51
|
Ozkan A, Hakyemez B, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T, Taskapilioglu O, Altundal Y, Tunali A. Tumor lysis syndrome as a contributory factor to the development of reversible posterior leukoencephalopathy. Neuroradiology 2006; 48:887-92. [PMID: 16983525 DOI: 10.1007/s00234-006-0142-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 07/22/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reversible posterior leukoencephalopathy syndrome (RPLS) is a recently described clinical and radiological entity comprising headache, seizures, altered level of consciousness and visual disturbances in association with transient posterior cerebral white-matter abnormalities. METHOD We report a young woman with Burkitt's lymphoma who developed RPLS after combined chemotherapy administered during the tumor lysis syndrome. RESULTS The symptoms in this patient fitted well with those of RPLS; they included abrupt alterations in mental status, seizures, headache, visual changes and characteristic neuroradiological findings. She was given further combination chemotherapy without any neurological complications, at which time she had already recovered from both RPLS and tumor lysis syndrome. CONCLUSION Although many etiological factors have been reported in the development of RPLS, the underlying mechanism is not yet well understood. With prompt and appropriate management, RPLS is usually reversible, and chemotherapy can be continued after complete recovery from RPLS. We suggest that tumor lysis syndrome should be considered as a contributory factor to the development of RPLS in patients for whom treatment with combined chemotherapy for hematological malignancies is planned.
Collapse
Affiliation(s)
- A Ozkan
- Division of Hematology, Department of Internal Medicine, Uludag University Hospital, Uludag University School of Medicine, 16059 Bursa, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
52
|
Moawad FJ, Hartzell JD, Biega TJ, Lettieri CJ. Transient blindness due to posterior reversible encephalopathy syndrome following ephedra overdose. South Med J 2006; 99:511-4. [PMID: 16711314 DOI: 10.1097/01.smj.0000215739.90211.3b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is most often associated with hypertensive emergencies and is characterized by seizures, mental status changes and visual disturbances. We report a case of a previously healthy young man who developed multiorgan failure and transient cortical blindness following ingestion of a performance-enhancing ephedra-based supplement. Neuroimaging findings confirmed the clinical suspicion of PRES. Radiographic abnormalities and neurologic dysfunction subsequently resolved with correction of his systolic blood pressure. This case emphasizes the need for prompt treatment and consideration of toxic ingestions in patients presenting with hypertension-related end-organ dysfunction.
Collapse
Affiliation(s)
- Fouad J Moawad
- Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307, USA.
| | | | | | | |
Collapse
|
53
|
Lamy C, Oppenheim C, Méder JF, Mas JL. Neuroimaging in Posterior Reversible Encephalopathy Syndrome. J Neuroimaging 2006. [DOI: 10.1111/j.1552-6569.2004.tb00223.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
54
|
Ozyurek H, Oguz G, Ozen S, Akyuz C, Karli Oguz K, Anlar B, Aysun S. Reversible posterior leukoencephalopathy syndrome: report of three cases. J Child Neurol 2005; 20:990-3. [PMID: 16417849 DOI: 10.1177/08830738050200121201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reversible posterior leukoencephalopathy syndrome is characterized clinically by headache, abnormalities of mental status and visual perception, and seizures. Despite its diverse causes, common precipitating factors are defined as abrupt elevations of blood pressure, renal decompensation, fluid retention, and immunosuppressive therapy. We report three children with reversible posterior leukoencephalopathy syndrome presenting with generalized seizures and headache. The causes of reversible posterior leukoencephalopathy syndrome were considered to be acute hypertension and immunosuppressive therapy in case 1 with systemic lupus erythematosus, chemotherapy (vincristine and/or actinomycin-D) and hyponatremia in case 2, and acute hypertension in case 3, admitted with a familial Mediterranean fever attack. In light of these cases, we review the literature for the etiology, clinical and laboratory findings, and pathogenetic mechanisms of the disease.
Collapse
Affiliation(s)
- Hamit Ozyurek
- Department of Pediatrics, Section of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
55
|
New PZ. NEUROLOGICAL COMPLICATIONS OF CHEMOTHERAPEUTIC AND BIOLOGICAL AGENTS. Continuum (Minneap Minn) 2005. [DOI: 10.1212/01.con.0000293682.01555.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
56
|
Argumentaire. Nephrol Ther 2005. [DOI: 10.1016/s1769-7255(05)80005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
57
|
Abstract
A variety of acute neurologic disorders present with visual signs and symptoms. In this review the authors focus on those disorders in which the clinical outcome is dependent on timely and accurate diagnosis. The first section deals with acute visual loss, specifically optic neuritis, ischemic optic neuropathy (ION), retinal artery occlusion, and homonymous hemianopia. The authors include a discussion of those clinical features that are helpful in distinguishing between inflammatory and ischemic optic nerve disease and between arteritic and nonarteritic ION. The second section concerns disc edema with an emphasis on the prevention of visual loss in patients with increased intracranial pressure. The third section deals with abnormal ocular motility, and includes orbital inflammatory disease, carotid-cavernous fistulas, painful ophthalmoplegia, conjugate gaze palsies, and neuromuscular junction disorders. The final section concerns pupillary abnormalities, with a particular emphasis on the dilated pupil and on carotid artery dissection. Throughout there are specific guidelines for the management of these disorders, and areas are highlighted in which there is ongoing controversy.
Collapse
Affiliation(s)
- Valerie Purvin
- Indiana University Medical Center, Department of Ophthalmology, Indianapolis, IN 46280, USA.
| | | |
Collapse
|
58
|
Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg 2005; 107:1-16. [PMID: 15567546 DOI: 10.1016/j.clineuro.2004.07.012] [Citation(s) in RCA: 237] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Revised: 07/27/2004] [Accepted: 07/27/2004] [Indexed: 02/08/2023]
Abstract
Neurological complications whether due to the uremic state or its treatment, contribute largely to the morbidity and mortality in patients with renal failure. Despite continuous therapeutic advances, many neurological complications of uremia, like uremic encephalopathy, atherosclerosis, neuropathy and myopathy fail to fully respond to dialysis. Moreover, dialytic therapy or kidney transplantation may even induce neurological complications. Dialysis can directly or indirectly be associated with dialysis dementia, dysequilibrium syndrome, aggravation of atherosclerosis, cerebrovascular accidents due to ultrafiltration-related arterial hypotension, hypertensive encephalopathy, Wernicke's encephalopathy, hemorrhagic stroke, subdural hematoma, osmotic myelinolysis, opportunistic infections, intracranial hypertension and mononeuropathy. Renal transplantation itself can give rise to acute femoral neuropathy, rejection encephalopathy and neuropathy in graft versus host disease. The use of immunosuppressive drugs after renal transplantation can cause encephalopathy, movement disorders, opportunistic infections, neoplasms, myopathy and progression of atherosclerosis. We address the clinical, pathophysiological and therapeutical aspects of both central and peripheral nervous system complications in uremia.
Collapse
Affiliation(s)
- R Brouns
- Department of Neurology and Memory Clinic, Middelheim General Hospital, Antwerp, Belgium
| | | |
Collapse
|
59
|
Ortega-Carnicer J, Ambrós A, Diarte JI. Reversible posterior leukoencephalopathy syndrome in a young trauma patient. Resuscitation 2005; 64:119-20. [PMID: 15629565 DOI: 10.1016/j.resuscitation.2004.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Indexed: 11/24/2022]
|
60
|
Tam CS, Galanos J, Seymour JF, Pitman AG, Stark RJ, Prince HM. Reversible posterior leukoencephalopathy syndrome complicating cytotoxic chemotherapy for hematologic malignancies. Am J Hematol 2004; 77:72-6. [PMID: 15307110 DOI: 10.1002/ajh.20147] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS) is an uncommon but distinctive clinicoradiological entity comprising of headache, seizures, visual disturbance, and altered mental function, in association with posterior cerebral white matter edema. With appropriate management, RPLS is reversible in the majority of cases. Previous reported associations of RPLS include hypertension, eclampsia, renal failure, and use of immunosuppressive drugs; reports in the adult hematology setting are rare. We report two cases of adults undergoing treatment for hematological malignancies who developed RPLS, and we emphasize the importance of early recognition and institution of appropriate management in reducing the risk of development of permanent neurological disability.
Collapse
Affiliation(s)
- C S Tam
- Hematology Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
61
|
Lamy C, Mas JL. Hypertensive Encephalopathy. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
62
|
De Galien à Sainte Genevièveet de Sainte Genevie à Sainte Anne! Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
63
|
Abstract
Neurologic complications of chemotherapy are relatively common. The diagnosis of chemotherapy-associated neurotoxicity remains a clinical one, and is largely based on the exclusion of other possible causes. The goal of this review is to describe the neurotoxicity associated with established chemothrerapeutic agents and with some of the newer biologic agents, monoclonal antibodies and targeted molecular therapies used in the treatment of cancer.
Collapse
Affiliation(s)
- Scott R Plotkin
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02446, USA
| | | |
Collapse
|
64
|
Adin CA, Gregory CR, Kyles AE, Cowgill L. Diagnostic predictors of complications and survival after renal transplantation in cats. Vet Surg 2001; 30:515-21. [PMID: 11704946 DOI: 10.1053/jvet.2001.28418] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify preoperative diagnostic results that predict postoperative complications and survival in feline renal-transplant recipients. STUDY DESIGN Retrospective clinical study. ANIMALS Sixty-one feline renal allograft recipients. METHODS Medical records for 61 consecutive cats that underwent renal allograft transplantation between January 1, 1996, and December 1, 1999, were reviewed. Age, diagnosis, body weight, body condition score, preoperative medical treatment, systolic blood pressure, packed cell volume, biochemical parameters at admission and at the time of surgery, postoperative complications, and postoperative survival were recorded. Associations of preoperative data with the occurrence of postoperative complications were determined using logistic regression. Postoperative survival was graphed using a Kaplan-Meier cumulative-survival plot. Associations of covariates with postoperative survival were analyzed using Cox proportional hazards analysis. RESULTS Two parameters were significantly associated with occurrence of postoperative central nervous system (CNS) disorders: blood urea nitrogen concentration (odds ratio = 1.083; 95% CI = 1.018 to 1.148) and serum creatinine concentration (odds ratio = 1.8; 95% CI = 1.413 to 2.187) at the time of surgery. Postoperative survival 6 months after transplantation was 59%, though 3-year survival remained at 42%. Of all covariates investigated, only recipient age (relative hazard = 1.183; 95% CI = 1.039 to 1.334) was significantly associated with survival. CONCLUSION AND CLINICAL RELEVANCE Standard measures of preoperative renal dysfunction do not predict postoperative survival in cats after renal transplantation, although an increase in the degree of preoperative azotemia is associated with an increased risk of CNS disorders after surgery. Increased recipient age is associated with decreased survival after renal transplantation.
Collapse
Affiliation(s)
- C A Adin
- Veterinary Medical Teaching Hospital of the University of California, Davis 95616, USA
| | | | | | | |
Collapse
|
65
|
Teive HA, Brandi IV, Camargo CH, Bittencourt MA, Bonfim CM, Friedrich ML, de Medeiros CR, Werneck LC, Pasquini R. Reversible posterior leucoencephalopathy syndrome associated with bone marrow transplantation. ARQUIVOS DE NEURO-PSIQUIATRIA 2001; 59:784-9. [PMID: 11593283 DOI: 10.1590/s0004-282x2001000500024] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Reversible posterior leucoencephalopathy syndrome (RPLS) has previously been described in patients who have renal insufficiency, eclampsia, hypertensive encephalopathy and patients receiving immunosuppressive therapy. The mechanism by which immunosuppressive agents can cause this syndrome is not clear, but it is probably related with cytotoxic effects of these agents on the vascular endothelium. We report eight patients who received cyclosporine A (CSA) after allogeneic bone marrow transplantation or as treatment for severe aplastic anemia (SSA) who developed posterior leucoencephalopathy. The most common signs and symptoms were seizures and headache. Neurological dysfunction occurred preceded by or concomitant with high blood pressure and some degree of acute renal failure in six patients. Computerized tomography studies showed low-density white matter lesions involving the posterior areas of cerebral hemispheres. Symptoms and neuroimaging abnormalities were reversible and improvement occurred in all patients when given lower doses of CSA or when the drug was withdrawn. RPLS may be considered an expression of CSA neurotoxicity.
Collapse
Affiliation(s)
- H A Teive
- Serviço de Neurologia, Unidade de Transplante de Medula Ossea, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Mukherjee P, McKinstry RC. Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging. Radiology 2001; 219:756-65. [PMID: 11376265 DOI: 10.1148/radiology.219.3.r01jn48756] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To characterize the changes in brain water diffusion caused by reversible posterior leukoencephalopathy syndrome (RPLS). MATERIALS AND METHODS Twelve patients with the clinical features and conventional magnetic resonance (MR) imaging findings of RPLS underwent diffusion-tensor echo-planar MR imaging. The isotropic diffusion coefficient (D) and diffusion anisotropy (A(sigma)) were measured in posterior regions of diffusion abnormality and in anterior areas of normal-appearing brain. RESULTS Across all 12 subjects, the mean D of (1.09 +/- 0.13 [SD]) x 10(-3) mm(2)/sec in affected posterior regions was 26% greater than its value of (0.87 +/- 0.07) x 10(-3) mm(2)/sec in normal-appearing anterior regions. The mean A(sigma) of 0.15 +/- 0.03 in posterior regions was 35% less than its value of 0.23 +/- 0.02 in anterior regions (t(11) = 9.58; P <.001). There was a significant inverse correlation between D and A(sigma) in posterior regions (r = -0.67; P <.018) but not in anterior regions (r = -0.12; P =.719). A follow-up study performed in one patient after resolution of symptoms documented reversal of elevated isotropic diffusion and at least partial recovery of anisotropy loss. CONCLUSION The increased magnitude of brain water diffusion characteristic of RPLS is accompanied by reduced A(sigma). The magnitudes of these two effects are correlated and may be reversible. These observations support the proposal that vasogenic edema due to cerebrovascular autoregulatory dysfunction is the underlying pathophysiologic mechanism in uncomplicated RPLS.
Collapse
Affiliation(s)
- P Mukherjee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
| | | |
Collapse
|
67
|
Abstract
Reversible posterior leukoencephalopathy syndrome is a recently recognized disorder with characteristic radiologic findings that mainly involve the white/gray matter of the parieto-occipital lobes. This complex syndrome is associated with cyclosporine A therapy or a variety of other conditions in which blood pressure rises acutely. Twelve patients from a variety of conditions who met the diagnostic criteria for this syndrome were studied. Interestingly, three of these patients had intra-abdominal neurogenic tumors, which have rarely been reported. Initial cranial magnetic resonance imaging scans revealed fairly symmetric areas of increased T(2) signal involving both white and gray matter of parieto-occipital lobes in the majority of the patients. However, the lesions were often located outside the parieto-occipital regions. Four patients had occipital region magnetic resonance spectroscopy during the acute phase, which revealed high lactate peak and normal N-acetyl aspartate/creatine and choline peaks. With appropriate treatment, most patients recovered from this syndrome and experienced almost complete resolution of brain lesions on follow-up magnetic resonance imaging. One patient, however, continued to have small residual hemosiderin deposits on a follow-up magnetic resonance imaging with neurologic sequellae. In conclusion, a better understanding of this complex syndrome may obviate unnecessary investigations and allow management of the associated problems in prompt and appropriate ways.
Collapse
Affiliation(s)
- S Kwon
- Department of Pediatrics, Kyungpook National University Hospital, Samdeok 2-50, Joong-Gu, Taegu 7000-721, South Korea
| | | | | |
Collapse
|
68
|
Russell MT, Nassif AS, Cacayorin ED, Awwad E, Perman W, Dunphy F. Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings. Magn Reson Imaging 2001; 19:129-32. [PMID: 11295355 DOI: 10.1016/s0730-725x(01)00217-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 55 year old female receiving gemcitabine for stage IV non-small cell carcinoma of the lung developed the clinical-radiologic syndrome of posterior reversible encephalopathy syndrome (PRES). She had clinical manifestations of headaches, increasing somnolence and tonic-clonic seizures. The fluid-attentuated inversion recovery (FLAIR) MR imaging sequence conspicuously showed bihemispheric, symmetrical cortical and subcortical white matter hyperintensities that preponderantly involved the parietal and occipital lobes. Diffusion-weighted imaging (DWI) sequence reflected the preponderant existence of vasogenic edema in the involved areas. MR spectroscopy showed no significant N-acetyl aspartate (NAA) depletion or lactate elevation prospectively, indicating the absence of significant neuronal loss and reversibility of the brain parenchymal changes. The clinical and radiologic manifestations essentially resolved completely with discontinuation of the drug.
Collapse
Affiliation(s)
- M T Russell
- Saint Louis School of Medicine, St. Louis University Hospital, St. Louis, MO 63110, USA
| | | | | | | | | | | |
Collapse
|
69
|
Abstract
Posterior leukoencephalopathy syndrome is a newly recognised brain disorder that predominantly affects the cerebral white matter. Oedematous lesions particularly involve the posterior parietal and occipital lobes, and may spread to basal ganglia, brain stem, and cerebellum. This rapidly evolving neurological condition is clinically characterised by headache, nausea and vomiting, seizures, visual disturbances, altered sensorium, and occasionally focal neurological deficit. Posterior leukoencephalopathy syndrome is often associated with an abrupt increase in blood pressure and is usually seen in patients with eclampsia, renal disease, and hypertensive encephalopathy. It is also seen in the patients treated with cytotoxic and immunosuppressive drugs such as cyclosporin, tacrolimus, and interferon alfa. The lesions of posterior leukoencephalopathy are best visualised with magnetic resonance (MR) imaging. T2 weighted MR images, at the height of symptoms, characteristically show diffuse hyperintensity selectively involving the parieto-occipital white matter. Occasionally the lesions also involve the grey matter. Computed tomography can also be used satisfactorily to detect hypodense lesions of posterior leukoencephalopathy. Early recognition of this condition is of paramount importance because prompt control of blood pressure or withdrawal of immunosuppressive agents will cause reversal of the syndrome. Delay in the diagnosis and treatment can result in permanent damage to affected brain tissues.
Collapse
Affiliation(s)
- R K Garg
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
70
|
Abstract
A hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage. Most patients presenting with hypertensive emergency have chronic hypertension, although the disorder can present in previously normotensive individuals, particularly when associated with pre-eclampsia or acute glomerulonephritis. The pathophysiological mechanisms causing acute hypertensive endothelial failure are complex and incompletely understood but probably involve disturbances of the renin-angiotensin-aldosterone system, loss of endogenous vasodilator mechanisms, upregulation of proinflammatory mediators including vascular cell adhesion molecules, and release of local vasoconstrictors such as endothelin 1. Magnetic resonance imaging has demonstrated a characteristic hypertensive posterior leucoencephalopathy syndrome predominantly causing oedema of the white matter of the parietal and occipital lobes; this syndrome is potentially reversible with appropriate prompt treatment. Generally, the therapeutic approach is dictated by the particular presentation and end-organ complications. Parenteral therapy is generally preferred, and strategies include use of sodium nitroprusside, beta-blockers, labetelol, or calcium-channel antagonists, magnesium for pre-eclampsia and eclampsia; and short-term parenteral anticonvulsants for seizures associated with encephalopathy. Novel therapies include the peripheral dopamine-receptor agonist, fenoldapam, and may include endothelin-1 antagonists.
Collapse
Affiliation(s)
- C J Vaughan
- Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, NY, USA
| | | |
Collapse
|
71
|
Taylor MB, Jackson A, Weller JM. Dynamic susceptibility contrast enhanced MRI in reversible posterior leukoencephalopathy syndrome associated with haemolytic uraemic syndrome. Br J Radiol 2000; 73:438-42. [PMID: 10844872 DOI: 10.1259/bjr.73.868.10844872] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We describe a case of reversible posterior leukoencephalopathy associated with haemolytic uraemic syndrome. Following remission confirmed on MRI, the patient relapsed several months later. Neuroimaging findings on conventional MRI and FLAIR sequences and dynamic susceptibility contrast enhanced MRI are described. White matter abnormalities may be shown on CT or MRI in this syndrome. However, dynamic susceptibility contrast enhanced MRI showed far more extensive abnormality within the brain. In addition, phase contrast angiographic measurement of flow in the carotid and basilar arteries indicated a significant elevation of cerebral blood flow, suggesting a decrease in global cerebrovascular resistance. These observations support existing theories that the disorder is manifested by autoregulatory disturbance in small cerebral vessels. Our findings suggest that this abnormality is far more extensive than is demonstrated on T2 weighted MR images and that it is associated with global abnormality of cerebrovascular autoregulation.
Collapse
Affiliation(s)
- M B Taylor
- Stopford Medical School, University of Manchester, UK
| | | | | |
Collapse
|
72
|
|
73
|
Kyles AE, Gregory CR, Wooldridge JD, Mathews KG, Aronson LR, Bernsteen L, Ilkiw JE. Management of hypertension controls postoperative neurologic disorders after renal transplantation in cats. Vet Surg 1999; 28:436-41. [PMID: 10582740 DOI: 10.1111/j.1532-950x.1999.00436.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the prevalence and describe the management of hypertension and central nervous system (CNS) complications after renal transplantation in cats. We also compared the prevalence of CNS complications between cats monitored and treated for postoperative hypertension and a previously described, historical control group of cats not monitored or treated for postoperative hypertension. STUDY DESIGN Retrospective clinical study. ANIMALS OR SAMPLE POPULATION A total of 34 client-owned cats that received renal allografts for the treatment of end-stage renal failure. METHODS Medical records were reviewed. Data obtained included preoperative and postoperative systolic blood pressures, antihypertensive therapy, response to treatment, neurologic signs, and clinical outcome. The results were compared with a historical control group of feline renal allograft recipients that were neither monitored nor treated for postoperative hypertension. RESULTS Severe postoperative hypertension occurred in 21 of 34 of cats. Hypertension was treated in all 21 cats with subcutaneously administered hydralazine which reduced systolic blood pressure to less than 170 mm Hg in 15 minutes in 20 of 21 cats; hydralazine produced hypotension in one cat and failed to control hypertension in 1 cat. After transplantation, seizures were observed in one cat and other neurologic complications (stupor, ataxia, and central blindness) were observed in three cats. The prevalence of seizures and neurologic complication-related deaths after transplantation was significantly reduced with treatment of postoperative hypertension. CONCLUSIONS AND CLINICAL RELEVANCE Hypertension is a major contributing factor to postoperative seizure activity after renal transplantation in cats; treatment of hypertension reduces the frequency of neurologic complications.
Collapse
Affiliation(s)
- A E Kyles
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, USA
| | | | | | | | | | | | | |
Collapse
|
74
|
Abstract
We previously reported that erythropoietin (Epo) is present in human cerebrospinal fluid (CSF). It is not known whether CSF Epo concentrations change under conditions of CNS injury or, if so, whether this change reflects loss of blood-brain barrier integrity or increased CNS Epo synthesis. We hypothesized that CSF Epo increases in conditions of neural injury including hypoxia, meningitis, and intraventricular hemorrhage (IVH) and that CSF Epo concentrations are independent of plasma Epo concentrations. To test these hypotheses, Epo concentrations were measured in 122 paired CSF and blood samples obtained from neonates and children categorized as follows: 16, asphyxia; 31, meningitis; 11, IVH; 41, controls. Twelve infants treated with recombinant Epo (rEpo) and 11 additional samples from children with miscellaneous neurologic problems were also evaluated. CSF and plasma Epo concentrations were significantly higher in asphyxiated infants than in controls (225.0+/-155.0 versus 4.5+/-0.5 mU/mL; mean +/- SEM, p < 0.05, respectively, in CSF; 1806.7+/-1254 versus 5.2+/-0.5, p < 0.05 in plasma). Neonates with IVH had higher CSF Epo concentrations than controls (p < 0.01) but did not have higher plasma Epo concentrations than controls. Patients with meningitis did not have elevated CSF or plasma Epo concentrations. There was no correlation between CSF and plasma Epo concentrations in infants treated with rEpo. We conclude that Epo is selectively increased in the CSF by hypoxia, less so by IVH, and not at all by meningitis. rEpo treatment does not elevate CSF Epo. These findings suggest that rEpo does not cross the blood-brain barrier and that hypoxia induces increased CNS synthesis of Epo.
Collapse
Affiliation(s)
- S E Juul
- Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610-0296, USA
| | | | | |
Collapse
|
75
|
Affiliation(s)
- S E Juul
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, USA
| |
Collapse
|
76
|
Torocsik HV, Curless RG, Post J, Tzakis AG, Pearse L. FK506-induced leukoencephalopathy in children with organ transplants. Neurology 1999; 52:1497-500. [PMID: 10227644 DOI: 10.1212/wnl.52.7.1497] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
FK506-induced leukoencephalopathy is a well-known entity in adult organ transplant patients. The neurotoxicity of FK506 immunosuppression is frequently reversible, with either reduction or cessation of the drug. This neurologic syndrome is not well documented in children. We report the clinical and radiologic features in four pediatric cases of FK506 leukoencephalopathy. In two of the four patients this syndrome was reversible.
Collapse
Affiliation(s)
- H V Torocsik
- Department of Neurology, University of Miami School of Medicine, FL, USA
| | | | | | | | | |
Collapse
|
77
|
Abstract
Seizures are commonly encountered in patients who do not have epilepsy. Factors that may provoke such seizures include organ failure, electrolyte imbalance, medication and medication withdrawal, and hypersensitive encephalopathy. There is usually one underlying cause, which may be reversible in some patients. A full assessment should be done to rule out primary neurological disease. Treatment of seizures in medically ill patients is aimed at correction of the underlying cause with appropriate short-term anticonvulsant medication. Phenytoin is ineffective in the management of seizures secondary to alcohol withdrawal, and in those due to theophylline or isoniazid toxicity. Control of blood pressure is important in patients with renal failure and seizures. Non-convulsive status epilepticus should be considered in any patient with confusion or coma of unclear cause, and electroencephalography should be done at the earliest opportunity. Most ill patients with secondary seizures do not have epilepsy, and this should be explained to patients and their families. Only those patients with recurrent seizures and uncorrectable predisposing factors need long-term treatment with anticonvulsant medication.
Collapse
Affiliation(s)
- N Delanty
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA.
| | | | | |
Collapse
|
78
|
Wagner FF, Flegel WA, Kubanek B. Blood transfusion: influence of transfusion therapy on outcome. Curr Opin Anaesthesiol 1998; 11:167-75. [PMID: 17013215 DOI: 10.1097/00001503-199804000-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Few studies have addressed the influence of different transfusion therapies on outcome in a convincing way. Proven adverse impact of allogeneic blood on outcome is minimal. Acute mortality has declined to about 1 : 500,000 and the rate of transfusion-transmitted infections is decreasing, too. Data on postoperative infections and non-Hodgkin's lymphoma as possible adverse effects are controversial. Evidence for an increased risk of tumour recurrences is lacking. Alternatives to allogeneic blood may have appreciable risks: perioperative blood recovery had a fatality rate of more than 1 : 40,000. Reduction of allogeneic blood exposure may not be equated with improved outcome.
Collapse
Affiliation(s)
- F F Wagner
- Abteilung Transfusionsmedizin, Universität and DRK-Blutspendezentrale Ulm, Ulm, Germany
| | | | | |
Collapse
|
79
|
Delanty N, Needell N. Erythropoietin and visual hallucinations in patients on dialysis. PSYCHOSOMATICS 1998; 39:83-5. [PMID: 9538683 DOI: 10.1016/s0033-3182(98)71391-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|