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Shiraishi W. Blood transfusion-induced posterior reversible encephalopathy syndrome presenting severe brain atrophy: A report of two cases. Clin Case Rep 2022; 10:e05286. [PMID: 35035968 PMCID: PMC8752457 DOI: 10.1002/ccr3.5286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/09/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
Several cases of posterior reversible encephalopathy syndrome (PRES) after blood transfusion have been reported, but the long-term prognosis is unknown. Here, we report two cases of blood transfusion-associated PRES with severe brain atrophy at 1 year after onset. We report the case with a discussion of pathological mechanisms.
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Affiliation(s)
- Wataru Shiraishi
- Department of NeurologyKokura Memorial HospitalKitakyushu CityJapan
- Shiraishi Internal Medicine ClinicNogata CityJapan
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Gurumukhani JK, Patel HD, Patel DM, Patel MV, Patel MM, Mahuwala ZK, Desai J. Posterior Reversible Encephalopathy Syndrome Following Blood Transfusion: A Rare Case Report with Literature Review. Open Neurol J 2021. [DOI: 10.2174/1874205x02115010031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background:
Posterior reversible encephalopathy syndrome (PRES) is clinicoradiological disease entity characterized by headache, seizures, altered sensorium and corticalvisual loss with characteristic MRI features of subcortical white matter hyperintensities on T2W imaging. Though hypertension is a traditional hallmark of PRES, uncommon causes without hypertension have been described. We report an unusual such case without hypertension, precipitated by red cell transfusion.
Case Presentation:
A 40 years female received six units of packed cell transfusion for severe anemia (Hemoglobin 3.0 Gm %) transfused over 8 hours. She was having menorrhagia and was operated on for a hysterectomy. She developed a headache on the second postoperative day for five days and no cause was revealed in spite of extensive workup, including MRI brain and CSF study. On the sixth day, she had recurrent seizures followed by altered sensorium in the absence of hypertension. Her repeat MRI brain findings were consistent with PRES.
Conclusion:
We reviewed 25 cases, including the present one as PRES after the blood transfusion. 24 were females, and 16 of 19 developed PRES in the course of chronic anemia lasting over 1 month. Anemia was severe in 18 of 25 cases, with haemoglobin (Hb) levels < 4.0 Gm%. In 16 of 20 cases, Hb levels increased to 5 g/dl by red cell blood transfusion until the onset of PRES. On MRI brain, 23 of 25 cases showed vasogenic edema and 3 of 25 cases showed an irreversible neurological deficit. When treating severe chronic anemia rapid correction of Hb with blood transfusion, one should consider a possibility of PRES in post-transfusion neurological symptoms in spite of normal diagnostic workup.
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Dube M, Rathore R. Blood-transfusion-related posterior reversible encephalopathy syndrome - A description of a new case and review of the literature. Brain Circ 2021; 6:269-273. [PMID: 33506150 PMCID: PMC7821805 DOI: 10.4103/bc.bc_9_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome associated with headache, altered mental status, seizures, and visual disturbances and characterized by white matter vasogenic edema affecting predominantly the posterior occipital and parietal lobes of the brain. Neurological complications of blood transfusion are uncommon, and blood-transfusion-related PRES is seldom reported. We report here one such case of PRES. A 61-year-old Asian woman with chronic anemia presented with a history of fall, causing fracture of the left femur neck. As her hemoglobin was 5 g per deciliter, she was transfused with four units of packed cells in three consecutive days. At the time of admission, she was alert, normotensive, and afebrile. Later, she developed mild headache and had a generalized tonic-clonic seizure. Her brain magnetic resonance (MR) imaging showed edema in bilateral frontal lobes and parieto-occipital lobes with normal MR venogram, consistent with PRES. We described her disorder as blood-transfusion-related PRES. Immunologic, as well as non-immunologic complications of blood transfusion, are known but, PRES is rare. Cumulative effects of blood transfusion on blood flow, blood viscosity, endothelial dysfunction leads to blood-brain barrier dysfunction, which culminates into vasogenic edema and vasoconstriction despite normal systemic blood pressure, leading to blood-transfusion-related PRES.
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Affiliation(s)
- Mukesh Dube
- Department of Medicine, Rajshree Medical Research Institute and Hospital Bareilly, Bareilly, Uttar Pradesh, India
| | - Rashi Rathore
- Department of Radiology, Clara Swain Mission Hospital JV, Bareilly, Uttar Pradesh, India
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Mitaka H, Seijo L, Motohashi K, Nakai M, Burger A. Posterior reversible encephalopathy syndrome induced by red blood cell transfusion. QJM 2019; 112:617-618. [PMID: 31127941 DOI: 10.1093/qjmed/hcz126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Mitaka
- From the Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine, First Avenue and 16th Street, Baird Hall 20th Floor, New York, NY, USA
| | - L Seijo
- From the Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine, First Avenue and 16th Street, Baird Hall 20th Floor, New York, NY, USA
| | - K Motohashi
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima, Tokyo, Japan
| | - M Nakai
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima, Tokyo, Japan
| | - A Burger
- From the Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine, First Avenue and 16th Street, Baird Hall 20th Floor, New York, NY, USA
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Lai HC, Wu TS, Liu YT, Wu ZF, Tseng WC. Use of bispectral index monitoring to predict the outcome of patients with posterior reversible encephalopathy syndrome: Two case reports. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/jmedsci.jmedsci_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nakamura Y, Sugino M, Tsukahara A, Nakazawa H, Yamamoto N, Arawaka S. Posterior reversible encephalopathy syndrome with extensive cytotoxic edema after blood transfusion: a case report and literature review. BMC Neurol 2018; 18:190. [PMID: 30419835 PMCID: PMC6231260 DOI: 10.1186/s12883-018-1194-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 10/31/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is described as a clinical-radiological disease entity with good prognosis. In brain MRI, PRES generally presents with vasogenic edema. Although PRES is induced by various causes, a small number of PRES cases have occurred after red cell blood transfusion. It is unclear whether there are characteristic features in PRES after blood transfusion. CASE PRESENTATION Here, we report a case of 75-year-old Japanese woman who had acute exacerbation of subacute anemia by bleeding from gastric ulcer. After receiving a red cell blood transfusion, she showed disturbance of consciousness with extensive cytotoxic and small vasogenic edema in the occipitoparietal area on brain MRI. She was diagnosed as PRES and suffered irreversible impairments of visual acuity and fields in both eyes. We summarized and discussed clinical features of cases with PRES after blood transfusion. CONCLUSIONS A total of 21 cases including the present one have been reported as PRES after blood transfusion. Of the cases, 20 of 21 were female, and 15 of 17 developed PRES in the course of chronic anemia lasting over 1 month. Anemia was severe in 15 of 20 cases, with hemoglobin levels < 3.5 g/dl. In 14 of 17 cases, hemoglobin levels increased to 5 g/dl by red cell blood transfusion until the onset of PRES. On brain MRI, 2 of 21 cases showed cytotoxic edema and 3 of 21 cases showed irreversible neurological disturbance. In this patient, the occurrence of PRES in subacute anemia and the presence of extensive cytotoxic brain edema with irreversible neurological deficits were characteristic points. When treating severe anemia, even with a subacute progression, we should consider a possibility that PRES occurs after blood transfusion with extensive cytotoxic brain edema and irreversible neurological changes.
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Affiliation(s)
- Yoshitsugu Nakamura
- Division of Neurology, Aino Hospital, 11-18 Takadacho, Osaka, Ibaraki, 567-0011, Japan. .,Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Masakazu Sugino
- Division of Neurology, Aino Hospital, 11-18 Takadacho, Osaka, Ibaraki, 567-0011, Japan.,Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Akihiro Tsukahara
- Division of Neurology, Aino Hospital, 11-18 Takadacho, Osaka, Ibaraki, 567-0011, Japan.,Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiroko Nakazawa
- Division of Internal Medicine, Aino Hospital, 11-18 Takadacho, Osaka, Ibaraki, 567-0011, Japan
| | - Naomune Yamamoto
- Division of Internal Medicine, Aino Hospital, 11-18 Takadacho, Osaka, Ibaraki, 567-0011, Japan
| | - Shigeki Arawaka
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
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Ma X, Su W, Chen H. Reversible splenial lesion syndrome after blood transfusion presents callosal disconnection syndrome: A case report. Medicine (Baltimore) 2018; 97:e11127. [PMID: 29901639 PMCID: PMC6023686 DOI: 10.1097/md.0000000000011127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Reversible splenial lesion syndrome (RESLES) is a reversible condition with an excellent prognosis in most patients. The clinical features include altered states of consciousness, delirium, headache, and seizures, but no callosal disconnection syndromes have been described in RESLES. PATIENT CONCERNS We presented a 57-year-old patient with alien hand syndrome, autotopagnosia, gait disorders, and left ideomotor apraxia after blood transfusion. The brain magnetic resonance imaging (MRI) showed a few regions with high signal intensity in the genu, body, and splenium of the right corpus callosum on diffusion weighted images. Cerebrovascular examination was unremarkable. DIAGNOSES He was diagnosed with RESLES and callosal disconnection syndrome. INTERVENTIONS The patient received symptomatic and supportive treatment in our hospital. OUTCOMES He recovered to baseline on following up of 6 months and abnormalities on brain MRI completely disappeared. LESSONS Neurologists should be aware of the symptoms of callosal disconnection syndrome in RESLES. In addition, caution should be taken when transfusing blood products in patients with gastrointestinal bleeding.
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