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Piga M, Mathieu A. Managing CNS involvement in systemic lupus erythematosus. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ijr.11.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lahlou M, Berrady R, Rabhi S, Messouak O, Belahssen MF, Bono W. [Posterior reversible encephalopathy syndrome in a patient with lupus: differential diagnosis to discuss]. Rev Neurol (Paris) 2011; 167:863-5. [PMID: 21889180 DOI: 10.1016/j.neurol.2011.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/13/2011] [Accepted: 03/16/2011] [Indexed: 10/17/2022]
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53
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Reversible Posterior Leukoencephalopathy Syndrome in a Patient With Systemic Sclerosis. J Clin Rheumatol 2011; 17:290-1. [DOI: 10.1097/rhu.0b013e31822a28b4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Varaprasad IR, Agrawal S, Prabu VNN, Rajasekhar L, Kanikannan MA, Narsimulu G. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus. J Rheumatol 2011; 38:1607-11. [PMID: 21572160 DOI: 10.3899/jrheum.101308] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study the clinical profile of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE) and analyze the risk factors and outcomes associated with it. METHODS We identified patients with SLE and PRES from January 2006 to October 2010. Data were collected on demographic details, lupus characteristics, PRES-related features, laboratory abnormalities, treatment details, and outcomes. RESULTS We studied 13 patients (all female) ages 14-37 years (median 23 yrs; 4 were aged < 18 yrs with juvenile SLE). Duration of lupus ranged from 1.5 to 36 months (median 6 mo). Six patients had PRES as a part of their initial presentation of lupus. All had active lupus and hypertension; 9 had nephritis. Four patients were on treatment with cyclophosphamide therapy when they developed PRES. Antihypertensives and antiepileptics were the mainstay of treatment along with supportive care. Immunosuppressive therapy was guided by lupus-related major organ manifestations. Two patients had focal neurological deficits; one had persistent hemiparesis at followup. One patient died. CONCLUSION PRES occurs in young lupus patients and in the early part of the disease. Focal deficits are not uncommon. It can be the presenting manifestation of lupus. Management is predominantly symptomatic. Immunosuppression is directed by other major organ manifestations. Early diagnosis and appropriate management is productive.
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Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual disturbances, and seizures. Radiological features typically include edema of the posterior cerebral regions, especially of the parietooccipital lobes. Atypical imaging features, such as involvement of anterior cerebral regions, deep white matter, and the brain stem are also frequently seen. Vasoconstriction is common in vascular imaging. Different conditions have been associated with PRES, but toxemia of pregnancy, solid organ or bone marrow transplantation, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension are most commonly described. The pathophysiology of PRES is unclear and different hypotheses are being discussed. Posterior reversible encephalopathy syndrome is best managed by monitoring and treatment in the setting of a neurointensive care unit. The prognosis is usually benign with complete reversal of clinical symptoms within several days, when adequate treatment is immediately initiated. Treatment of severe hypertension, seizures, and withdrawal of causative agents represent the hallmarks of specific therapy in PRES. Delay in diagnosis and treatment may lead to permanent neurological sequelae. Therefore, awareness of PRES is of crucial importance for the intensivist.
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Affiliation(s)
- Dimitre Staykov
- Neurology Department, University of Erlangen-Nuremberg, Germany.
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Dos Reis Simões da Silva FM, Burgos Pêgo PM, Henriques Vendrell MC, de Azevedo Batalha Ferreira Dos Santos Farias MJ, Ribeiro Timóteo ÂC, Martins da Costa MC, Monteiro Barbosa Moreira Cravo IM, Ribeiro Gomes FM. Posterior Reversible Encephalopathy Syndrome and Anti-Angiogenic Agents: A Case Report. Neuroophthalmology 2011; 35:32-37. [PMID: 27956931 DOI: 10.3109/01658107.2010.539763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 08/26/2010] [Accepted: 08/26/2010] [Indexed: 11/13/2022] Open
Abstract
Posterior reversible encephalopathy syndrome is an increasingly recognised clinico-radiological entity, associated with several medical conditions (such as systemic arterial hypertension) and characterised by seizures, altered mental status, headaches, and visual symptoms. Magnetic resonance imaging is a key component in this diagnosis, with hyperintense foci in T2-weighted images, corresponding to vasogenic oedema. The pathophysiology is not fully understood but probably involves loss of auto-regulation of cerebral vasculature or endothelial dysfunction or both. A 56-year-old male, suffering from a gastro-intestinal stromal tumour with hepatic metastasis resistant to imatinib, on therapy with sunitinib, came to the Emergency Department because of headaches, hallucinations, and loss of vision. There was no previous history of high blood pressure. A hypertensive crisis was diagnosed; ophthalmological examination on admission showed no light perception bilaterally. Brain imaging displayed bilateral parieto-occipital and frontal vasogenic oedema, consistent with the clinical diagnosis of posterior reversible encephalopathy syndrome. After treatment of hypertension and suspension of sunitinib, the patient recovered from his symptoms. Control imaging showed no oedema. Angiogenesis inhibitors, such as sunitinib and bevacizumab, can cause hypertension, one of the many medical conditions associated with the posterior reversible encephalopathy syndrome. This syndrome should be considered in cases of acute visual loss, particularly in view of its reversible nature when diagnosed and treated promptly.
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Fujieda Y, Kataoka H, Odani T, Otomo K, Kato M, Fukaya S, Oku K, Horita T, Yasuda S, Atsumi T, Koike T. Clinical features of reversible posterior leukoencephalopathy syndrome in patients with systemic lupus erythematosus. Mod Rheumatol 2011; 21:276-81. [PMID: 21225443 DOI: 10.1007/s10165-010-0386-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/04/2010] [Indexed: 11/24/2022]
Abstract
To characterize reversible posterior leukoencephalopathy syndrome (RPLS) in systemic lupus erythematosus (SLE) in terms of treatments for resolution and its clinical course, we reviewed 28 cases of RPLS in SLE including our cases in view of the treatment. Of these, 15 cases improved with blood pressure control and 13 required immunosuppressive therapy for activity of SLE presenting neurological manifestations. Patients without immunosuppressants at onset of RPLS more frequently required immunosuppressive therapy to recover it than those precedingly using these agents [31% (4/13) versus 87% (13/15), p = 0.008, chi-square test]. Brain magnetic resonance imaging (MRI) is important for diagnosis of RPLS-SLE in the patient with SLE who develops neurological disturbance and rapidly increasing blood pressure. When 7-day therapy for hypertension and convulsion does not reverse the manifestations, immunosuppressive treatments would be recommended to reverse RPLS.
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Affiliation(s)
- Yuichiro Fujieda
- Department of Medicine II, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan.
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Golden J, Heacock L, Boonyasampant M, Chiechi MV, Koppel B, Inamdar S. Posterior reversible encephalopathy syndrome in a 13-year-old female with mild systemic lupus erythematosus. Clin Pediatr (Phila) 2011; 50:76-8. [PMID: 20724322 DOI: 10.1177/0009922810378736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Children with posterior reversible encephalopathy syndrome associated with atypical diffusion-weighted imaging and apparent diffusion coefficient. Clin Exp Nephrol 2010; 15:275-80. [DOI: 10.1007/s10157-010-0380-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
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Blanch García P, Moral Torres E, Marín Muñoz J, Corominas Macías H, Mallafre Anduig J. Síndrome de encefalopatía posterior reversible causada por emergencia hipertensiva en paciente con lupus. HIPERTENSION Y RIESGO VASCULAR 2010. [DOI: 10.1016/j.hipert.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The differential diagnosis and empiric management of altered mental status and seizures often overlap. Altered mental status may accompany seizures or simply be the manifestation of a postictal state. This article provides an overview of the numerous causes of altered mental status and seizures: metabolic, toxic, malignant, infectious, and endocrine causes. The article focuses on those agents that should prompt the emergency physician to initiate unique therapy to abate the seizure and correct the underlying cause.
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Affiliation(s)
- David E Slattery
- Department of Emergency Medicine, University of Nevada School of Medicine, 901 Rancho Lane, Suite #135, Las Vegas, NV 89106, USA.
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CHEN HA, LIN YJ, CHEN PC, CHEN TY, LIN KC, CHENG HH. Systemic lupus erythematosus complicated with posterior reversible encephalopathy syndrome and intracranial vasculopathy. Int J Rheum Dis 2010; 13:e79-82. [DOI: 10.1111/j.1756-185x.2010.01545.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ebbo M, Benarous L, Thomas G, Jourde N, Genot S, Bernit E, Veit V, Harlé JR, Schleinitz N. [Posterior reversible encephalopathy syndrome induced by a cough and cold drug containing pseudoephedrine]. Rev Med Interne 2010; 31:440-4. [PMID: 20398975 DOI: 10.1016/j.revmed.2009.10.436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 10/04/2009] [Accepted: 10/12/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome is a clinico-radiological entity characterized by neurologic symptoms in association with usually reversible bilateral posterior hemispheric oedema on neuroimaging. Many pathological conditions and treatments have been associated with this syndrome. CASE REPORT We report a 19-year-old woman, followed-up for hypocomplementemic urticarial vasculitis, who presented with a posterior reversible encephalopathy syndrome induced by the intake of an over-the-counter cold remedy containing pseudoephedrine. Clinical manifestations and radiological abnormalities resolved after anti-hypertensive therapy and withdrawal of sympathomimetic drug. CONCLUSION The diagnosis of posterior reversible encephalopathy syndrome should be considered in patients with compatible clinical and radiological presentation because of its potential reversibility with an appropriate management. Intake of drugs, including over-the-counter cough and cold drugs, should be looked for in the history as well as autoimmune disorders.
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Affiliation(s)
- M Ebbo
- Service de médecine interne, hôpital de la Conception, Assistance publique-Hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France.
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Terwiel E, Hanrahan R, Lueck C, D'Rozario J. Reversible posterior encephalopathy syndrome associated with bortezomib. Intern Med J 2010; 40:69-71. [DOI: 10.1111/j.1445-5994.2009.02097.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sutter R, Mengiardi B, Lyrer P, Czaplinski A. Posterior reversible encephalopathy as the initial manifestation of a Guillain–Barré syndrome. Neuromuscul Disord 2009; 19:709-10. [DOI: 10.1016/j.nmd.2009.06.370] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/25/2009] [Accepted: 06/10/2009] [Indexed: 11/26/2022]
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Finsterer J, Stöllberger C, Ostermann E, Zuntner G, Huber J, Tscherney R. Recurrent posterior reversible encephalopathy syndrome in mitochondrial disorder. Blood Press 2009; 18:126-9. [DOI: 10.1080/08037050902975106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Morelle J, Cosnard G, Jadoul M, Kanaan N. Transient blindness and seizures in severe lupus nephritis. Clin Kidney J 2009; 2:331-2. [PMID: 25984031 PMCID: PMC4421231 DOI: 10.1093/ndtplus/sfp061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/14/2009] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Guy Cosnard
- Division of Neuroradiology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Posterior reversible encephalopathy syndrome as a complication of acute lupus activity. Clin Neurol Neurosurg 2009; 111:359-63. [DOI: 10.1016/j.clineuro.2008.11.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 10/19/2008] [Accepted: 11/23/2008] [Indexed: 11/19/2022]
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Fulminant leucocytoclastic brainstem vasculitis in a patient with otherwise indolent systemic lupus erythematosus. Lupus 2009; 18:486-90. [DOI: 10.1177/0961203308101548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The spectrum of central nervous system (CNS) vascular pathology in systemic lupus erythematosus (SLE) includes small vessel vasculopathy, thromboembolism, perivascular lymphocytic infiltration and, rarely, overt transmural vasculitis. We present the case of a patient, who experienced three CNS relapses over total disease duration of 26 years, with otherwise indolent disease. The first two relapses were suspicious of vasculitis and the last was proven at autopsy. The short duration between final relapse onset and death in this SLE CNS vasculitis case was, to our knowledge, unique. Histopathological investigation demonstrated multiple confluent areas of haemorrhage in the medulla due to an acute small vessel leucocytoclastic vasculitis.
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Abstract
PURPOSE OF REVIEW The ophthalmologist may be called upon to evaluate visual loss in a patient with posterior reversible encephalopathy syndrome. Familiarity with presentation and clinical management is imperative, as visual loss is often reversible with prompt treatment directed at causative factors. RECENT FINDINGS Since its initial description in 1996, the predisposing factors, clinical presentation and radiographic variation of posterior reversible encephalopathy syndrome continue to expand. Case reports of newly uncovered associations of the syndrome appear frequently. Originally considered a subcortical disease of the posterior cerebrum, posterior reversible encephalopathy syndrome has been shown to affect gray matter and can involve both the anterior and posterior cortex, brainstem, cerebellum or even the spinal cord. The pathophysiologic basis of cerebral edema and molecular mechanisms of edema underlying the syndrome are currently being revealed. SUMMARY Acute hypertension, eclampsia, immunosuppressive medication, infection or autoimmune diseases can all result in the clinical syndrome of vasogenic edema in the central nervous system leading to headache, seizure, confusion and frequent visual loss. The biologic basis for the syndrome is likely an insult to cerebral vascular autoregulation. MRI is essential in diagnosing a cerebral cause for visual loss. The ophthalmologist may have the initial opportunity to diagnose the syndrome. Treatment may reverse clinical deficits, and is based on eliminating the etiologic causation.
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Bibliography. Current world literature. Neuro opthalmology. Curr Opin Ophthalmol 2008; 19:541-4. [PMID: 18854700 DOI: 10.1097/icu.0b013e328317c7c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Rolando Cimaz
- AOU Meyer and University of Florence, Florence, Italy
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Une crise convulsive chez une patiente lupique. Rev Med Interne 2008; 29:738-40. [DOI: 10.1016/j.revmed.2008.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 06/04/2008] [Indexed: 11/21/2022]
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