereas 48 patients displayed other types of acute brain lesions. Patients with PRES often showed lesions in atypical regions, including frontal lobes, the corpus callosum, and the basal ganglia. Source of infection was mostly gram-negative bacteria originating from pneumonia or intraabdominal infections. Patients with PRES were not different from other patients with SAE with brain lesions in terms of features of sepsis and neurological outcome. However, patients with PRES showed increased prevalence of seizures and intraabdominal source of infection. CONCLUSIONS PRES is highly prevalent in SAE, often encompasses unusual brain regions, and usually presents with generalized seizures. Patients with SAE and PRES do not appear to have distinguishing clinical and diagnostic workup features. However, generalized seizures may serve as warning signs for presence of PRES in patients with SAE.
Collapse
Affiliation(s)
- Günseli Orhun
- Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Serra Sencer
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Perihan Ergin Özcan
- Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Barburoğlu
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Figen Esen
- Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
50
|
de Medeiros FC, Rocha Sousa BM, Cruz Santos DN, Novais Matias Sion G, Fontes Alves C. Posterior reversible encephalopathy syndrome as the first clinical manifestation of lupus nephritis. Acta Neurol Belg 2022; 122:219-221. [PMID: 33591552 DOI: 10.1007/s13760-021-01614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | | | - Cibele Fontes Alves
- Department of Pathology, José Rosário Vellano University (UNIFENAS), Belo Horizonte, MG, Brazil
| |
Collapse
|