1
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Lei CL, Gui XL, Wang LY, Guo YJ, Li Y. Analysis of drug-induced posterior reversible encephalopathy syndrome using the food and drug administration adverse drug events reporting system database. Expert Opin Drug Saf 2024; 23:607-616. [PMID: 38478961 DOI: 10.1080/14740338.2024.2327510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/03/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE In this retrospective pharmacovigilance study, we gathered data on drug-induced posterior reversible encephalopathy syndrome (PRES). Our goal was to identify the primary suspect drugs in PRES by analyzing the Food and Drug Administration Adverse Events Reporting System (FAERS) database. METHODS We identified and analyzed reports of PRES listed in the FAERS database between 2004 and 2021. Using the reporting odds ratio and 95% confidence interval, we evaluated the safety signals for each of the drugs associated with PRES. RESULTS We reviewed 11,077 reports of adverse events corresponding to PRES. The primary suspect drug categories were antineoplastics, immunosuppressants, and glucocorticoids. PRES was 24.77% more likely to occur in females than in males. Drug-induced PRES usually occurs in individuals with cancer, those who have undergone an organ/stem cell transplant, and those with autoimmune conditions. CONCLUSION Our results show that the drugs most commonly suspected to cause PRES were antineoplastics, immunosuppressants, and glucocorticoids. Future studies are needed to illuminate the pathophysiological alterations that underlie PRES. In the meantime, prescribers and patients should be made aware of the potential risks of PRES associated with pharmaceutical therapy, and the summaries of product characteristics for individual drugs should be updated to include this information.
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Affiliation(s)
- Cai-Lu Lei
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
- School of Pharmaceutical Science, Guangxi Medical University, Nanning, China
| | - Xiao-Long Gui
- Department of Gastrointestinal & Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin-Yu Wang
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
| | - You-Jia Guo
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yan Li
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
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Li Y, Song J, Huq AM, Timilsina S, Gershwin ME. Posterior reversible encephalopathy syndrome and autoimmunity. Autoimmun Rev 2023; 22:103239. [PMID: 36464226 DOI: 10.1016/j.autrev.2022.103239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by acute or subacute onset of neurological symptoms (e.g., headache, seizure, confusion, vomiting, and diminished eyesight) and impaired endothelial barrier function of the cerebral circulation that leads to bilateral subcortical vasogenic edema, while exhibiting a "reversible" feature in most cases. Clinically, various predisposing or precipitating conditions have been identified, such as hypertension, autoimmune diseases, renal dysfunction/failure, preeclampsia/eclampsia, post-transplantation conditions, and certain therapeutic agents. Among several putative mechanisms, the immune activation hypothesis prevails, as up to 50% of patients with PRES harbor abnormalities related to autoimmunity, such as concurrent systemic lupus erythematosus. In this Review, we summarize the clinical and laboratory evidence that places PRES in the context of autoimmunity.
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Affiliation(s)
- Yang Li
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China
| | - Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China.
| | - Ahm M Huq
- Department of Pediatrics, Central Michigan University, Detroit, MI 48201, USA
| | - Suraj Timilsina
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
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3
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Su L, Qi Z, Guan S, Wei L, Zhao Y. Exploring the risk factors for ischemic cerebrovascular disease in systemic lupus erythematosus: A single-center case-control study. Front Immunol 2022; 13:978910. [PMID: 36238309 PMCID: PMC9552613 DOI: 10.3389/fimmu.2022.978910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesIschemic cerebrovascular disease (ICVD) is one of the most common and severe complications in systemic lupus erythematosus (SLE). We aim to explore the risk factors for ICVD in SLE and to assess their associated clinical characteristics.MethodsIn this study, 44 lupus patients with ICVD (ICVD-SLE) and 80 age- and sex-matched lupus patients without ICVD (non-ICVD-SLE) who were hospitalized in our center between 2014 and 2021 were enrolled. A comprehensive set of clinical and socio-demographic data was recorded. In the ICVD-SLE group, the modified Rankin score (mRS) at 90 days after the occurrence of ICVD, the brain MRI, and arterial ultrasonography findings were collected. Group comparisons were made with continuous variables using an independent t-test or the Mann–Whitney test, and with categorical variables using the chi-square test or Fisher exact test. Multivariate logistic regression analysis was performed to identify the risk factors for ICVD in SLE. Patients with ICVD-SLE were divided into three subgroups according to the gradations of intracranial arterial stenosis (ICAS). The subgroup comparisons were performed by one-way ANOVA test or Kruskal–Wallis test.ResultsOf the 44 patients with ICVD, 45% had a large-vessel ischemic stroke, 50% had a symptomatic lacunar stroke, and 9% had a transient ischemic attack. 2 (4.5%) had both large-vessel ischemic stroke and symptomatic lacunar stroke. Multivariate logistic regression analysis showed that cutaneous vasculitis (OR=7.36, 95% CI=2.11–25.65), anticardiolipin antibody (aCL) (OR=4.38, 95% CI=1.435–13.350), and lupus anticoagulant (LA) (OR=7.543,95% CI=1.789–31.808) were the risk factors, and hydroxychloroquine (HCQ) therapy (OR=0.198, 95% CI=0.078–0.502) was the protective factor, after controlling for confounders. During the analysis of the subgroups, no significant difference was observed between the patients in the group without internal carotid arterial occlusion (ICAS) and those with severe ICAS except for diagnostic delay. However, patients in the moderate ICAS group were older when SLE occurred (P<0.01), had a longer diagnostic delay (P<0.01), a lower percentage of hypocomplementemia (P=0.05) and steroids and HCQ therapy (P=0.01, P=0.05, respectively), a trend toward lower mRS score, but a higher incidence of carotid atherosclerotic plaque (P<0.01), when compared with the other two subgroups.ConclusionCutaneous vasculitis and antiphospholipid antibodies (aPLs) are associated with an increased risk of ICVD, while HCQ therapy may provide protection against ICVD in SLE. The ICVD in younger lupus patients is associated with complement-mediated inflammation and poorer outcome, and require immunosuppressive therapy, whereas the ICVD in elderly patients are characterized by moderate ICAS and carotid atherosclerotic plaques.
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Affiliation(s)
- Li Su
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhigang Qi
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lian Wei
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Zhao
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yi Zhao,
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de Medeiros FC, Rocha Sousa BM, Cruz Santos DN, Novais Matias Sion G, Fontes Alves C. Posterior reversible encephalopathy syndrome as the first clinical manifestation of lupus nephritis. Acta Neurol Belg 2022; 122:219-221. [PMID: 33591552 DOI: 10.1007/s13760-021-01614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | | | - Cibele Fontes Alves
- Department of Pathology, José Rosário Vellano University (UNIFENAS), Belo Horizonte, MG, Brazil
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5
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Duarte AC, Barata Silvério T, Sousa S, Ribeiro AC, Canas da Silva J, Gonçalves P. Recurrent Posterior Reversible Encephalopathy Syndrome: An Unusual Presentation of Neurolupus. J Clin Rheumatol 2021; 27:e8-e9. [PMID: 31743266 DOI: 10.1097/rhu.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Valdez-López M, Aguirre-Aguilar E, Valdés-Ferrer SI, Martínez-Carrillo FM, Arauz A, Barrera-Vargas A, Merayo-Chalico J. Posterior reversible encephalopathy syndrome: A neuropsychiatric manifestation of systemic lupus erythematosus. Autoimmun Rev 2020; 20:102739. [PMID: 33326853 DOI: 10.1016/j.autrev.2020.102739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 12/29/2022]
Abstract
Posterior Reversible Encephalopathy Syndrome (PRES) is an acute neurological syndrome clinically characterized by seizures, altered mental status, headache, and visual disturbances. It is caused by a variety of abnormalities in the endothelial function that ultimately result in vasogenic edema in the circulation of the central nervous system. This is reflected by the neuroimaging findings, that most often show reversible parieto-occipital edema. An important proportion of patients with PRES present with Systemic Lupus Erythematosus (SLE), and its complications, as their sole risk factors. This review describes the relationship between these two clinical entities and explains the pathophysiological models that have been proposed to describe the development of PRES. We explain how SLE can cause alterations in every pathway implicated in the development of PRES. Given the relatively high frequency and the distinct clinical course, PRES in the setting of SLE might be best described as a distinct neuropsychiatric syndrome associated with SLE.
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Affiliation(s)
- Martín Valdez-López
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Eduardo Aguirre-Aguilar
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Departmento of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Francisco M Martínez-Carrillo
- Departmento of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
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7
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Abraham P, Longardner K, Chen P, Huisa B, Handwerker J. Case 279: Central-Variant Posterior Reversible Encephalopathy Syndrome. Radiology 2020; 296:239-243. [DOI: 10.1148/radiol.2020181547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter Abraham
- From the School of Medicine (P.A.) and Departments of Neurosciences (K.L., P.C., B.H.) and Radiology (J.H.), University of California San Diego Medical Center, 200 West Arbor Dr, San Diego, CA 92103
| | - Katie Longardner
- From the School of Medicine (P.A.) and Departments of Neurosciences (K.L., P.C., B.H.) and Radiology (J.H.), University of California San Diego Medical Center, 200 West Arbor Dr, San Diego, CA 92103
| | - Patrick Chen
- From the School of Medicine (P.A.) and Departments of Neurosciences (K.L., P.C., B.H.) and Radiology (J.H.), University of California San Diego Medical Center, 200 West Arbor Dr, San Diego, CA 92103
| | - Branko Huisa
- From the School of Medicine (P.A.) and Departments of Neurosciences (K.L., P.C., B.H.) and Radiology (J.H.), University of California San Diego Medical Center, 200 West Arbor Dr, San Diego, CA 92103
| | - Jason Handwerker
- From the School of Medicine (P.A.) and Departments of Neurosciences (K.L., P.C., B.H.) and Radiology (J.H.), University of California San Diego Medical Center, 200 West Arbor Dr, San Diego, CA 92103
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8
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García-Grimshaw M, Domínguez-Moreno R, Valdés-Ferrer SI. Posterior Reversible Encephalopathy Syndrome: An Underrecognized Manifestation of Systemic Lupus Erythematosus. Neurohospitalist 2020; 10:234-235. [PMID: 32549950 DOI: 10.1177/1941874419889467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Rogelio Domínguez-Moreno
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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9
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Pirola JP, Baenas DF, Haye Salinas MJ, Benzaquén NR, Colazo M, Borghi MV, Lucero C, Álvarez AC, Retamozo S, Alvarellos A, Saurit V, Caeiro F. Posterior reversible leukoencephalopathy syndrome: Case series and review of the literature. REUMATOLOGIA CLINICA 2020; 16:169-173. [PMID: 29859809 DOI: 10.1016/j.reuma.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe clinical manifestations, antecedents, comorbidities and associated treatments, imaging findings, and follow-up in patients with posterior reversible encephalopathy syndrome. METHODS A retrospective, descriptive analysis of admitted patients was performed between June 2009 and May 2014 in a third-level care hospital. We evaluated age, sex, comorbidities, symptoms, values of blood pressure at admission, renal function, medication and time elapsed until the disappearance of symptoms. RESULTS Thirteen patients were included. In all, 77% of them had a history of hypertension at baseline and 85% had impaired renal function. The most prevalent comorbidity was renal transplantation, and 85% had deterioration of renal function. Five of the patients had undergone renal transplantation. The most common clinical manifestation was seizures. All had subcortical lesions and bilateral parietooccipital involvement was the finding most frequently observed. CONCLUSION This syndrome should be taken into account in the differential diagnoses of patients presenting with acute neurological syndromes and the abovementioned risk factors.
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Affiliation(s)
- Juan Pablo Pirola
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Diego Federico Baenas
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | | | | | - Marcela Colazo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Victoria Borghi
- Servicio de Neurología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Cecilia Lucero
- Servicio de Neurología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Ana Cecilia Álvarez
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Soledad Retamozo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Alejandro Alvarellos
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Francisco Caeiro
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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10
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Shaban A, Leira EC. Neurological Complications in Patients with Systemic Lupus Erythematosus. Curr Neurol Neurosci Rep 2019; 19:97. [PMID: 31773306 DOI: 10.1007/s11910-019-1012-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Systemic lupus erythematosus (SLE) is commonly associated with neurological manifestations. Rapid recognition and treatment of these complications may improve outcomes. In this article, we review the neurological conditions associated with SLE, their diagnosis and management strategies. RECENT FINDINGS Recent meta-analysis showed that patients with neuropsychiatric manifestations of SLE were more likely to have positive antiphospholipid, antiribosomal P, and antineuronal antibodies. Another meta-analysis showed an association between SLE and antiphospholipid antibodies with cognitive impairment. Two large retrospective studies have shown that the peripheral nervous system is commonly involved in SLE frequently alongside the central nervous system. Neurological manifestations occur in most of SLE patients. Antiphospholipid antibodies are common in patients with SLE and increase the odds of neurological complications. Management typically involved a combination of treatments directed toward the neurological complication and therapies directed toward SLE itself. The efficacy of these treatment protocols, however, has not been rigorously studied and deserves further investigation.
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Affiliation(s)
- Amir Shaban
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Enrique C Leira
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.,Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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11
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Nemati R, Mehdizadeh S, Salimipour H, Yaghoubi E, Alipour Z, Tabib SM, Assadi M. Neurological manifestations related to Crohn's disease: a boon for the workforce. Gastroenterol Rep (Oxf) 2019; 7:291-297. [PMID: 31413837 PMCID: PMC6688734 DOI: 10.1093/gastro/gox034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/28/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022] Open
Abstract
The neurological manifestations of Crohn's disease and its prevalence are not well known. Here, we report five patients of confirmed Crohn's disease with different neurological presentations. The neurological presentations include anterior ischemic optic neuropathy, myelopathy, posterior reversible encephalopathy syndrome, chronic inflammatory demyelinating polyneuropathy, and chronic axonal sensory and motor polyneuropathy. These manifestations should be kept in mind in the assessment of Crohn's disease.
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Affiliation(s)
- Reza Nemati
- Department of Neurology, Bushehr University of Medical Sciences, Bushehr, Iran.,The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Somayeh Mehdizadeh
- Department of Pathology, Rasul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Salimipour
- Department of Neurology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zeinab Alipour
- Department of Gastroenterology and Hepatology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyed Masoud Tabib
- Department of Gastroenterology and Hepatology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
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12
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Cui HW, Lei RY, Zhang SG, Han LS, Zhang BA. Clinical features, outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a case-control study. Lupus 2019; 28:961-969. [PMID: 31208267 DOI: 10.1177/0961203319856416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this paper is to investigate the clinical features, outcomes, and risk factors for posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE). METHODS From 2011 to October 2017, SLE patients with PRES were identified from the First Affiliated Hospital of Zhengzhou University, China. Patients presenting with neuropsychiatric lupus hospitalized in the same period were included as controls. Additionally, survival status was acquired via telephone follow-up in March 2018. RESULTS Thirty episodes of PRES were identified in 29 SLE patients from a total of 7059 SLE patients (prevalence 0.43%). Patients with PRES had a younger age at onset than controls, with seizures more commonly the initial clinical manifestation (80.00% vs 42.37%, p = 0.001). Multiple logistic regression yet again confirmed several known risk factors, including younger age (odds ratio (OR) 1.15 (95% confidence interval (CI) 1.13-1.16)), nephritis (OR 20.74 (18.10-23.75)), history of hypertension (OR 1.17 (1.05-1.31)), SLE Disease Activity Index without neurologic symptoms (SLEDAI-N) score >12 (OR 1.14 (1.11-1.18)) and eclampsia (OR 9.38 (7.84-11.23)). Furthermore, we identified two novel independent risk factors for PRES in SLE: white blood cells >9 × 109/l (OR 2.33 (2.05-2.64)) and heart failure (OR 2.10 (1.18-2.42)). At follow-up, SLE patients with PRES had higher mortality than controls (30.77% vs 8.33%, respectively, p = 0.012). CONCLUSIONS PRES may be a reversible neurological deficit in patients with SLE other than neuropsychiatric lupus. Our results indicate two new risk factors for PRES and that PRES is associated with a higher mortality rate.
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Affiliation(s)
- H-W Cui
- 1 Department of General ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - R-Y Lei
- 2 Department of Emergency ICU, the First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
| | - S-G Zhang
- 1 Department of General ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - L-S Han
- 3 Department of Rheumatology, the First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
| | - B-A Zhang
- 4 Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China
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13
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Mustafa KN, Qasem U, Al-Ryalat NT, Bsisu IK. Rituximab-associated posterior reversible encephalopathy syndrome. Int J Rheum Dis 2018; 22:160-165. [PMID: 30398015 DOI: 10.1111/1756-185x.13427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/26/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Khader N Mustafa
- Division of Rheumatology, Department of Internal Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Ula Qasem
- Division of Rheumatology, Department of Internal Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Nosaiba T Al-Ryalat
- Department of Radiology, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Isam K Bsisu
- School of Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan
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14
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McGlasson S, Wiseman S, Wardlaw J, Dhaun N, Hunt DPJ. Neurological Disease in Lupus: Toward a Personalized Medicine Approach. Front Immunol 2018; 9:1146. [PMID: 29928273 PMCID: PMC5997834 DOI: 10.3389/fimmu.2018.01146] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/07/2018] [Indexed: 12/11/2022] Open
Abstract
The brain and nervous system are important targets for immune-mediated damage in systemic lupus erythematosus (SLE), resulting in a complex spectrum of neurological syndromes. Defining nervous system disease in lupus poses significant challenges. Among the difficulties to be addressed are a diversity of clinical manifestations and a lack of understanding of their mechanistic basis. However, despite these challenges, progress has been made in the identification of pathways which contribute to neurological disease in SLE. Understanding the molecular pathogenesis of neurological disease in lupus will inform both classification and approaches to clinical trials.
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Affiliation(s)
- Sarah McGlasson
- MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Anne Rowling Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart Wiseman
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David P. J. Hunt
- MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Anne Rowling Clinic, University of Edinburgh, Edinburgh, United Kingdom
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15
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Damrongpipatkul U, Oranratanachai K, Kasitanon N, Wuttiplakorn S, Louthrenoo W. Clinical features, outcome, and associated factors for posterior reversible encephalopathy in Thai patients with systemic lupus erythematosus: a case-control study. Clin Rheumatol 2017; 37:691-702. [DOI: 10.1007/s10067-017-3892-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022]
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16
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Bazuaye-Ekwuyasi E, Chow RD, Schmalzle S. An atypical subacute presentation of posterior reversible encephalopathy syndrome. J Community Hosp Intern Med Perspect 2017; 7:269-274. [PMID: 29046760 PMCID: PMC5637638 DOI: 10.1080/20009666.2017.1369381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/07/2017] [Indexed: 01/15/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) characteristically presents with rapid onset of headache, seizure, encephalopathy, and visual changes, along with evidence of parieto-occipital vasogenic edema on magnetic resonance imaging. We describe the case of a 41-year-old female with a protracted presentation of two of the four classic PRES symptoms, which were not immediately recognized as PRES due to the presence of multiple other comorbidities and reasons for encephalopathy. This case highlights the possibility of atypical presentations of PRES and the diagnostic challenges in making this clinical diagnosis when competing diagnoses are present.
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Affiliation(s)
- Eseosa Bazuaye-Ekwuyasi
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.,Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Robert Dobbin Chow
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Sarah Schmalzle
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.,Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Zekić T, Benić MS, Antulov R, Antončić I, Novak S. The multifactorial origin of posterior reversible encephalopathy syndrome in cyclophosphamide-treated lupus patients. Rheumatol Int 2017; 37:2105-2114. [PMID: 29043491 DOI: 10.1007/s00296-017-3843-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/03/2017] [Indexed: 01/13/2023]
Abstract
The cyclophosphamide as a predisposing factor for Posterior Reversible Encephalopathy Syndrome (PRES) and therapeutic option for systemic lupus erythematosus (SLE) is still confusing. The first and only case of PRES, probably induced by cyclophosphamide, in Croatia followed by the findings of 36 SLE patients diagnosed with PRES after treatment with cyclophosphamide worldwide are described. An 18-year-old Caucasian female patient with a 1-year history of SLE was admitted to the hospital due to lupus nephritis and acute arthritis. After the second dose of cyclophosphamide was administered, according to the Euro-lupus protocol, the patient presented with a grand mal status epilepticus. The differential diagnosis of neurolupus, cerebrovascular insult, and infection were excluded. The MRI findings showed brain changes in corresponding to PRES. The treatment consisted of antihypertensives, antiepileptics, antiedema therapy, mechanical ventilation, and avoiding further cyclophosphamide use. A Naranjo Adverse Drug Reaction Probability Scale total score of five and a probable reaction related to drug therapy (cyclophosphamide, PRES) was confirmed. In this systematic review, along with cyclophosphamide use, the main predisposing factors involved in PRES occurrence in SLE patients were active SLE and renal involvement. Due to the high number of simultaneously involved predisposing factors (max. six) and their overlapping effect, it is still not possible to clearly establish the role of every factor on PRES onset. The use of cyclophosphamide, as a contributing factor for PRES onset, should be carefully assessed, based on clinicians' experience and knowledge, in the setting of active SLE.
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Affiliation(s)
- Tatjana Zekić
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Ronald Antulov
- Department of Radiology, Sydvestjyisk Sygehus, Esbjerg, Denmark
| | - Igor Antončić
- Department of Neurology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
- University of Rijeka Medical School, Rijeka, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
- University of Rijeka Medical School, Rijeka, Croatia
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Ferreira TS, Reis F, Appenzeller S. Posterior reversible encephalopathy syndrome and association with systemic lupus erythematosus. Lupus 2016; 25:1369-1376. [DOI: 10.1177/0961203316643598] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction Posterior reversible encephalopathy syndrome (PRES) is a neurological complex disorder with many clinical associations and causative factors. It is important to recognize this condition because early diagnosis and treatment usually result in its complete resolution, radiological imaging becoming the key for the correct diagnosis. Methods We retrospectively reviewed charts and magnetic resonance imaging findings in the University of Campinas from January 2005 to July 2015, selecting three cases of patients with systemic lupus erythematosus syndrome who developed PRES, for whom risk factors, characteristics, magnetic resonance imaging findings and neurological resolution were analyzed. We also conducted a review of the English-language literature. Results The three cases had neurological symptoms like acute onset of headache, altered mental status, cortical blindness and seizures. Brain magnetic resonance imaging demonstrated posterior cortical and white matter alterations involving posterior brain territories, which were more conspicuous on T2-weighted and fluid-attenuated inversion recovery . Spectroscopy, diffusion-weighted imaging and susceptibility-weighted imaging were also important for neuroradiological evaluation. Immunosuppressive drugs were taken in all cases. Partial clinical and radiological recovery was observed in two cases, and complete resolution was observed in the third patient. Literature review We found 52 cases of PRES in systemic lupus erythematosus patients. Almost all patients were women 94%, ranging from 8 to 62 years old. Posterior brain territory involvements were found in 98% of patients. Hemorrhagic complications involved 26% of patients, becoming a risk factor for clinical sequels. The total percentage of patients with no complete resolution of radiological findings on follow-up images was 27.5%. Discussion In patients with autoimmune disorders, endothelial dysfunction may occur secondary to autoimmunity and the use of cytotoxic drugs, supposedly facilitating the occurrence of more severe PRES. The hypothesis that patients with autoimmune diseases have a propensity to develop non-reversible lesions has been raised.
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Affiliation(s)
- TS Ferreira
- Department of Radiology, University of Campinas, Campinas, Brazil
| | - F Reis
- Department of Radiology, University of Campinas, Campinas, Brazil
| | - S Appenzeller
- Department of Clinics, University of Campinas, Campinas, Brazil
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Nasri A, Bedoui I, Mrissa R, Riahi A, Derbali H, Zaouali J, Messelmani M, Mansour M. Recurrent status epilepticus in posterior reversible encephalopathy syndrome as initial feature of pediatric lupus: A newly diagnosed case and literature review. Brain Dev 2016; 38:835-41. [PMID: 27068876 DOI: 10.1016/j.braindev.2016.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a recently described clinico-neuroradiological syndrome with several predisposing conditions. Systemic lupus erythematosus (SLE), beginning in 15-20% in childhood, is considered as a potential underlying etiology of PRES. In children, status epilepticus (SE) rarely complicates PRES, and exceptionally occurs in SLE. METHODS We report on an illustrative case of PRES complicating pediatric lupus revealed by recurrent SE, and we further review through a Pubmed search the previously reported cases of pediatric SLE, PRES and SE. RESULTS We describe the case of a 12-year old girl who presented with recurrent status epilepticus associated to high blood pressure and renal involvement. Brain imaging showed classical aspects of PRES. Immunological tests including antinuclear, anti-DNA, and anticardiolipin antibodies were positive. The diagnosis of SLE was established. The Pubmed search identified a total number of 9 children with SE in SLE, and 26 with PRES, including our patient. CONCLUSIONS We discussed the clinical and paraclinical features of PRES in SLE with epilepsy, their underlying pathophysiological aspects, and their management challenges. PRES should be considered in initial recurrent SE in children, justifying a battery of tests comprising immunological testing. Anticardiolipin antibodies seem to play a crucial role in epilepsy, PRES and renal involvement in pediatric SLE. Further studies are needed to clarify whether PRES should be considered one of the neuropsychiatric manifestations of SLE or a consequence of active disease in other organ systems or its treatment.
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Affiliation(s)
- Amina Nasri
- Department of Neurology, Military Hospital, Tunisia.
| | - Ines Bedoui
- Department of Neurology, Military Hospital, Tunisia
| | - Ridha Mrissa
- Department of Neurology, Military Hospital, Tunisia
| | - Anis Riahi
- Department of Neurology, Military Hospital, Tunisia
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Merayo-Chalico J, Apodaca E, Barrera-Vargas A, Alcocer-Varela J, Colunga-Pedraza I, González-Patiño A, Arauz A, Abud-Mendoza C, Martínez-Martínez M, Gómez-Martín D. Clinical outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a multicentric case-control study. J Neurol Neurosurg Psychiatry 2016; 87:287-94. [PMID: 25804426 DOI: 10.1136/jnnp-2014-310145] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/02/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a well-known but rare complication in patients (<1%) with systemic lupus erythematosus (SLE). However, current epidemiological data are quite scant. The aim of the present study was to describe potentially unrecognised risk factors. PATIENTS AND METHODS We performed a multicentre, retrospective case-control study in Mexico between 1999 and 2014. We included a total of 168 patients who accounted for 77 episodes of PRES, as follows: SLE/PRES, 43 patients with 48 episodes; SLE without PRES, 96 patients; and PRES without SLE, 29 patients. SLE diagnosis was considered when patients fulfilled ≥4 American College of Rheumatology criteria. PRES was defined by reversible neurological manifestations and MRI changes. RESULTS Patients with SLE/PRES were younger, presented with seizures as the most common manifestation (81%) and 18% had the typical occipital MRI finding. Hypertension (OR=16.3, 95% CI 4.03 to 65.8), renal dysfunction (OR=6.65, 95% CI 1.24 to 35.6), lymphopenia (OR=5.76, 95% CI 1.36 to 24.4), Systemic Lupus Erythematosus Activity Index ≥ 6 points (OR=1.11, 95% CI 1.01 to 1.22) and younger age (OR=0.86, 95% CI 0.81 to 0.91, p<0.001) were independent risk factors for development of PRES in SLE. Furthermore, dyslipidemia also characterised the association between PRES and SLE (OR=10.6, 95% CI 1.17 to 96.4). CONCLUSIONS This is the largest reported series of patients with SLE and PRES. We were able to corroborate the known risk factors for of PRES, and found two previously undescribed factors (lymphopenia and dyslipidemia), which suggests that endothelial dysfunction is a key element in PRES pathogenesis in lupus patients.
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Affiliation(s)
- Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elia Apodaca
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge Alcocer-Varela
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Iris Colunga-Pedraza
- Department of Rheumatology, Hospital Universitario Dr José E González, Monterrey, Nuevo León, Mexico
| | - Alejandra González-Patiño
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Carlos Abud-Mendoza
- Regional Unit of Rheumatology and Osteoporosis, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, Mexico
| | - Marco Martínez-Martínez
- Regional Unit of Rheumatology and Osteoporosis, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, Mexico
| | - Diana Gómez-Martín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Budhoo A, Mody GM. The spectrum of posterior reversible encephalopathy in systemic lupus erythematosus. Clin Rheumatol 2015; 34:2127-34. [PMID: 26298534 DOI: 10.1007/s10067-015-3055-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022]
Abstract
Our aim was to compare our South African cohort of systemic lupus erythematosus (SLE) and posterior reversible encephalopathy syndrome (PRES) with other published series. We reviewed the records of 10 patients with SLE and PRES seen over a 10-year period and their demographic data, clinical manifestations, laboratory tests, imaging findings, and outcome were recorded. We identified 10 females who included six Indians, three mixed ethnicity, and one African Black. Three patients had PRES at the onset of SLE. The most common manifestations at presentation were seizures (100 %), hypertension (80 %), and altered mental state (50 %). On neuroimaging, nine patients had bilateral involvement, and the occipital (90 %), parietal (90 %), and frontal lobes (50 %) were most commonly involved. The risk factors for PRES were disease activity (90 %), renal disease (80 %) and hypertension (80 %). Ninety percent of the patients were on immunosuppressive therapy. Immunosuppressive therapy was increased in six patients (60 %), continued in two and reduced in two patients after the diagnosis of PRES. Seven patients recovered completely and three patients died from co-morbidities. A review of the larger case series of SLE and PRES showed that the presentation and neuroimaging findings were similar; most patients had active disease at the time of PRES and the majority of patients required intensification of immunosuppressive therapy. We have shown that the majority of patients with SLE have active disease at the time of PRES, and they require an increase in their immunosuppressive therapy.
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Affiliation(s)
- Amritha Budhoo
- Department of Rheumatology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Girish M Mody
- Department of Rheumatology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
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Abstract
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital - University of Connecticut, Hartford CT, USA
| | - Jodi Speiser
- Section of Dermatopathology, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Posterior reversible encephalopathy syndrome in a patient with systemic lupus erythematosus/systemic sclerosis overlap syndrome. Case Rep Rheumatol 2014; 2014:862570. [PMID: 25506024 PMCID: PMC4258344 DOI: 10.1155/2014/862570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/10/2014] [Indexed: 11/22/2022] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinicoradiologic entity associated with diverse medical conditions. It is very important to properly recognize this condition because early diagnosis and treatment usually result in its complete resolution, whereas a delay in giving an adequate therapy may lead to permanent neurologic sequelae. A case of posterior reversible encephalopathy syndrome in a female patient with an overlap syndrome of systemic lupus erythematosus and systemic sclerosis is presented here.
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Akins PT, Axelrod Y, Silverthorn JW, Guppy K, Banerjee A, Hawk MW. Management and outcomes of malignant posterior reversible encephalopathy syndrome. Clin Neurol Neurosurg 2014; 125:52-7. [DOI: 10.1016/j.clineuro.2014.06.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/05/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
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Lai CC, Chen WS, Chang YS, Wang SH, Huang CJ, Guo WY, Yang WC, Huang DF. Clinical Features and Outcomes of Posterior Reversible Encephalopathy Syndrome in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2013; 65:1766-74. [DOI: 10.1002/acr.22047] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/25/2013] [Accepted: 05/01/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Chien-Chih Lai
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Wei-Sheng Chen
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Yu-Sheng Chang
- Shuang Ho Hospital, Taipei Medical University, New Taipei City, and National Yang-Ming University; Taipei Taiwan
| | - Shu-Hung Wang
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Chun-Jui Huang
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Wan-Yuo Guo
- Taipei Veterans General Hospital; Taipei Taiwan
| | | | - De-Feng Huang
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
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Jung SM, Moon SJ, Kwok SK, Ju JH, Park KS, Park SH, Kim HY. Posterior reversible encephalopathy syndrome in Korean patients with systemic lupus erythematosus: risk factors and clinical outcome. Lupus 2013; 22:885-91. [DOI: 10.1177/0961203313496341] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurologic condition associated with systemic lupus erythematosus (SLE). This study aimed to demonstrate the risk factors and clinical outcome of PRES in patients with SLE. Fifteen patients with SLE were diagnosed with PRES by characteristic clinical manifestations and magnetic resonance imaging (MRI) features from 2000 to 2012. Clinical profiles and outcomes were assessed for this study population. Additionally, 48 SLE patients with neurologic symptoms who underwent brain MRI were included for comparative analyses. The median age and duration of SLE in patients with PRES was 27 and 6.1 years, respectively. Comparison between patients with and without PRES revealed significant differences in the presentation of hypertension and seizure, lupus nephritis with renal insufficiency, treatment with high-dose steroid and cyclophosphamide, recent transfusion, and lupus activity measured by SLE disease activity index. Renal failure was the single independent factor with a high odds ratio of 129.250 by multivariate analysis. Of 15 patients, four experienced relapse and two died of sepsis during hospitalization. Our results suggest that lupus nephritis with renal dysfunction and other related clinical conditions can precede the occurrence of PRES in patients with SLE. It is important to perform early brain imaging for a timely diagnosis of PRES when clinically suspected.
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Affiliation(s)
- SM Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - S-J Moon
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - S-K Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - JH Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - K-S Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - S-H Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - H-Y Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, South Korea
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Li Q, Lv F, Wei Y, Yan B, Xie P. Posterior reversible encephalopathy syndrome in a patient with systemic lupus erythematosus after cessation of oral prednisone. Neurol Sci 2013; 34:2241-2. [PMID: 23780667 DOI: 10.1007/s10072-013-1479-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Qi Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Garg N, Woltjer R, Hamilton B, Neuwelt EA, Rosenbaum JT. A 67-Year-Old Woman Receiving Tumor Necrosis Factor α Inhibitor Therapy Presenting With Neurologic Dysfunction. Arthritis Care Res (Hoboken) 2013. [DOI: 10.1002/acr.21882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Shaharir SS, Remli R, Marwan AA, Said MSM, Kong NCT. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: pooled analysis of the literature reviews and report of six new cases. Lupus 2013; 22:492-6. [DOI: 10.1177/0961203313478303] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder which is increasingly recognized to occur in systemic lupus erythematosus (SLE). Objective The purpose of this study was to identify the characteristics of SLE patients with PRES and the associated factors of the poor outcome among them. Methods We investigated SLE patients who developed PRES between 2005–2011 at the Universiti Kebangsaan Malaysia Medical Centre. A comprehensive literature search was done to find all published cases of PRES in SLE. Pooled analysis was conducted to identify the factors associated with poor outcome. Results There were 103 cases of PRES in SLE published in the literature but only 87 cases were included in the analysis in view of incomplete individual data in the remaining cases. The majority of the cases were Asians (74.2%), female (95.4%) with mean age of 26.3 ± 8.8 years. PRES was highly associated with active disease (97.5%), hypertension (91.7%) and renal involvement (85.1%). We found that 79 patients had a full recovery (90.8%) with a mean onset of full clinical recovery in 5.6 ± 4.1 days. On univariate analysis and logistic regression analysis the predictors of poor outcome, defined as incomplete clinical recovery or death, were intracranial hemorrhage, odds ratio (OR) 14 (1.1–187.2), p = 0.04 and brainstem involvement in PRES, OR 10.9 (1.3–90.6), p = 0.003. Conclusion Intracranial hemorrhage and brainstem involvement were the two important predictors of poor outcome of PRES. Larger prospective studies are needed to further delineate the risk of poor outcome among them.
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Affiliation(s)
- SS Shaharir
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - R Remli
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - AA Marwan
- Department of Internal Medicine, Universiti Sains Islam Malaysia, Malaysia
| | - MSM Said
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - NCT Kong
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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Lee CH, Lee YM, Ahn SH, Ryu DW, Song JH, Lee MS. Cyclophosphamide-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Lupus Nephritis. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.2.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Chang-Hoon Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yu Min Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Seon Ho Ahn
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Dae Woong Ryu
- Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Ju Hung Song
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Myeung-Su Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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Blimp-1 siRNA inhibits B cell differentiation and prevents the development of lupus in mice. Hum Immunol 2012; 74:297-301. [PMID: 23220434 DOI: 10.1016/j.humimm.2012.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/14/2012] [Accepted: 11/27/2012] [Indexed: 01/05/2023]
Abstract
Cumulative evidence suggest that B-lymphocytes play a role in the development of systemic lupus erythematosus (SLE). Thus, the therapeutic approach targeting specific B cells provides a promising way to treat SLE. Blimp-1 (B lymphocyte induced maturation protein), a transcriptional factor, controls the terminal differentiation of mature B cells to plasma cells. To explore the potential of Blimp-1 in the SLE development, we constructed the adenovirus encoding Blimp-1 siRNA, and injected it into BWF1 lupus mice. The results demonstrated that Blimp-1 siRNA decreased the Blimp-1 expression of B cells by regulating XBP-1 (X Box binding protein-1), BCMA (B-cell maturation antigen) expression through c-myc pathway. In addition, Blimp-1 siRNA eliminated anti-dsDNA antibody-producing plsma cells, reduced serum anti-dsDNA antibody levels and impeded the development of lupus. Therefore, our data provide the insight into the mechanism of Blimp-1 in SLE development and might represent a promising therapeutic strategy for autoantibody-mediated diseases.
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Liu B, Zhang X, Zhang FC, Yao Y, Zhou RZ, Xin MM, Wang LQ. Posterior reversible encephalopathy syndrome could be an underestimated variant of "reversible neurological deficits" in Systemic Lupus Erythematosus. BMC Neurol 2012; 12:152. [PMID: 23217201 PMCID: PMC3545963 DOI: 10.1186/1471-2377-12-152] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 11/19/2012] [Indexed: 12/03/2022] Open
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) has been increasingly identified in patients with systemic lupus erythematosus (SLE) owing to the advance in neuroimaging techniques. Prompt diagnosis is pivotal to improve its outcome. To analyze the clinical and radiographic profile of PRES in patients with SLE and search for the appropriate treatment strategy PRES in SLE. Methods SLE patients who fulfilled the diagnostic criteria for PRES from August 2008 to January 2011 were evaluated at baseline, and followed to determine clinical outcomes. Data were analysis on clinical characteristics, laboratory abnormalities, treatment details, and outcomes. Results Ten episodes of PRES in patients with SLE were identified. All patients were female, mean age of onset was 22.93 ± 2.48 years, and SLEDAI at the onset of PRES were 25.8 ± 5.7. All cases had acute onset of headache, altered mental status, stupor, vomiting, cortical blindness and seizures. Neurological symptoms were the initial manifestation of SLE in three cases. Head magnetic resonance imaging (MRI) demonstrated posterior white matter edema involving the parietal, temporal and occipital lobes, which were more conspicuous on T2 weighted spin echo and diffusion-weighted MR imaging (DWI) than on computed tomography (CT) scan. Complete clinical and radiographic recovery was observed in 8 patients after prompt treatment with corticosteroids. Conclusions PRES might be due to lupus per se besides other traditional causative factors such as hypertension. PRES might be an underestimated variant of “reversible neurological deficits” in SLE. Prompt recognition and timely management is important to prevent permanent neurological deficits.
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Affiliation(s)
- Bin Liu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
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Lefèvre G, Zéphir H, Warembourg F, Michelin E, Pruvo JP, Hachulla E, Semah F, Dubucquoi S, Lenfant P, Vermersch P, Hatron PY, Prin L, Launay D. [Neuropsychiatric systemic lupus erythematosus (1st part). Cases definitions and diagnosis and treatment of central nervous system and psychiatric manifestations of systemic lupus erythematosus]. Rev Med Interne 2012; 33:491-502. [PMID: 22579860 DOI: 10.1016/j.revmed.2012.03.356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 01/02/2012] [Accepted: 03/31/2012] [Indexed: 11/29/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease, which primarily affects skin and joints. Peripheral neurologic syndrome and central nervous system (CNS) manifestations are common in lupus patients but are not always attributable to lupus itself. A classification, published in 1999 by the American College of Rheumatology (ACR) research committee, described 12 CNS syndromes and seven peripheral neurologic syndromes compatible with "neuropsychiatric systemic lupus erythematosus" (NPSLE). Despite this consensus, studies which have been published since 1999 have reported a prevalence of NPSLE varying from 20 to 97 %, which shows the diagnosis difficulty and the heterogeneity of neuropsychiatric manifestations in SLE. In order to understand the limits of this classification, we propose in this first part an exhaustive review of publications describing neuropsychiatric manifestations according to the ACR 1999 classification. We also detail case definitions, prevalence and risk factors, clinical characteristics and diagnosis of each lupus-related psychiatric and CNS manifestation.
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Affiliation(s)
- G Lefèvre
- Service de médecine interne, université de Lille Nord-de-France, centre de référence maladies auto-immunes rares (sclérodermie), hôpital Claude-Huriez, CHRU de Lille, 1, rue Michel-Polonovski, 59037 Lille, France; EA2686, Institut d'immunologie, université Lille Nord-de-France, faculté de médecine H.-Warembourg, 59037 Lille, France
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Bhavsar SV, White CM, Fifi-Mah A. A fulminant neurologic presentation of systemic lupus erythematosus. Int J Rheum Dis 2012; 15:e34-6. [PMID: 22462433 DOI: 10.1111/j.1756-185x.2011.01663.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ogunneye O, Hernandez-Montfort JA, Ogunneye Y, Ogu I, Landry D. Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: a case report. J Med Case Rep 2012; 6:89. [PMID: 22448715 PMCID: PMC3319422 DOI: 10.1186/1752-1947-6-89] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/26/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Posterior reversible encephalopathy syndrome is a clinical and radiological entity. The most accepted theory of posterior reversible encephalopathy syndrome is a loss of autoregulation in cerebral blood flow with a subsequent increase in vascular permeability and leakage of blood plasma and erythrocytes, producing vasogenic edema. In infection-associated posterior reversible encephalopathy syndrome, a clinical pattern consistent with systemic inflammatory response syndrome develops. Parainfluenza virus has not been reported in the medical literature to be associated with posterior reversible encephalopathy syndrome. Case presentation We report herein the case of a 54-year-old Caucasian woman with posterior reversible encephalopathy syndrome associated with parainfluenza virus infection who presented with generalized headache, blurring of vision, new-onset seizure and flu-like symptoms. Conclusion Infection-associated posterior reversible encephalopathy syndrome as well as hypertension-associated posterior reversible encephalopathy syndrome favor the contribution of endothelial dysfunction to the pathophysiology of this clinicoradiological syndrome. In view of the reversible nature of this clinical entity, it is important that all physicians are well aware of posterior reversible encephalopathy syndrome in patients presenting with headache and seizure activity. A detailed clinical assessment leading to the recognition of precipitant factors in posterior reversible encephalopathy syndrome is paramount.
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Affiliation(s)
- Owolabi Ogunneye
- Department of Medicine, Baystate Medical Center, Tufts University School Of Medicine, 759 Chestnut Street, Springfield, MA 01199, USA.
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Cellucci T, Benseler SM. Posterior reversible encephalopathy syndrome: increasing recognition of an important clinical entity in young patients with systemic lupus erythematosus. J Rheumatol 2012; 38:1544-5. [PMID: 21807785 DOI: 10.3899/jrheum.110774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Maur M, Tomasello C, Frassoldati A, Dieci MV, Barbieri E, Conte P. Posterior Reversible Encephalopathy Syndrome During Ipilimumab Therapy for Malignant Melanoma. J Clin Oncol 2012; 30:e76-8. [DOI: 10.1200/jco.2011.38.7886] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Barber CE, Leclerc R, Gladman DD, Urowitz MB, Fortin PR. Posterior Reversible Encephalopathy Syndrome: An Emerging Disease Manifestation in Systemic Lupus Erythematosus. Semin Arthritis Rheum 2011; 41:353-63. [DOI: 10.1016/j.semarthrit.2011.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/08/2011] [Accepted: 07/09/2011] [Indexed: 10/17/2022]
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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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Aszalós Z. [Neurological and psychiatric manifestations of systemic lupus erythematosus and antiphospholipid syndrome]. Orv Hetil 2011; 152:597-605. [PMID: 21436024 DOI: 10.1556/oh.2011.29087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neurological or psychiatric symptoms are present in 60% of the cases with systemic lupus erythematosus. Direct lesions of nervous system are associated with the presence of antibodies, vasculitis, thrombosis and impairments mediated by cytokines. Damages caused by injuries of other organs or those due to therapy are known as indirect causes. In the complex pathogenesis the primary cause is neuronal dysfunction mediated by autoantibodies, vasculopathia and coagulopathia. Until now, more than 20 antibodies have been identified in association with damages of the nervous system. These antibodies may impair neurons or astrocytes and may promote thrombotic processes in vessels of the brain. Activation of endothelial cells and disturbance of blood-brain barrier are also pathogenic factors. In patients with systemic lupus erythematosus the most frequent psychiatric manifestations are organic psychosyndrome, particularly deterioration of cognitive functions, and depression, while the most common neurological syndromes are epilepsy and ischemic stroke. In the pathogenesis of antiphospholipid syndrome β2-glycoprotein I plays the most important role; binding to its antibody the complex may interact with cells and modify haemostatic actions. The most frequent neurological manifestations of antiphospholipid syndrome are headache and ischemic stroke.
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Affiliation(s)
- Zsuzsa Aszalós
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088.
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Marrone LCP, Marrone BF, de la Puerta Raya J, Gadonski G, da Costa JC. Gemcitabine monotherapy associated with posterior reversible encephalopathy syndrome. Case Rep Oncol 2011; 4:82-7. [PMID: 21475595 PMCID: PMC3072184 DOI: 10.1159/000324581] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinicoradiologic entity that may present with headaches, altered mental status, seizures and visual loss as well as specific neuroimaging findings. We report a case of a 74-year-old woman receiving adjuvant gemcitabine chemotherapy as monotherapy for a stage IIa pancreatic adenocarcinoma, who developed posterior reversible encephalopathy syndrome.
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Des pathologies encéphaliques à connaître — Syndrome d’encéphalopathie postérieure réversible. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0116-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Understanding Posterior Reversible Encephalopathy Syndrome. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2011 2011. [DOI: 10.1007/978-3-642-18081-1_56] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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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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Muscal E, Traipe E, de Guzman MM, Myones BL, Brey RL, Hunter JV. MR imaging findings suggestive of posterior reversible encephalopathy syndrome in adolescents with systemic lupus erythematosus. Pediatr Radiol 2010; 40:1241-5. [PMID: 20119723 DOI: 10.1007/s00247-009-1540-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/04/2009] [Accepted: 12/24/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endothelial damage, hypertension and cytotoxic medications may serve as risk factors for the posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus. There have been few case reports of these findings in pediatric lupus patients. OBJECTIVE We describe clinical and neuroimaging findings in children and adolescents with lupus and a PRES diagnosis. MATERIALS AND METHODS We identified all clinically acquired brain MRIs of lupus patients at a tertiary care pediatric hospital (2002-2008). We reviewed clinical features, conventional MRI and diffusion-weighted imaging (DWI) findings of patients with gray- and white-matter changes suggestive of vasogenic edema and PRES. RESULTS Six pediatric lupus patients presenting with seizures and altered mental status had MRI findings suggestive of PRES. In five children clinical and imaging changes were seen in conjunction with hypertension and active renal disease. MRI abnormalities were diffuse and involved frontal regions in five children. DWI changes reflected increased apparent diffusivity coefficient (unrestricted diffusion in all patients). Clinical and imaging changes significantly improved with antihypertensive and fluid management. CONCLUSION MRI changes suggestive of vasogenic edema and PRES may be seen in children with active lupus and hypertension. The differential diagnosis of seizures and altered mental status should include PRES in children, as it does in adults.
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Affiliation(s)
- Eyal Muscal
- Baylor College of Medicine and Pediatric Rheumatology Center, Texas Children's Hospital, 6621 Fannin St., MC 3-2290, Houston, TX 77030, 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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Dahlgren M, Khosroshahi A, Stone JH. A 22-year-old woman with severe headaches, vomiting, and tonic-clonic seizures. Arthritis Care Res (Hoboken) 2010; 63:165-71. [PMID: 20506341 DOI: 10.1002/acr.20249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 04/29/2010] [Indexed: 11/10/2022]
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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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