1
|
Faye I, Niang FG, Diedhiou M, Niang I, Diop AD, Diop AN. Posterior reversible encephalopathy syndrome: A case report. Radiol Case Rep 2024; 19:2895-2897. [PMID: 38706814 PMCID: PMC11066987 DOI: 10.1016/j.radcr.2024.03.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024] Open
Abstract
Posterior Reversible Encephalopathy Syndrome (PRES) is a radio-clinical entity associating reversible damage of the central nervous system and typical brain imaging. The clinical context is often suggestive with, in half of cases, the use of vasoactive substances (cannabis, antidepressants, nasal decongestants) and/or postpartum. The etiologies are dominated by hypertensive encephalopathy, preeclampsia, eclampsia, immunosuppressive therapies, and systemic diseases. We report a case of posterior encephalopathy syndrome occurring in a young female without hypertension. It was about a 40-year-old female without hypertension underlying condition, received at the emergency department for headaches and generalized tonic-clonic seizures. The physical examination was unremarkable, and her blood pressure was 130/70 mm Hg. CT scan revealed bilateral white matter hypodensity in the posterior occipital regions and a right frontal subarachnoid hemorrhage. There was no aneurysmal malformation of the polygon of Willis and no cerebral thrombophlebitis. Brain MRI showed T2 and FLAIR hypersignal areas in the occipital and frontal cortico-subcortical regions, with no diffusion signal abnormalities or contrast enhancement, and a right frontal subarachnoid hemorrhagic lesion with no other impairment. The diagnosis of reversible posterior encephalopathy syndrome was made up, and the outcome was favorable under treatment. Posterior reversible encephalopathy syndrome is an uncommon but probably underdiagnosed condition. Hypertensive encephalopathy is the most common etiology. However, there would be cases of PRES without hypertension as shown in this observation.
Collapse
Affiliation(s)
- Ibrahima Faye
- Medical Imaging Department Saint Louis Regional Hospital, Saint-Louis, Senegal
| | - Fallou Galass Niang
- Medical Imaging Department Saint Louis Regional Hospital, Saint-Louis, Senegal
- UFR 2S, Gaston Berger University, Saint-Louis, Senegal
| | | | - Ibrahima Niang
- Medical Imaging Department FANN Hospital University, Dakar, Senegal
| | | | | |
Collapse
|
2
|
Affiliation(s)
- Romergryko G Geocadin
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
| |
Collapse
|
3
|
Lucia M, Viviana M, Alba C, Giulia D, Carlo DR, Grazia PM, Luca T, Federica VM, Immacolata VA, Grazia PM. Neurological Complications in Pregnancy and the Puerperium: Methodology for a Clinical Diagnosis. J Clin Med 2023; 12:jcm12082994. [PMID: 37109329 PMCID: PMC10141482 DOI: 10.3390/jcm12082994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Neurological complications in pregnancy and the puerperium deserve particular attention from specialists due to the worsening of the clinical picture for both the mother and the fetus. This narrative review of existing data in the literature aims to analyze the most common "red flag symptoms" attributable to neurological complications such as pre-eclampsia (PE), eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), cerebral vasoconstriction syndrome (RCVS), stroke, CVS thrombosis, pituitary apoplexy, amniotic fluid embolism and cerebral aneurysm rupture, with the aim of providing a rapid diagnostic algorithm useful for the early diagnosis and treatment of these complications. The data were derived through the use of PubMed. The results and conclusions of our review are that neurological complications of a vascular nature in pregnancy and the puerperium are conditions that are often difficult to diagnose and manage clinically. For the obstetrics specialist who is faced with these situations, it is always important to have a guide in mind in order to be able to unravel the difficulties of clinical reasoning and promptly arrive at a diagnostic hypothesis.
Collapse
Affiliation(s)
- Merlino Lucia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Matys Viviana
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Crognale Alba
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - D'Ovidio Giulia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Della Rocca Carlo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
| | - Porpora Maria Grazia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Titi Luca
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Viscardi Maria Federica
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Volpicelli Agnese Immacolata
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Piccioni Maria Grazia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
4
|
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a group of clinical syndromes typically characterized by bilateral reversible vasogenic edema of the subcortical white matter in the parieto-occipital region on neuroimaging that causes a wide variety of acute or subacute neurological symptoms, including headache, mental status alteration, seizures, and visual dysfunction. PRES is classically suspected in patients with severe hypertension, renal failure, autoimmune disorders, eclampsia, or immunosuppressant medications. Frequent neurological evaluations and neuroimaging examinations by computed tomography or magnetic resonance imaging are required for both the diagnosis and assessment of the condition. Early detection of the disease is key for a rapid recovery and good prognosis.
Collapse
Affiliation(s)
- Yuya Ando
- Department of General Medicine, National Defense Medical College, Japan
- Department of Family Medicine, Graduated School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Japan
| | - Azusa Sano
- Department of General Medicine, National Defense Medical College, Japan
| | - Naoya Fujita
- Department of General Medicine, National Defense Medical College, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| |
Collapse
|
5
|
González-García N, Díaz de Terán J, López-Veloso AC, Mas-Sala N, Mínguez-Olaondo A, Ruiz-Piñero M, Gago-Veiga AB, Santos-Lasaosa S, Viguera-Romero J, Pozo-Rosich P. Headache: pregnancy and breastfeeding Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia 2022; 37:1-12. [PMID: 31047730 DOI: 10.1016/j.nrl.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.
Collapse
Affiliation(s)
| | - J Díaz de Terán
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España
| | - A C López-Veloso
- Servicio de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España
| | - N Mas-Sala
- Servicio de Neurología, Hospital Universitario Sant Joan de Déu, Fundación Althaia, Manresa, Barcelona, España
| | - A Mínguez-Olaondo
- Servicio de Neurología, Hospital Universitario Donostia, Donostia, España; Servicio de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - M Ruiz-Piñero
- Servicio de Neurología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, España
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Viguera-Romero
- Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España, Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma Barcelona, España
| |
Collapse
|
6
|
Makouei M, Hartup LA, Neuhoff BK, Boyd AR, Daftaribesheli L, Mirmoeeni S, Azari Jafari A, Godoy DA, Seifi A. The pathophysiologic, diagnostic, and therapeutic aspects of posterior reversible encephalopathy syndrome during pregnancy. J Matern Fetal Neonatal Med 2021; 35:8735-8743. [PMID: 34879767 DOI: 10.1080/14767058.2021.2001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with a wide range of symptoms, including visual disturbances, headache, vomiting, seizures, and altered consciousness. This review describes the pathophysiology of PRES, as well as the clinical, diagnostic, and therapeutic intervention during pregnancy. The gold standard for diagnosis of PRES is Magnetic Resonance Imaging (MRI), helping to differentiate it from other similar conditions. The aim of this paper is to review the principal aspects of PRES, general care, blood pressure control, and seizures prevention while avoiding potential injuries to the mother and fetus in the event of pregnancy. We concluded that PRES can be effectively treated and reversed if prompt diagnostic action is made, and adequate care is initiated.
Collapse
Affiliation(s)
- Mahsa Makouei
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lindsay Anne Hartup
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Barbara Kate Neuhoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angela Rodriguez Boyd
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Laleh Daftaribesheli
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Hospital Carlos Malbran, Catamarca, Argentina
| | - Ali Seifi
- Division of Neuro Critical Care, Department of Neurosurgery, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| |
Collapse
|
7
|
Headache: pregnancy and breastfeeding. Recommendations of the Spanish Society of Neurology's Headache Study Group. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:1-12. [PMID: 34535428 DOI: 10.1016/j.nrleng.2018.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.
Collapse
|
8
|
Predictors of posterior reversible encephalopathy syndrome in women with hypertension in pregnancy: A prospective observational study. Pregnancy Hypertens 2021; 23:191-195. [PMID: 33508767 DOI: 10.1016/j.preghy.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Posterior reversible encephalopathy syndrome (PRES) is a clinical neuro-radiologic abnormality associated with eclampsia and is diagnosed with magnetic resonance imaging (MRI). However, MRI scans to detect PRES may be difficult to obtain routinely. Thus, it would be useful to see whether standard demographic, clinical and laboratory parameters are predictive of PRES. STUDY DESIGN Prospective observational cohort study. MAIN OUTCOME MEASURE Prediction of PRES with standard parameters. RESULTS 30 hypertensive pregnant women were enrolled. Brain MRI scans were performed after delivery till 7 days post-partum. Area under curves (AUC)s for clinical and laboratory parameters were generated for PRES prediction. A total of 8 women (5 with eclampsia and 3 with preeclampsia with features of severity) had PRES features in MRI. The most specific parameters for predicting PRES were age (<24 years), platelet count (<0.69 lacs/mm3), serum ALT (>129 IU/L) and AST (>55 IU/L), total bilirubin (>1.3 mg/dl), low hemoglobin (<8.7 g/dl) and presence of seizures. The most sensitive predicting parameters were serum uric acid > 5.2 mg/dl, systolic blood pressure (SBP) > 164 mm Hg, diastolic blood pressure > 100 mmHg and serum creatinine > 0.8 mg/dl. The best AUCs > 70% and good Youden indices were obtained for age < 24 years, SBP > 164 mm Hg, total bilirubin > 1.3 mg/dl, AST > 55 IU/L, hemoglobin < 8.7 mg/dl and uric acid > 5.2 mg/dl. CONCLUSION In women with preeclampsia, younger age, raised SBP, elevated serum total bilirubin, uric acid and AST and low hemoglobin best predict PRES.
Collapse
|
9
|
Anderson RC, Patel V, Sheikh-Bahaei N, Liu CSJ, Rajamohan AG, Shiroishi MS, Kim PE, Go JL, Lerner A, Acharya J. Posterior Reversible Encephalopathy Syndrome (PRES): Pathophysiology and Neuro-Imaging. Front Neurol 2020; 11:463. [PMID: 32612567 PMCID: PMC7308488 DOI: 10.3389/fneur.2020.00463] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/29/2020] [Indexed: 12/18/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) represents a unique clinical entity with non-specific clinical symptoms and unique neuroradiological findings. This syndrome may present with a broad range of clinical symptoms from headache and visual disturbances to seizure and altered mentation. Typical imaging findings include posterior-circulation predominant vasogenic edema. Although there are many well-documented diseases associated with PRES, the exact pathophysiologic mechanism has yet to be fully elucidated. Generally accepted theories revolve around disruption of the blood-brain barrier secondary to elevated intracranial pressures or endothelial injury. In this article, we will review the clinical, typical, and atypical radiological features of PRES, as well as the most common theories behind the pathophysiology of PRES. Additionally, we will discuss some of the treatment strategies for PRES related to the underlying disease state.
Collapse
Affiliation(s)
- Redmond-Craig Anderson
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vishal Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nasim Sheikh-Bahaei
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Chia Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Anandh G Rajamohan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul E Kim
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John L Go
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
10
|
Gumus Guler B, Ozler S. Increased levels of serum serglycin and agrin is associated with adverse perinatal outcome in early onset preeclampsia. Fetal Pediatr Pathol 2019; 38:418-431. [PMID: 31018746 DOI: 10.1080/15513815.2019.1604922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Goal: Our aim was to determine whether alterations in serum serglycin and agrin levels in early-onset preeclampsia (EOPE) are useful in predicting adverse perinatal outcomes such as fetal growth restriction (FGR), intrauterine fetal demise (IUFD), preterm delivery and/or neonatal unit admission. Materials and Methods: A prospective case-controlled study enrolled 88 pregnant patients (44 EOPE and 44 controls). Maternal serum serglycin and agrin levels were determined before the 34th gestational week by enzyme-linked immunosorbent assay. Results: Compared with controls, women with EOPE had significantly higher serglycin and agrin levels (p = .018; p = .048). Multivariable logistic regression analysis revealed serglycin was independently associated with FGR in EOPE (OR 0.866; 95% CI 0.779-0.953). Agrin was independently associated with IUFD in EOPE (OR 0.757, 95% CI 0.636-0.879). Conclusions: The current study suggests that increased maternal serum serglycin is associated with FGR, and increased maternal serum agrin is associated with IUFD in EOPE.
Collapse
Affiliation(s)
- Basak Gumus Guler
- Department of Health Sciences, Istinye Universitesi , Istanbul , Turkey
| | - Sibel Ozler
- Department of Perinatology, Konya Egitim ve Arastirma Hastanesi , Konya , Turkey
| |
Collapse
|
11
|
Postpartum Posterior Reversible Encephalopathy Syndrome (PRES): Three Case Reports and Literature Review. Case Rep Obstet Gynecol 2019; 2019:9527632. [PMID: 30809401 PMCID: PMC6369475 DOI: 10.1155/2019/9527632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 11/17/2022] Open
Abstract
Posterior reversible encephalopathy syndrome is a rare complication generally associated with headache and acute changes in blood pressure. Delay in the diagnosis and treatment may result in death or in irreversible neurological sequelae. We present three cases of PRES occurring in young women during puerperium. We report a literature review ranged from January 1990 to June 2015 describing clinical features, diagnostic and medical approach, and maternal outcome.
Collapse
|
12
|
Katsevman GA, Turner RC, Cheyuo C, Rosen CL, Smith MS. Post-partum posterior reversible encephalopathy syndrome requiring decompressive craniectomy: case report and review of the literature. Acta Neurochir (Wien) 2019; 161:217-224. [PMID: 30659351 DOI: 10.1007/s00701-019-03798-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis. Despite initial conservative therapy including anti-epileptic drugs, magnesium therapy, empiric antibiotics, and Trendelenburg positioning, the patient continued to deteriorate. Follow-up imaging was suggestive of PRES with signs of intracranial hypertension. The patient underwent a decompressive suboccipital craniectomy for refractory and severe PRES and later fully recovered. This case highlights the sometimes difficult diagnosis of PRES, possible association with pregnancy, eclampsia/preeclampsia and/or cerebrospinal fluid drainage, and the rare but life-saving need for decompression in severe cases.
Collapse
|
13
|
Kasuya C, Suzuki M, Koda Y, Sato H, Kashima K, Honda K, Kazama Y, Akiyama K, Seki Y, Yoneoka Y. A headache-free reversible cerebral vasoconstriction syndrome (RCVS) with symptomatic brain stem ischemia at late pregnancy as a rare manifestation of RCVS resolved with termination of pregnancy by semi-urgent cesarean section. Oxf Med Case Reports 2018; 2018:omy101. [PMID: 30487987 PMCID: PMC6247141 DOI: 10.1093/omcr/omy101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
A 32-year-old pregnant woman in her 39th week of pregnancy presented at the emergency room complaining of sudden-onset dizziness with gaze disturbance and was admitted to our hospital. Her past medical history included hypertension, diabetes mellitus and infarction in the right medulla oblongata 18 months prior to this event. Magnetic resonance (MR) angiography showed multiple irregular stenosis of the intracranial arterial system. Although MR images revealed no fresh ischemic or hemorrhagic lesions, she was diagnosed with reversible cerebral vasoconstriction syndrome (RVCS) associated with pregnancy. Cesarean section immediately resolved the headache-free ischemic RCVS. The postpartum course of the patient was uneventful as well as that of her baby. Follow-up MR angiography showed improvement of intracranial vasoconstriction and follow-up MR imaging showed improvement of a left medial pontine ischemic lesion on diffusion-weighted image. This report describes a rare manifestation of pregnancy-related RCVS.
Collapse
Affiliation(s)
- Chisato Kasuya
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Mina Suzuki
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yukako Koda
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Hitomi Sato
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Katsunori Kashima
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Keisuke Honda
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yoshiki Kazama
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| |
Collapse
|
14
|
Vitucci A, Lojacono A, Gatti E, Prefumo F, Fratelli N. Atypical presentation and imaging features of postpartum posterior reversible encephalopathy syndrome. J OBSTET GYNAECOL 2018; 39:412-414. [PMID: 30226402 DOI: 10.1080/01443615.2018.1474188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Annachiara Vitucci
- a Department of Obstetrics and Gynaecology , University of Brescia , Brescia , Italy
| | - Andrea Lojacono
- a Department of Obstetrics and Gynaecology , University of Brescia , Brescia , Italy
| | - Enza Gatti
- b Unit of Neuroradiology , Spedali Civili , Brescia , Italy
| | - Federico Prefumo
- a Department of Obstetrics and Gynaecology , University of Brescia , Brescia , Italy
| | - Nicola Fratelli
- a Department of Obstetrics and Gynaecology , University of Brescia , Brescia , Italy
| |
Collapse
|
15
|
Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
Collapse
Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
| |
Collapse
|
16
|
Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornello R, Raffaelli B, Terrin A, Reuter U, Mitsikostas DD. Headache and pregnancy: a systematic review. J Headache Pain 2017; 18:106. [PMID: 29052046 PMCID: PMC5648730 DOI: 10.1186/s10194-017-0816-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/11/2017] [Indexed: 02/06/2023] Open
Abstract
This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify “red flag symptoms” suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.
Collapse
Affiliation(s)
- A Negro
- Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sapienza University of Rome, Sant'Andrea Hospital, 00189, Rome, Italy.
| | - Z Delaruelle
- Department of Neurology, Ghent University Hospital, 9000, Ghent, Belgium
| | - T A Ivanova
- Institute of Professional Education, Chair of Neurology. I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S Khan
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, -2600, Glostrup, DK, Denmark
| | - R Ornello
- Department of Neurology, University of L'Aquila, 67100, L'Aquila, Italy
| | - B Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - A Terrin
- Department of Neurosciences, Headache Centre, University of Padua, 35128, Padua, Italy
| | - U Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - D D Mitsikostas
- Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, 11528, Athens, Greece
| | | |
Collapse
|
17
|
Tetsuka S, Nonaka H. Importance of correctly interpreting magnetic resonance imaging to diagnose posterior reversible encephalopathy syndrome associated with HELLP syndrome: a case report. BMC Med Imaging 2017; 17:35. [PMID: 28545408 PMCID: PMC5445265 DOI: 10.1186/s12880-017-0208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe haemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome in pregnancy are possible underlying trigger factors for posterior reversible encephalopathy syndrome (PRES). Magnetic resonance imaging (MRI) shows diffuse signal abnormalities involving the subcortical white matter in the parieto-occipital lobes. Although the diagnosis of RPES was clearly established by the distinctive reversibility of clinical and radiological abnormalities, it is difficult to distinguish from differential diagnosis. Thus, it is important to correctly interpret MRI. CASE PRESENTATION We describe a case of HELLP syndrome with PRES. A 38-year-old pregnant woman was admitted to our hospital as an emergency case with a complaint of upper abdominal pain and headache at 29 weeks of pregnancy and the development of HELLP syndrome. An emergency caesarean section was immediately performed. After the operation, the patient received intravenous corticosteroids, and her blood pressure was controlled. Thereafter, she showed an altered mental status. MRI showed hypersignal intense lesions in the cortical and subcortical white matter in the occipital lobes, basal ganglia and callosal splenium in both the fluid-attenuated inversion recovery (FLAIR) sequence and apparent diffusion coefficient (ADC), but these lesions were not recognized in diffusion-weighted imaging (DWI). These images were suggestive of PRES. The patient was kept in the hospital and received the appropriate treatment, after which the patient's level of consciousness improved and all laboratory tests and imaging examinations returned normal. CONCLUSION The MRI findings were useful for the prompt diagnosis of PRES, characterized by hypersignals in FLAIR and ADC, but not in DWI. Additionally, there was an "atypical" MRI appearance of basal ganglial and callosal splenial involvement in this case, which may mistakenly lead clinicians to diagnose other aetiologies than typical PRES. It is considered that vasogenic oedema is the main pathology of PRES according to the MRI image findings. MRI is the gold standard for diagnosing PRES because it can provide information about cerebral involvement earlier than CT; further, it can be a useful tool in the differential diagnosis. This technique facilitated the prompt diagnosis and treatment of the said patient, ultimately resulting in a good outcome.
Collapse
Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, Hospital of Yuki, 9629-1, Yuki, Yuki-City, Ibaraki, 307-0001, Japan.
| | - Hiroaki Nonaka
- Obstetrics & Gynecology, Hospital of International University of Health and Welfare, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| |
Collapse
|
18
|
A Horned Viper Bite Victim with PRES. Case Rep Neurol Med 2017; 2017:1835796. [PMID: 28487791 PMCID: PMC5402235 DOI: 10.1155/2017/1835796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/23/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022] Open
Abstract
Neurological complications of snake bites have been well documented in the literature as neuromuscular paralysis and cerebrovascular complications; posterior reversible encephalopathy syndrome was rarely described. A 23-year-old lady presented near full term of her pregnancy with a horned snake Cerastes cerastes bite; after successful delivery she started complaining of altered mental status and visual disturbance with ulceration over the site of the snake bite. On admission, the patient had Glasgow Coma Score of 12, blood pressure 130/80 mmHg, temperature 38°C, sinus tachycardia at 120 beats per minute, severe dehydration, and reduction in visual acuity to "hand motion" in both eyes with poor light projection and sluggish pupillary reactions. CT brain was not conclusive; MRI revealed features of PRES. Treatment was mostly supportive within one week; the patient regained consciousness; visual disturbance, however, persisted. This patient as well as the few previously described cases highlights PRES as a possible complication of snake bites.
Collapse
|
19
|
Villelli NW, Prevedello DM, Ikeda DS, Montaser AS, Otto BA, Carrau RL. Posterior Reversible Encephalopathy Syndrome Causing Vision Loss After Endoscopic Endonasal Resection of Pituitary Adenoma. World Neurosurg 2017; 100:708.e1-708.e10. [DOI: 10.1016/j.wneu.2017.02.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/26/2022]
|
20
|
Orgul G, Uckan H, Aktoz F, Deren O. Acute onset of blindness associated with posterior reversible encephalopathy syndrome: a HELLP syndrome case report. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2016-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon disorder. PRES presents with clinical findings such as headache, seizures, visual disturbances, and altered consciousness. Here, we present a PRES case in the second trimester of pregnancy with intrauterine fetal demise. A 40-year-old woman, gravida 4 para 3, was diagnosed with HELLP syndrome based on the clinical and laboratorial findings. An emergent caesarean section was performed under magnesium sulphate (MgSO4) treatment. She had suffered vision loss with normal fundoscopic findings at postpartum period. All the clinical, laboratory and imaging findings (MRI) confirmed the diagnosis of PRES. Careful observation of the clinical findings and prompt treatment is necessary for pregnancies complicated by PRES to prevent undesirable outcomes.
Collapse
Affiliation(s)
- Gokcen Orgul
- Department of Obstetrics and Gynecology , Division of Perinatology, Hacettepe University Faculty of Medicine , No:81, Sıhhiye , Ankara , Turkey , Phone: +90 555 606 62 54, Fax: +90 (312) 305 50 00
| | - Hasan Uckan
- Department of Obstetrics and Gynecology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Fatih Aktoz
- Department of Obstetrics and Gynecology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ozgur Deren
- Department of Obstetrics and Gynecology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| |
Collapse
|
21
|
Magsi S, Zafar A. Malignant Posterior Reversible Encephalopathy Syndrome-An Exacting Challenge for Neurocritical Care Physicians. Neurohospitalist 2017; 7:196-199. [PMID: 28974999 DOI: 10.1177/1941874416688989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.
Collapse
|
22
|
Posterior reversible encephalopathy syndrome in pregnancy: a retrospective series of 36 patients from mainland China. Ir J Med Sci 2017; 186:699-705. [DOI: 10.1007/s11845-017-1567-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
|
23
|
Treatment principles of ovarian teratoma with anti-N-methyl-d-aspartate receptor encephalitis. Arch Gynecol Obstet 2016; 294:623-9. [DOI: 10.1007/s00404-016-4050-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
|