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Lin J, Chen W, Zhong S, Qian K, Chen H, Lin L. Posterior reversible encephalopathy syndrome associated with use of anlotinib to treat squamous cell carcinoma of the cervix: case report and literature review. Front Pharmacol 2023; 14:1255785. [PMID: 38169843 PMCID: PMC10758437 DOI: 10.3389/fphar.2023.1255785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Background: Posterior reversible encephalopathy syndrome (PRES), a neurological disorder with an unknown aetiology, is characterised by visual impairment, headache, vomiting, seizures, and transient alterations in consciousness. Case report: We present the case of a 49-year-old woman with advanced cervical carcinoma who received second-line therapy with oral anlotinib (12 mg, days 1-14, every 21 days) and injectable tislelizumab (200 mg, day 1, every 21 days). After 7 days of anlotinib administration, she began experiencing symptoms suggestive of PRES and was diagnosed on day 11. Interruption of anlotinib and supportive treatment led to recovery of her binocular vision. The Naranjo score (+5) graded the causality of this reaction as probable, suggesting the possibility that the event may have been an adverse reaction to anlotinib. Ethics: This case report was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Reference no. K-2023-068, 2023/06/09). Informed consent was obtained from the patient and her family.
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Affiliation(s)
- Jietao Lin
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
- Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
| | - Wenmin Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Sha Zhong
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Kai Qian
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
| | - Hanrui Chen
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
| | - Lizhu Lin
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guagnzhou, Guangdong, China
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De Stefano P, Ménétré E, Stancu P, Mégevand P, Vargas MI, Kleinschmidt A, Vulliémoz S, Wiest R, Beniczky S, Picard F, Seeck M. Added value of advanced workup after the first seizure: A 7-year cohort study. Epilepsia 2023; 64:3246-3256. [PMID: 37699424 DOI: 10.1111/epi.17771] [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: 04/19/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE This study was undertaken to establish whether advanced workup including long-term electroencephalography (LT-EEG) and brain magnetic resonance imaging (MRI) provides an additional yield for the diagnosis of new onset epilepsy (NOE) in patients presenting with a first seizure event (FSE). METHODS In this population-based study, all adult (≥16 years) patients presenting with FSE in the emergency department (ED) between March 1, 2010 and March 1, 2017 were assessed. Patients with obvious nonepileptic or acute symptomatic seizures were excluded. Routine EEG, LT-EEG, brain computed tomography (CT), and brain MRI were performed as part of the initial workup. These examinations' sensitivity and specificity were calculated on the basis of the final diagnosis after 2 years, along with the added value of advanced workup (MRI and LT-EEG) over routine workup (routine EEG and CT). RESULTS Of the 1010 patients presenting with FSE in the ED, a definite diagnosis of NOE was obtained for 501 patients (49.6%). Sensitivity of LT-EEG was higher than that of routine EEG (54.39% vs. 25.5%, p < .001). Similarly, sensitivity of MRI was higher than that of CT (67.98% vs. 54.72%, p = .009). Brain MRI showed epileptogenic lesions in an additional 32% compared to brain CT. If only MRI and LT-EEG were considered, five would have been incorrectly diagnosed as nonepileptic (5/100, 5%) compared to patients with routine EEG and MRI (25/100, 25%, p = .0001). In patients with all four examinations, advanced workup provided an overall additional yield of 50% compared to routine workup. SIGNIFICANCE Our results demonstrate the remarkable added value of the advanced workup launched already in the ED for the diagnosis of NOE versus nonepileptic causes of seizure mimickers. Our findings suggest the benefit of first-seizure tracks or even units with overnight EEG, similar to stroke units, activated upon admission in the ED.
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Affiliation(s)
- Pia De Stefano
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Eric Ménétré
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Stancu
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Andreas Kleinschmidt
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Vulliémoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Berne, Bern, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus and Danish Epilepsy Center, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fabienne Picard
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
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Mankoo D. Anton syndrome with bilateral occipital infarct: A case report. Radiol Case Rep 2023; 18:4461-4464. [PMID: 37860783 PMCID: PMC10582287 DOI: 10.1016/j.radcr.2023.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023] Open
Abstract
Anton syndrome results from damage to the visual cortex of the occipital lobes, where the anterior visual pathways remain intact. This damage results in the characteristic triad of cortical blindness, visual anosognosia, and visual confabulation. This case describes an 80-year-old male with a background of renal transplant 7 years prior, admitted to hospital with worsening transplant function, and soon after developed sudden onset cortical blindness. On examination, the patient was found to be in denial of his blindness and showed signs of visual confabulation, both of which pointed toward a diagnosis of Anton syndrome. Radiological investigation with computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral ischemic stroke of the occipital lobes, which was later theorized to have occurred due to sirolimus-induced thrombotic microangiopathy (TMA). To the author's knowledge, this is the first case report of sirolimus-induced TMA, bilateral ischemic occipital lobe stroke, and Anton's syndrome, within the same diagnosis. This case highlights that a diagnosis of bilateral occipital stroke with denial of blindness should suggest a diagnosis of Anton syndrome. This report also discusses the importance of differentiating bilateral occipital infarction on CT imaging, from posterior reversible encephalopathy syndrome (PRES), using MRI.
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Affiliation(s)
- Dylan Mankoo
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Colney, Norwich, United Kingdom, NR4 7UY
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4
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Deng T, Zhang X, Peng X, Peng H, He L, Hu Y. Clinical features and prognostic analysis of posterior reversible encephalopathy syndrome in children. Int J Dev Neurosci 2022; 82:349-360. [PMID: 35373858 DOI: 10.1002/jdn.10184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/05/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to investigate the clinical features and prognosis of posterior reversible encephalopathy syndrome (PRES) in children. METHODS Clinical data of children with PRES diagnosed at the Children's Hospital of Chongqing Medical University from June 2015 to May 2019 were retrospectively analyzed. RESULTS The study enrolled 47 patients with a mean age at diagnosis of 8.79 ± 3.72 years (range, 2-15 years). PRES causes included renal disorder (29/47), hematological disease (13/47), and hypertension (5/47). PRES manifested as seizure (43/47), headache (28/47), visual impairment (18/47), dizziness (18/47), vomiting (18/47), and mental and behavioral abnormalities (17/47). Forty-six children had hypertension (46/47) at PRES onset. Magnetic resonance imaging (MRI) mainly involved the parietal and occipital lobes (42/47), 38 cases were mild (38/47), 7 were moderate (7/47), and 2 were severe (2/47). The clinical symptoms of 41 patients (41/47) were relieved within 1-2 weeks. Thirty-seven children were followed up for 7-54 months (modified Rankin Scale). Twenty-five children had favorable outcomes (25/37). Twelve children had adverse outcomes (12/37), including epilepsy, disorders of consciousness, visual impairment, and mental decline. Analysis of single factors revealed that severity on MRI, length of in-hospital stay, and mental and behavioral abnormalities were related to adverse outcomes after PRES. Analysis of multiple factors revealed that severity on MRI and length of in-hospital stay were independent risk factors for PRES. CONCLUSION Pediatric PRES is a clinical radiographic syndrome with multiple etiologies. Most patients have a good prognosis. Severity on MRI and length of in-hospital stay are independent risk factors.
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Affiliation(s)
- Ting Deng
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China.,Xi'an Children's Hospital, China
| | - Xinyu Zhang
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China
| | - Xiaoling Peng
- Division of Science and Technology, Beijing Normal University-Hongkong Baptist University United International College, China
| | - Hailun Peng
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China.,Department of Radiology, Children's Hospital of Chongqing Medical University, China
| | - Ling He
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China.,Department of Radiology, Children's Hospital of Chongqing Medical University, China
| | - Yue Hu
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China
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Postpartum headache – diagnosis and treatment. BJA Educ 2022; 22:176-181. [PMID: 35496646 PMCID: PMC9039472 DOI: 10.1016/j.bjae.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
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Alshami A, Al-Bayati A, Douedi S, Hossain MA, Patel S, Asif A. Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study. BMC Neurol 2021; 21:107. [PMID: 33750332 PMCID: PMC7941613 DOI: 10.1186/s12883-021-02143-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus. Methods We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition. Results A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality. Conclusion PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.
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Affiliation(s)
- Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Asseel Al-Bayati
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA.
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
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Bhat V, Rao SS, Balakrishnan C. Posterior Reversible Encephalopathy Syndrome in Thrombotic Thrombocytopenic Purpura. Ann Indian Acad Neurol 2020; 23:555-557. [PMID: 33223681 PMCID: PMC7657295 DOI: 10.4103/aian.aian_59_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek Bhat
- Department of General Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Sanjukta S Rao
- Department of General Medicine, St. John's Medical College, Bangalore, Karnataka, India
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8
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Bogdanov EI, Khasanov IA. [Posterior reversible encephalopathy syndrome and arterial hypertension]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:17-23. [PMID: 32678543 DOI: 10.17116/jnevro202012006117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify a correlation between systolicdiastolic blood pressure (BP) and severity of clinical/radiological presentations in patients with posterior reversible encephalopathy syndrome (PRES). MATERIAL AND METHODS Clinical and paraclinic data of patients with PRES hospitalized in the Republican Clinical Hospital, Kazan in 2010-2018 were analyzed. Nineteen patients were found, all of them were women, aged 18-67 years, mean age 33.50±15.03 years. Clinical and paraclinic data included anamnesis, neurological examination, neuroimaging, first measurements of systolic and diastolic BP after symptoms'onset. RESULTS AND CONCLUSION Diastolic BP values can be associated with the incidence of depression of consciousness, systolic BP values - with the number of damaged structures. In total, BP is the significant factor implemented in the presence of endothelial dysfunction that defines the severity of encephalopathy.
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Affiliation(s)
- E I Bogdanov
- Kazan State Medical University, Kazan, Russia.,Republican Clinical Hospital, Kazan, Russia
| | - I A Khasanov
- Kazan State Medical University, Kazan, Russia.,Republican Clinical Hospital, Kazan, Russia
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YILDIRIM-ÇETİN G. Posterior Reversibl Ensefalopati Sendromu: Sistemik Lupus Eritematozuslu hastalarda görülen nadir ve acil klinik bir antite. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.626090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Posteriores reversibles enzephalopathisches Syndrom und Hyperammonämie: zwei Entitäten für Hirnödem und Status epilepticus bei einer Patientin nach Lungentransplantation. Anaesthesist 2020; 69:506-513. [DOI: 10.1007/s00101-020-00771-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
ZusammenfassungFünf Wochen nach primär erfolgreicher Lungentransplantation entwickelt eine 58-jährige Patientin rasch progrediente neurologische Symptome mit Vigilanzverlust. Als Ursachen können einerseits ein posteriores reversibles enzephalopathisches Syndrom (PRES) unter Therapie mit Tacrolimus, andererseits eine schwere Hyperammonämie durch Sepsis mit Ureaplasma urealyticum identifiziert werden. Infektionen mit Ureaplasmen, die Ammoniak als Stoffwechselprodukt produzieren, werden durch spezifische „polymerase chain reaction“(PCR, Polymerase Kettenreaktion)-Verfahren zunehmend bei Immunsupprimierten identifiziert und sollten grundsätzlich als Ursache für unklare neurologische Symptome in Betracht gezogen werden.
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Ghali MGZ, Styler MJ. Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1702934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractThe posterior reversible encephalopathy syndrome was characterized by Hinchey and colleagues in the 1990s. The condition frequently afflicts patients suffering from hematologic and solid organ malignancy and individuals undergoing transplantation. Cases are more frequently described in the adult population compared with children. In the pediatric population, malignancy, transplantation, renal disease, and hypertension represent the most common etiologies. Theories on pathogenesis have centered upon cerebrovascular dysautoregulation with increases in blood–brain barrier permeability. This generates vasogenic edema of the cerebral parenchyma and consequent neurologic deficits. The parietal and occipital lobes are affected with greatest prevalence, though frontal and temporal lobe involvement is frequent, and that of the contents of the infratentorial posterior cranial fossa are occasionally described. The clinical presentation involves a characteristic constellation of neurologic signs and symptoms, most typically inclusive of headache, visual-field disturbances, abnormalities of visual acuity, and seizures. Supportive care, withdrawal of the offending agent, antihypertensive therapy, and prophylactic anticonvulsants affect convalescence in majority of cases. The principal challenge lies in identifying the responsible agent precipitating the condition in patients with malignancy and those having undergone transplantation and thus deciding which medication among a multidrug treatment regimen to withhold, the duration of drug cessation required to effect clinical resolution, and the safety of resuming treatment with the compound. We accordingly reviewed and evaluated the literature discussing the posterior reversible encephalopathy syndrome in children.
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Affiliation(s)
- Michael G. Z. Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Michael J. Styler
- Department of Hematology and Oncology, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
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Lee IH, Kim HK, Ahn DJ. Concurrent pituitary apoplexy and posterior reversible encephalopathy syndrome in a patient with end-stage renal disease on hemodialysis: A case report. Medicine (Baltimore) 2020; 99:e18987. [PMID: 32000433 PMCID: PMC7004754 DOI: 10.1097/md.0000000000018987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pituitary apoplexy (PA) and posterior reversible encephalopathy syndrome (PRES) are rare neurologic diseases that show acute neuro-ophthalmologic symptoms such as headache, decreased visual acuity, and altered consciousness. These diseases are rarely found in patients with end-stage renal disease (ESRD) on hemodialysis, and simultaneous occurrence of these 2 diseases has not been reported. PATIENT CONCERNS The patient was a 75-year-old man with a history of hypertension, diabetes mellitus, and non-functioning pituitary macroadenoma. He had been receiving hemodialysis for ESRD for 3 months before his presentation to the emergency room. The patient complained of headache, vomiting, and dizziness that started after the previous day's hemodialysis. The patient had voluntarily discontinued his antihypertensive medication 2 weeks before presentation and had high blood pressure with marked fluctuation during hemodialysis. Complete ptosis and ophthalmoplegia on the right side suggested 3rd, 4th, and 6th cranial nerve palsies. DIAGNOSES Magnetic resonance imaging of the brain revealed a pituitary tumor, intratumoral hemorrhage within the sella, and symmetric vasogenic edema in the subcortical white matter in the parieto-occipital lobes. Based on these findings, the patient was diagnosed with PA and PRES. INTERVENTIONS Intravenous administration of hydrocortisone (50 mg every 6 hours after a bolus administration of 100 mg) was initiated. Although surgical decompression was recommended based on the PA score (5/10), the patient declined surgery. OUTCOMES Headache and ocular palsy gradually improved after supportive management. The patient was discharged on the 14th day of hospitalization with no recurrence 5 months post-presentation. Current therapy includes antihypertensive agents, oral prednisolone (7.5 mg/day), and maintenance hemodialysis. LESSONS Neurologic abnormalities developed in a patient with ESRD on hemodialysis, suggesting the importance of prompt diagnosis and treatment in similar instances.
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Affiliation(s)
| | - Ho Kyun Kim
- Department of Radiology, Daegu Catholic University School of Medicine
| | - Dong Jik Ahn
- Department of Internal Medicine, HANSUNG Union Internal Medicine Clinic and Dialysis Center, Daegu, Republic of Korea
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Chaudhry FB, Raza S, Ahmad U. Anton's syndrome: a rare and unusual form of blindness. BMJ Case Rep 2019; 12:12/12/e228103. [PMID: 31801772 DOI: 10.1136/bcr-2018-228103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Anton syndrome is characterised by visual anosognosia. It results from damage to both occipital lobes, while the anterior visual pathways remain intact. We describe four cases of Anton's syndrome. First case is that of a 73-year-old woman, who presented with two separate events of intraparenchymal brain haemorrhage, 4 years apart. Her first stroke affected the left and second affected the right occipital lobe. Bilateral occipital lobe damage resulted in cortical blindness. Second case is an 88-year-old man, who suffered from two ischaemic strokes, 2 days apart. Each stroke involved one posterior cerebral artery. This resulted in bilateral occipital and temporal lobe infarcts. Third case is a 64-year-old woman with chronic renal failure, who suffered bilateral occipital lobe infarction after haemodialysis, due to posterior reversible encephalopathy syndrome. Last case is that of an 80-year-old woman who suffered a basilar artery stroke, resulting in bilateral thalamic, temporal and occipital lobe infarction.
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Affiliation(s)
| | - Samavia Raza
- Radiology Department, John Radcliffe Hospital, Oxford, UK
| | - Usman Ahmad
- Gastroenterology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Ghali MGZ, Davanzo J, Leo M, Rizk E. Posterior reversible encephalopathy syndrome in pediatric patients: pathophysiology, diagnosis, and management. Leuk Lymphoma 2019; 60:2365-2372. [PMID: 31556774 DOI: 10.1080/10428194.2019.1594210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is well-described in adults, but has been reported with relative rarity in children, usually occurring in the context of chemotherapy for acute leukemia. Pathogenesis involves perturbed cerebral autoregulation leading to vasogenic edema predominantly affecting the parieto-occipital white matter, though involvement of the frontal and temporal lobes, as well as posterior fossa, is also described. We review the literature on the pathophysiology, diagnosis, and management of PRES in pediatric patients.
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Affiliation(s)
- Michael G Z Ghali
- Department of Neurological Surgery, Houston Methodist Hospital , Houston , TX , USA.,Department of Neurological Surgery, Penn State Hershey Medical Center , Hershey , PA , USA
| | - Justin Davanzo
- Department of Neurological Surgery, Penn State Hershey Medical Center , Hershey , PA , USA
| | - Madeline Leo
- Department of Neurological Surgery, Penn State Hershey Medical Center , Hershey , PA , USA
| | - Elias Rizk
- Department of Neurological Surgery, Penn State Hershey Medical Center , Hershey , PA , USA
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El-Sheikh S, Memon M, Mujtaba A, Heena H. An Uncommon Cause of Posterior Reversible Encephalopathy Syndrome Related to Antibiotic Ingestion. Cureus 2018; 10:e3540. [PMID: 30648073 PMCID: PMC6318117 DOI: 10.7759/cureus.3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state manifested with a unique computed tomography (CT) or magnetic resonance imaging (MRI) appearance. PRES is associated with different conditions, such as eclampsia, sepsis, organ transplantation, and drugs, especially immunosuppressive medications. Besides pharmacologic side effects, antibiotics can cause PRES as well. Here, we report a 37-year-old female from Saudi Arabia, presenting to the emergency department (ED) with a two-day history of fluctuations in consciousness level, headache, and blurring of vision. A generalized vesicular skin rash preceded the condition for one month; this was diagnosed as chicken pox and the patient received co-amoxiclav for a possible superadded bacterial infection. Besides clinical manifestations, the patient had radiological abnormalities, which were resolved following the withdrawal of causative antibiotics. Ascertaining the exact etiological cause of PRES is essential for diagnosing this reversible condition as these patients undergo a complete neurological recovery if the underlying cause is identified early.
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Affiliation(s)
| | - Muhamad Memon
- Internal Medicine, King Fahad Medical City, Riyadh, SAU
| | | | - Humariya Heena
- Epidemiology and Public Health, King Fahad Medical City, Riyadh, SAU
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Li X, Chai J, Wang Z, Lu L, Zhao Q, Zhou J, Ju F. Reversible posterior leukoencephalopathy syndrome induced by apatinib: a case report and literature review. Onco Targets Ther 2018; 11:4407-4411. [PMID: 30104882 PMCID: PMC6072830 DOI: 10.2147/ott.s166605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical-radiologic syndrome. There are reports that RPLS may be associated with cancer therapy including some chemotherapy drugs and antiangiogenic drugs. This paper reported a case of RPLS induced by apatinib, a vascular endothelial growth factor receptor 2 (VEGFR-2) tyrosine kinase inhibitor. A 47-year-old cervical cancer patient was administered apatinib, and 3 months later, headache, dizziness, blurred vision, and hypertension appeared. She was diagnosed with RPLS by nuclear magnetic resonance imaging (MRI). After apatinib discontinuation and normotensive treatment, her symptoms completely reversed. Antiangiogenic drugs potentially damage the balance of the blood–brain barrier by directly injuring vascular endothelial cells, resulting in the occurrence of RPLS. This case is the first report of RPLS induced by apatinib.
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Affiliation(s)
- Xutong Li
- Department of Oncology, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China,
| | - Jie Chai
- Department of Oncology, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China,
| | - Zhi Wang
- Department of MRI, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China
| | - Lin Lu
- Department of Oncology, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China,
| | - Qingye Zhao
- Department of Oncology, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China,
| | - Jie Zhou
- Department of Oncology, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China,
| | - Fang Ju
- Department of Oncology, Second Affiliated Hospital, Qingdao University, Qingdao, Shandong 266042, People's Republic of China,
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Schoucair R, Nicolas G, Ahdab R, Bejjani N, Abdalla EK. Posterior reversible encephalopathy syndrome (PRES) in mesenteric leiomyosarcoma: A case report. Int J Surg Case Rep 2018; 49:96-101. [PMID: 29980031 PMCID: PMC6031592 DOI: 10.1016/j.ijscr.2018.04.043] [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: 02/15/2018] [Accepted: 04/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a syndrome characterized by headache, confusion, visual loss and seizures. Many factors influence the appearance of this syndrome, predominantly eclampsia, certain medical treatments and malignant hypertension. Diagnosed by typical transient lesions on magnetic resonance imaging. CASE REPORT We present a case of mesenteric leiomyosarcoma in a 52 year old woman, who had severe headache, abdominal heaviness, and hypertension. Investigations revealed a mesenteric mass and a Posterior Reversible Encephalopathy Syndrome features on brain MRI, suggesting renin secretion by the tumor, causing the patient's symptoms. CONCLUSION Patient's symptoms disappeared after resection of the tumor, suggesting a renin production cessation.
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Affiliation(s)
- Ramy Schoucair
- Lebanese University, Beirut, Lebanon; LAUMRCH, Beirut, Lebanon
| | - Gregory Nicolas
- Lebanese University, Beirut, Lebanon; LAUMRCH, Beirut, Lebanon.
| | - Rechdi Ahdab
- Lebanese University, Beirut, Lebanon; LAUMRCH, Beirut, Lebanon
| | - Noha Bejjani
- Lebanese University, Beirut, Lebanon; LAUMRCH, Beirut, Lebanon
| | - Eddie K Abdalla
- Lebanese University, Beirut, Lebanon; LAUMRCH, Beirut, Lebanon
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Davi CB, Moraes BPD, Lichtenfels BF, Castro Filho JBSD, Portal MM, Montenegro RM, Manfro RC. Posterior reversible leukoencephalopathy syndrome (PRES) after kidney transplantation: a case report. ACTA ACUST UNITED AC 2018; 40:91-94. [PMID: 29796585 PMCID: PMC6533973 DOI: 10.1590/1678-4685-jbn-3825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/06/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Posterior reversible leukoencephalopathy syndrome (PRES) was first described by Hinchey in 1996. The syndrome is characterized by altered level of consciousness, headache, visual changes, and seizures associated with a vasogenic edema of the white matter that occurs predominantly in the occipital and parietal lobes. Imaging tests such as computed tomography (CT) and especially magnetic resonance imaging (MRI) support the diagnosis. CASE REPORT We report a case of a 48-year-old female patient who underwent a deceased donor kidney transplant and received tacrolimus as a part of the immunosuppressive regimen. Five weeks after transplantation she was admitted to the emergency due to sudden onset of confusion, disorientation, visual disturbances, and major headache. PRES was suspected and the diagnosis confirmed by brain MRI. Tacrolimus was withdrawn and rapid improvement of the neurological signs occurred leading to the conclusion that this drug triggered the syndrome. CONCLUSION PRES is an unusual complication after organ transplantation and should be considered in the appropriate clinical setting. Physicians must be aware of this condition in order to provide early detection and appropriate treatment since delay in removing the cause may lead to permanent sequelae.
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Affiliation(s)
- Carla Beatriz Davi
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Bruna Pinheiro de Moraes
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Bruno Fontes Lichtenfels
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Marcelle Maria Portal
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Rosangela Munhoz Montenegro
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Roberto Ceratti Manfro
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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Posterior Reversible Encephalopathy Syndrome: Risk Factors and Impact on the Outcome in Children With Acute Lymphoblastic Leukemia Treated With Nordic Protocols. J Pediatr Hematol Oncol 2018; 40:e13-e18. [PMID: 29200159 DOI: 10.1097/mph.0000000000001009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) in children with acute lymphoblastic leukemia has been increasingly recognized as a clinicoradiological entity. Our aim was to describe the incidence of PRES in pediatric patients with ALL, identify its risk factors, and examine its prognostic importance. For this research, we conducted a systematic, retrospective review of the patient records in a population-based series of children with acute lymphoblastic leukemia (n=643) treated in Finland from 1992 to 2008. Of the patients with ALL, 4.5% (n=29) developed radiologically confirmed PRES, of which 28 cases occurred during induction. Hypertension (P=0.006; odds ratio [OR], 4.10, confidence interval [CI], 1.50-11.25), constipation (P=0.001; OR, 5.60; CI, 2.02-15.52), and >14 days of alkalinization (P=0.017; OR, 3.27; CI, 1.23-8.68) were significant independent risk factors for PRES. One-third of the patients developed epilepsy. Relapses occurred significantly more often in those patients with PRES (P=0.001), which was associated with worse overall survival (P=0.040; 5-year survival=75.9% [60.3%-91.4%] vs. 88.4% [85.8%-90.9%]). Using NOPHO-ALL 92/2000 protocols, PRES is a significant early complication of therapy in ALL, and was associated with a poorer prognosis and significant neurological morbidity.
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Shah RR. Anti-Angiogenic Tyrosine Kinase Inhibitors and Reversible Posterior Leukoencephalopathy Syndrome: Could Hypomagnesaemia Be the Trigger? Drug Saf 2017; 40:373-386. [PMID: 28181126 DOI: 10.1007/s40264-017-0508-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS), also known frequently as posterior reversible encephalopathy syndrome (PRES), is a characteristic acute neuro-radiology syndrome with clinical presentation that typically includes acute hypertension, seizures and other neurological symptoms and signs. Many patients with RPLS have (a history of) pre-existing hypertension and in receipt of diuretics. It is being diagnosed more frequently and in association with an increasing number of morbidities and medications. Drugs most frequently implicated are immunosuppressant drugs and anticancer agents, including a number of anti-angiogenic tyrosine kinase inhibitors (TKIs). Hypomagnesaemia is a frequent finding at presentation in RPLS patients, which is known to lead to or aggravate hypertension. Pre-eclampsia, a variant of RPLS, responds effectively to intravenous magnesium. Cyclosporin, tacrolimus and some TKIs that induce RPLS are also known to give rise to both hypertension and hypomagnesaemia. This raises an interesting hypothesis that hypomagnesaemia may play a contributory role in triggering RPLS in some patients by acutely raising the blood pressure further. Additional systematic studies are required to test this hypothesis. If the hypothesis is confirmed, hypomagnesaemia offers an effective target for risk mitigation and prevention of RPLS in patients identified at risk.
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Affiliation(s)
- Rashmi R Shah
- Pharmaceutical Consultant, 8 Birchdale, Gerrards Cross, Buckinghamshire, UK.
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Godasi R, Rupareliya C, Bollu PC. Bilateral Occipital Lobe Hemorrhages Presenting as Denial of Blindness in Posterior Reversible Encephalopathy Syndrome- A Rare Combination of Anton Syndrome and Encephalopathy. Cureus 2017; 9:e1746. [PMID: 29218261 PMCID: PMC5714403 DOI: 10.7759/cureus.1746] [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] [Indexed: 11/05/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy (RPL) is an acute neurological syndrome characterized by the development of radiological abnormalities on brain imaging along with clinical manifestations, such as a headache, seizures, encephalopathy, etc. We report the case of a middle-aged male who presented to the emergency department after he woke up with complete blindness and was found to have hemorrhagic PRES. Intracranial hemorrhages were seen in around 15% of patients who presented with this condition. In this article, we review the different types of hemorrhages seen in the setting of PRES and their associations.
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Affiliation(s)
- Raja Godasi
- Department of Neurology, University of Missouri, Columbia, Missouri
| | | | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, Missouri
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Chou MCY, Lee CY, Chao SC. Temporary Visual Loss Due to Posterior Reversible Encephalopathy Syndrome in the Case of an End-Stage Renal Disease Patient. Neuroophthalmology 2017; 42:35-39. [PMID: 29467807 DOI: 10.1080/01658107.2017.1322109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinical phenomenon associated with headache, altered mental status, seizures, and visual disturbances along with radiographic acute cerebral oedema. Several conditions are correlated with posterior reversible encephalopathy syndrome, with acute hypertension, eclampsia, and cytotoxic agents being the most common. This report presents a case of posterior reversible encephalopathy syndrome in a 45-year-old male with multiple underlying conditions, including hypertension, diabetes, and end-stage renal disease. Sudden onset of bilateral visual loss with mild systemic feature of dizziness was noted on presentation. Radiologic findings showed characteristic findings of posterior reversible encephalopathy syndrome. Following prompt control of hypertension and haemodialysis, resolution of symptoms was noted.
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Affiliation(s)
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shih-Chun Chao
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Tetsuka S, Nonaka H. Importance of correctly interpreting magnetic resonance imaging to diagnose posterior reversible encephalopathy syndrome associated with HELLP syndrome: a case report. BMC Med Imaging 2017; 17:35. [PMID: 28545408 PMCID: PMC5445265 DOI: 10.1186/s12880-017-0208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe haemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome in pregnancy are possible underlying trigger factors for posterior reversible encephalopathy syndrome (PRES). Magnetic resonance imaging (MRI) shows diffuse signal abnormalities involving the subcortical white matter in the parieto-occipital lobes. Although the diagnosis of RPES was clearly established by the distinctive reversibility of clinical and radiological abnormalities, it is difficult to distinguish from differential diagnosis. Thus, it is important to correctly interpret MRI. CASE PRESENTATION We describe a case of HELLP syndrome with PRES. A 38-year-old pregnant woman was admitted to our hospital as an emergency case with a complaint of upper abdominal pain and headache at 29 weeks of pregnancy and the development of HELLP syndrome. An emergency caesarean section was immediately performed. After the operation, the patient received intravenous corticosteroids, and her blood pressure was controlled. Thereafter, she showed an altered mental status. MRI showed hypersignal intense lesions in the cortical and subcortical white matter in the occipital lobes, basal ganglia and callosal splenium in both the fluid-attenuated inversion recovery (FLAIR) sequence and apparent diffusion coefficient (ADC), but these lesions were not recognized in diffusion-weighted imaging (DWI). These images were suggestive of PRES. The patient was kept in the hospital and received the appropriate treatment, after which the patient's level of consciousness improved and all laboratory tests and imaging examinations returned normal. CONCLUSION The MRI findings were useful for the prompt diagnosis of PRES, characterized by hypersignals in FLAIR and ADC, but not in DWI. Additionally, there was an "atypical" MRI appearance of basal ganglial and callosal splenial involvement in this case, which may mistakenly lead clinicians to diagnose other aetiologies than typical PRES. It is considered that vasogenic oedema is the main pathology of PRES according to the MRI image findings. MRI is the gold standard for diagnosing PRES because it can provide information about cerebral involvement earlier than CT; further, it can be a useful tool in the differential diagnosis. This technique facilitated the prompt diagnosis and treatment of the said patient, ultimately resulting in a good outcome.
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Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, Hospital of Yuki, 9629-1, Yuki, Yuki-City, Ibaraki, 307-0001, Japan.
| | - Hiroaki Nonaka
- Obstetrics & Gynecology, Hospital of International University of Health and Welfare, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
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Sengupta P, Biswas S. Dialysis disequilibrium leading to posterior reversible encephalopathy syndrome in chronic renal failure. CEN Case Rep 2017; 5:154-157. [PMID: 28508968 DOI: 10.1007/s13730-016-0215-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/12/2016] [Indexed: 12/27/2022] Open
Abstract
Dialysis disequilibrium syndrome is a neurological adverse effect of acute hemodialysis in advanced uremic patients. Dialysis disequilibrium has a wide spectrum of clinical manifestations starting from subtle uneasiness, confusion, to florid and complex life threatening neurological deficit. In this case study, we present a patient who developed sudden cortical blindness following hemodialysis due to posterior reversible encephalopathy, which is a rare presentation of dialysis disequilibrium syndrome.
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Affiliation(s)
- Pratim Sengupta
- Department of Nephrology, ILS Hospital, 1, Mall Road, Near Nager Bazar Flyover, Dum Dum, Kolkata, 700080, India. .,, Flat No-4c, Block-A, AMRAPALI, 29/10 Harey Krishna Seth Lane, P.O- Sinthee, Kolkata, West Bengal, 700050, India.
| | - Sumanta Biswas
- ILS Hospital, 1, Mall Road, Near Nager Bazar Flyover, Dum Dum, Kolkata, 700080, India
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Abstract
Severe, recalcitrant dermatologic conditions often require systemic treatment. Although efficacious, these medications have been associated with wide-ranging adverse reactions. Some are reversible, predictable, and either dose-dependent or treatment length-dependent, while others are unpredictable, irreversible, and potentially fatal. This review examines the neuropsychiatric adverse effects associated with US FDA-approved medications for treatment of the following dermatologic pathologies that typically require systemic therapy: autoimmune dermatoses, acne, psoriasis, and melanoma. A search of the literature was performed, with adverse effects ranging from mild headaches and neuropathy to severe encephalopathies. The medications associated with the most serious reactions were those used to treat psoriasis, especially the older non-biologic medications such as cyclosporine A and methotrexate. Given the importance of these systemic dermatologic therapies in treating severe, recalcitrant conditions, and the wide variety of potentially serious neuropsychiatric adverse effects of these medications, neurologists, psychiatrists, dermatologists, oncologists, and primary care providers must be aware of the potential for these neuropsychiatric adverse reactions to allow for appropriate counseling, management, and medication withdrawal.
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Alves DR, Cruz C, Antunes C, Gonçalves N, Aquino E, Franco S, Carvalho C, Pais Martins A. Posterior Reversible Encephalopathy Syndrome in a pregnant patient: a PRESsing matter. Acta Anaesthesiol Scand 2016; 60:1473-1476. [PMID: 27666320 DOI: 10.1111/aas.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/12/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Affiliation(s)
- D. R. Alves
- Centro Hospitalar de Lisboa Ocidental; Lisbon Portugal
| | - C. Cruz
- Centro Hospitalar de Lisboa Central; Lisbon Portugal
| | - C. Antunes
- Centro Hospitalar de Lisboa Ocidental; Lisbon Portugal
| | - N. Gonçalves
- Centro Hospitalar de Lisboa Ocidental; Lisbon Portugal
| | - E. Aquino
- Centro Hospitalar de Lisboa Ocidental; Lisbon Portugal
| | - S. Franco
- Centro Hospitalar de Lisboa Ocidental; Lisbon Portugal
| | - C. Carvalho
- Centro Hospitalar de Lisboa Ocidental; Lisbon Portugal
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Abdullah HMA, Ullah W, Ahmad E, Anwer F. Posterior reversible encephalopathy syndrome in malignant hypertension secondary to focal segmental glomerulosclerosis. BMJ Case Rep 2016; 2016:bcr2016216512. [PMID: 27535734 PMCID: PMC5015126 DOI: 10.1136/bcr-2016-216512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/03/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition that occurs secondary to a variety of causes like autoimmune diseases, uncontrolled hypertension and immunosuppressive agents. We report an unusual association of PRES and malignant hypertension secondary to focal segmental glomerulosclerosis in a young woman, presenting with sudden loss of vision and seizures. She had uncontrolled hypertension and a Glasgow Coma Scale of 6/15. Brain MRI revealed high signals in cortical and subcortical white matter and some involvement of the periventricular areas. She improved dramatically with antihypertensive and antiepileptic medications and was discharged home in a stable condition. It is important to have a high clinical suspicion for this uncommon condition in an appropriate clinical setting, because a timely intervention can prevent long-term complications.
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Affiliation(s)
| | | | - Ejaz Ahmad
- Department of Medical Education, Griffin Hospital, Derby, Connecticut, USA
| | - Faiz Anwer
- Department of Internal Medicine, University of Arizona Medical Center, Tucson, Arizona, USA
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Brown CA, Munday JS, Mathur S, Brown SA. Hypertensive Encephalopathy in Cats with Reduced Renal Function. Vet Pathol 2016; 42:642-9. [PMID: 16145210 DOI: 10.1354/vp.42-5-642] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical, hemodynamic, and pathologic features of hypertensive encephalopathy in two cats with reduced renal mass are described. The cats developed a progressive syndrome of lethargy, ataxia, blindness, stupor, and seizures following an abrupt increase in blood pressure associated with a surgical reduction in renal mass. The cats had severe gross brain edema, evidenced by cerebellar changes of caudal coning and cranial displacement over the corpora quadrigemina and cerebral changes of widening and flattening of the gyri. Histologically, interstitial edema was most pronounced in the cerebral white matter. Hypertensive vascular lesions were present as hyaline arteriolosclerosis in one cat and hyperplastic arteriolosclerosis in the other. Rare foci of parenchymal microhemorrhages and necrosis were also observed. Systemic hypertension (especially severe or rapidly developing) accompanied by neurologic signs and the pathologic findings of diffuse brain edema with cerebral arteriolosclerosis are consistent with an etiologic diagnosis of hypertensive encephalopathy.
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Affiliation(s)
- C A Brown
- Athens Diagnostic Laboratory, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
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Agarwal H, Sebastian LJD, Gaikwad SB, Garg A, Mishra NK. Spinal cord involvement and contrast enhancement in posterior reversible encephalopathy syndrome. BJR Case Rep 2016; 2:20150326. [PMID: 30364367 PMCID: PMC6195939 DOI: 10.1259/bjrcr.20150326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/06/2015] [Indexed: 11/05/2022] Open
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Elmalik HH, ElAzzazy S, Salem KS, Bujassoum S. A Grave Outcome of Posterior Reversible Encephalopathy Syndrome in a Patient Receiving Avastin (Bevacizumab) for Metastatic High-Grade Serous Ovarian Cancer. Case Rep Oncol 2015; 8:290-4. [PMID: 26351436 PMCID: PMC4560300 DOI: 10.1159/000435805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 45-year-old female developed neurological symptoms and elevated diastolic blood pressure while on bevacizumab (Avastin) and gemcitabine for recurrent carboplatin-resistant high-grade serous ovarian cancer. A brain MRI diagnosed our patient with posterior reversible encephalopathy syndrome. We are discussing her presenting symptoms in this paper as well as the management and the outcome. We emphasize the importance of keeping this rare but very serious complication in all patients receiving bevacizumab.
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Affiliation(s)
- Hind H Elmalik
- National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - Shereen ElAzzazy
- National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | | | - Salha Bujassoum
- National Center for Cancer Care and Research (NCCCR), Doha, Qatar
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Schmidt V, Prell T, Treschl A, Klink A, Hochhaus A, Sayer HG. Clinical Management of Posterior Reversible Encephalopathy Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation: A Case Series and Review of the Literature. Acta Haematol 2015; 135:1-10. [PMID: 26159650 DOI: 10.1159/000430489] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/15/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a rare but serious complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). Among others, calcineurin inhibitors (CNI) for prophylaxis of graft-versus-host disease (GvHD) may promote the development of PRES, but the pathomechanism is still controversial. Discontinuation of CNI facilitates remission of symptoms but might contribute to the unfavorable prognosis of PRES due to an elevated incidence of GvHD. METHODS This is a case series of 7 patients with PRES from a retrospective analysis of 146 consecutive patients who received alloHSCT for hematologic malignancies. RESULTS At the onset of PRES, all patients presented a systemic infection, while no influence was seen for underlying disease, conditioning regimen, donor type, or GvHD. Discontinuation of CNI and control of the blood pressure reversed neurological symptoms in 6 patients, while 1 patient died from septic multiorgan failure. After bridging with prednisolone and/or mycophenolic acid, replacement of CNI by the mammalian target of rapamycin (mTOR) inhibitor everolimus effectively prevented severe GvHD without recurrence of PRES. CONCLUSIONS A systemic infection/inflammation may be an important cause of PRES. Prophylaxis of GvHD by the mTOR inhibitor everolimus in case of PRES after alloHSCT demonstrated promising results but needs to be validated in larger cohorts.
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Affiliation(s)
- Volker Schmidt
- Abteilung Hx00E4;matologie und Internistische Onkologie, Klinik fx00FC;r Innere Medizin II, Universitx00E4;tsklinikum Jena, Jena, Germany
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Therapy and differential diagnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum. Arch Gynecol Obstet 2015; 292:1217-23. [PMID: 26122264 DOI: 10.1007/s00404-015-3800-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Posterior reversible encephalopathy syndrome (PRES) is an usually reversible neuro-radiological clinical entity characterized by headache, confusion, visual disturbances or blindness and seizures. It rarely occurs without seizures. METHODS We conducted a literature review in MEDLINE about PRES during post partum and pregnancy, focusing on differential diagnosis and therapy. We reviewed 28 articles (case reports, original articles and reviews) describing PRES as well as a case of a severe, immediate postpartum HELLP syndrome (haemolysis, elevated liver enzyme levels, low platelet count) with PRES without generalized seizure. RESULTS The development of PRES after delivery is unusual. Magnetic resonance imaging represents the gold standard for the diagnosis of this condition. White matter oedema in the posterior cerebral hemispheres is typical on neuroimaging. PRES is reversible when early diagnosis is established and appropriate treatment is started without delay. The pathogenesis of PRES is discussed and the importance of a prompt diagnosis is emphasized, as the crucial role of rapid blood press reduction. CONCLUSION MRI is the diagnostic gold standard and it may be useful in the differential diagnosis. The goal of the therapy is to control elevated blood pressure and to prevent seizures or promptly manage it.
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Frantzen L, Rondeau-Lutz M, Mosquera F, Martinez C, Labani A, Weber JC. [Reversible posterior encephalopathy syndrome and cardiomyopathy after bevacizumab therapy]. Rev Med Interne 2015; 37:50-2. [PMID: 26031739 DOI: 10.1016/j.revmed.2015.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/16/2015] [Accepted: 04/28/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bevacizumab is an antibody directed against VEGF-A. It is approved for the treatment of many cancer diseases. Its side effects are currently not well known by physicians. CASE REPORT A 70-year-old female with metastatic colonic adenocarcinoma was admitted in the intensive care unit because of a coma, four days after having received a combined monthly chemotherapy containing bevacizumab, oxaliplatine, 5 fluorouracil, and folinic acid for the fourth time. On clinical examination, she presented with lower limbs spasticity and hypertension. Etiologic investigations, including cerebral tomodensitometry, cerebrospinal fluid examination, psychotropic drugs urinary testing, and electroencephalogram, were negative. Consciousness improved without any other treatment than nicardipine and urapidil, but the patient was initially confused. Cerebral magnetic resonance imaging showed changes suggestive of posterior reversible encephalopathy syndrome, but also involving frontal lobes. There were additional biological and echocardiographic changes suggestive of cardiac involvement. The patient recovered completely of both cardiac and neurologic manifestations 10 days later. CONCLUSION Physicians should be aware of cardiovascular adverse effects of bevacizumab. High blood pressure must be treated to avoid more severe complications. When a posterior reversible encephalopathy syndrome occurs, cardiac involvement should be investigated.
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Affiliation(s)
- L Frantzen
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Rondeau-Lutz
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - F Mosquera
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - C Martinez
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Faculté de médecine de Strasbourg, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - A Labani
- Service de radiologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Faculté de médecine de Strasbourg, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - J C Weber
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Faculté de médecine de Strasbourg, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
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Mjelle AB, Donner EM, Berg A. [A child with cramps and sudden vision loss during chemotherapy]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:441-4. [PMID: 25761031 DOI: 10.4045/tidsskr.13.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
| | - Erik Mikael Donner
- Barneklinikken Haukeland universitetssykehus * Nåværende arbeidssted: Barnkliniken, Ängelholms sjukehus Sverige
| | - Ansgar Berg
- Barneklinikken Haukeland universitetssykehus og Klinisk institutt 2 Universitetet i Bergen
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Jaiswal A, Sabnani I, Baran DA, Zucker MJ. A unique case of rituximab-related posterior reversible encephalopathy syndrome in a heart transplant recipient with posttransplant lymphoproliferative disorder. Am J Transplant 2015; 15:823-6. [PMID: 25648447 DOI: 10.1111/ajt.13021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/04/2014] [Accepted: 09/06/2014] [Indexed: 01/25/2023]
Abstract
Rituximab is commonly used as a first line therapy to treat posttransplant lymphoproliferative disorders (PTLDs). It has also proved useful in the management of refractory antibody mediated graft rejection. We report an unusual case in which a heart transplant recipient being treated with rituximab for PTLD developed altered mental status, hallucinations and visual symptoms and magnetic resonance imaging (MRI) findings of symmetrical enhancement suggestive of posterior reversible leukoencephalopathy syndrome (PRES). Resolution of these clinical symptoms and radiological findings after discontinuation of therapy confirmed the diagnosis. This is the first case of PRES seen due to rituximab in a heart transplant recipient. Another unique feature of the case is the development of PRES after second cycle of rituximab as compared to prior reports in nonheart transplant patients in which the syndrome developed after first dose administration. The objective of this case report is to increase the awareness of this rare entity amongst immunocompromised transplant patients.
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Affiliation(s)
- A Jaiswal
- Tulane University Heart and Vascular Institute, New Orleans, LA
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Straube A, Klein M, Erbguth F, Maschke M, Klawe C, Sander D, Hilz MJ, Ziemssen T, Klucken J, Kohl Z, Winkler J, Bettendorf M, Staykov D, Berrouschot J, Dörfler A. Metabolische Störungen. NEUROINTENSIV 2015. [PMCID: PMC7175475 DOI: 10.1007/978-3-662-46500-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Im folgenden Kapitel werden die verschiedenen metabolischen Störungen betrachtet. Zunächst wird auf die allgemeinen und spezifischen neurologischen Komplikationen bei Organtransplantation eingegangen. Dann geht es um die metabolischen Enzephalopathien: Störungen der Gehirntätigkeit bei angeborenen und erworbenen Stoffwechselerkrankungen im engeren Sinn, Elektrolytstörungen, Hypovitaminosen, zerebrale Folgen einzelner Organdysfunktionen, zerebrale Hypoxien, Endotheliopathien und Mitochondropathien. Anschließend werden das Alkoholdelir und die Wernicke-Enzephalopathie erörtert. Bei zahlreichen akuten Erkrankungen von Gehirn, Rückenmark und peripherem Nervensystem treten typische Störungen vegetativer Systeme auf, deren Erkennung und Therapie insbesondere bei Intensivpatienten eine vitale Bedeutung haben kann: die autonomen Störungen. Bei der zentralen pontinen Myelinolyse kommt es zu einer akuten, vorwiegend fokal-symmetrischen Demyelinisierung im Hirnparenchym. Auch Basalganglienerkrankungen können intensivmedizinisch relevant werden. Und schließlich wird die akute Stressreaktion betrachtet, die aufgrund der vielfältigen metabolischen und endokrinen Veränderungen bei kritischen Erkrankungen entsteht. Gerade das RCVS als neuere Krankheitsentität und wichtige Differenzialdiagnose zur Vaskulitis des ZNS verdient einen eigenen Platz, in diesem Unterkapitel werden ebenfalls verwandte Syndrome wie die hypertensive Enzephalopathie und das PRES abgehandelt.
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Pereira PR, Pinho J, Rodrigues M, Rocha J, Sousa F, Amorim J, Ribeiro M, Rocha J, Ferreira C. Clinical, imagiological and etiological spectrum of posterior reversible encephalopathy syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:36-40. [PMID: 25608125 DOI: 10.1590/0004-282x20140176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Analyze the cases of posterior reversible encephalopathy syndrome (PRES) admitted in a Neurology Department during an 8-year period. METHOD Retrospective observational study in a central hospital in the north of Portugal. RESULTS 14 patients were identified, mean age 52.3 years. Precipitating factors included: eclampsia, isolated arterial hypertension, spinal trauma and autonomic dysreflexia, Guillain-Barré syndrome, sepsis, sarcoidosis and pulmonary cryptococcosis and drugs. Most patients presented posterior-predominant vasogenic edema lesions, however 64.2% presented frontal lesions and in 42.8% cerebellum was involved. Four patients also had acute ischemic lesions and 1 had hemorrhagic lesions. During follow-up 10 patients recovered fully, 2 recovered partially, 1 suffered a recurrence and 2 died in hospital. CONCLUSION PRES has many etiological factors. The terms posterior and reversible should be revised because PRES frequently involves other brain regions and it is not always reversible. PRES patients may develop life-threatening complications and mortality is not negligible.
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Affiliation(s)
- P Ricardo Pereira
- Departamento de Medicina Interna, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - João Pinho
- Departamento de Neurologia, Hospital de Braga, Braga, Portugal
| | | | - João Rocha
- Departamento de Neurologia, Hospital de Braga, Braga, Portugal
| | - Filipa Sousa
- Departamento de Neurologia, Hospital de Braga, Braga, Portugal
| | - José Amorim
- Departamento de Neuroradiologia, Hospital de Braga, Braga, Portugal
| | - Manuel Ribeiro
- Departamento de Neuroradiologia, Hospital de Braga, Braga, Portugal
| | - Jaime Rocha
- Departamento de Neuroradiologia, Hospital de Braga, Braga, Portugal
| | - Carla Ferreira
- Departamento de Neurologia, Hospital de Braga, Braga, Portugal
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Tenta M, Uchida HA, Nunoue T, Umebayashi R, Okuyama Y, Kitagawa M, Maeshima Y, Sugiyama H, Wada J. Successful treatment by mycophenolate mofetil in a patient with focal segmental glomerulosclerosis associated with posterior reversible encephalopathy syndrome. CEN Case Rep 2014; 4:190-195. [PMID: 28509096 DOI: 10.1007/s13730-014-0165-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/24/2014] [Indexed: 01/16/2023] Open
Abstract
It has been reported that cyclosporine A (CsA) treatment may be associated with posterior reversible encephalopathy syndrome. We report a 16-year-old man who exhibited nephrotic syndrome and posterior reversible encephalopathy syndrome. Intensive antihypertensive therapy restored him to consciousness. Renal biopsy revealed that he suffered from focal segmental glomerulosclerosis. Although he was treated with prednisolone and low-density lipoprotein apheresis therapy, his proteinuria remained at high level. Then, mycophenolate mofetil (MMF) with less influence on vessel endothelium compared with CsA and tacrolimus was administered. Soon after, he reached remission of nephrotic syndrome without recurrence of posterior reversible encephalopathy syndrome. This is the first case that a young patient of focal segmental glomerulosclerosis with posterior reversible encephalopathy syndrome achieved a complete remission by MMF treatment without recurrence of posterior reversible encephalopathy syndrome. MMF may be effective for young patients of focal segmental glomerulosclerosis especially with clinical condition of vascular endothelial damage such as posterior reversible encephalopathy syndrome.
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Affiliation(s)
- Masafumi Tenta
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Haruhito Adam Uchida
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan.
| | - Tomokazu Nunoue
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Ryoko Umebayashi
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Yuka Okuyama
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Masashi Kitagawa
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Yohei Maeshima
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Hitoshi Sugiyama
- Department of Chronic Kidney Disease and Peritoneal Dialysis, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Jun Wada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, kita-ku, Okayama, 700-8558, Japan
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Praveen P, Padma S. Posterior-reversible-encephalopathy syndrome and antepartum eclampsia. J Obstet Gynaecol India 2014; 64:14-5. [PMID: 25404795 DOI: 10.1007/s13224-013-0398-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 02/17/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pallavi Praveen
- Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai, Tamilnadu India
| | - S Padma
- Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai, Tamilnadu India
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Zhang P, Li X, Li Y, Wang J, Zeng H, Zeng X. Reversible posterior leukoencephalopathy syndrome secondary to systemic-onset juvenile idiopathic arthritis: A case report and review of the literature. Biomed Rep 2014; 3:55-58. [PMID: 25469247 DOI: 10.3892/br.2014.380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/29/2014] [Indexed: 12/13/2022] Open
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinical syndrome based on changes in clinical imaging, and it has been reported to mainly occur in adults. However, it has been recently discovered that RPLS is also prevalent in infant patients, particularly in those using glucocorticoids, immunosuppressant medications and cytotoxic drugs. The current study presents a 5-year-old male with a previous diagnosis of systemic-onset juvenile idiopathic arthritis (SoJIA) and macrophage-activation syndrome who developed posterior reversible encephalopathy syndrome during treatment with glucocorticoids, disease-modifying antirheumatic drugs and biological agent (etanercept) therapy. After ~5 days of treatment, the patient made a complete clinical recovery; the magnetic resonance imaging reviewed 2 weeks later showed that the previous hyper-intensity signal had disappeared and the multiple lesions in the brain had been completely absorbed. The case report shows that, conforming to recent literature, SoJIA in infants should be considered a risk factor for developing RPLS. The clinical manifestations of the disease are multiple, but usually reversible, and the patients mostly have a good prognosis. Rapid diagnosis and treatment is essential as early treatment may prevent progression to irreversible brain damage. By increasing the awareness of RPLS, the patient care may improve and further insight may be gained.
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Affiliation(s)
- Pingping Zhang
- Department of Pediatrics, Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University and First Clinical Medical College, Jinan University, Guangzhou 510120, P.R. China ; Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, P.R. China
| | - Xiaofeng Li
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, P.R. China
| | - Yating Li
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, P.R. China
| | - Jing Wang
- Department of Pediatrics, Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University and First Clinical Medical College, Jinan University, Guangzhou 510120, P.R. China
| | - Huasong Zeng
- Department of Pediatrics, Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University and First Clinical Medical College, Jinan University, Guangzhou 510120, P.R. China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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Verma R, Gupta M, Chaudhari TS. Neurogenic vision loss: Causes and outcome. An experience from a tertiary center in Northern India. J Neurosci Rural Pract 2014; 5:340-8. [PMID: 25288834 PMCID: PMC4173229 DOI: 10.4103/0976-3147.139971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Vision loss can be a consequence of numerous disorders of eye and neural pathway conveying visual input to brain. A variety of conditions can affect visual pathway producing neurogenic vision loss. The presentation and course of vision loss depends on the site of involvement and underlying etiology. We conducted this unprecedented study to evaluate the characteristics and outcome of various diseases of the visual pathway. MATERIALS AND METHODS In this prospective cohort study, we evaluated 64 patients with neurogenic visual impairment. Ophthalmological causes were excluded in all of them. Their presentation, ophthalmological characteristics and investigation findings were recorded. These patients were followed up till 6 months. RESULTS Out of 69 patients evaluated, 5 were excluded as they had ophthalmological abnormalities. The remaining 64 cases (113 eyes) were enrolled. 54 cases were due to diseases of anterior visual pathway and rest 10 had cortical vision loss. The etiologic distribution is as follows: Isolated optic neuritis- 12 (19%), multiple sclerosis- 4 (6.3%), neuromyelitis optica- 5 (7.9%), tubercular meningitis- 15 (23.8%), non-arteritic ischemic optic neuropathy, ischemic optic neuropathy complicating cavernous sinus thrombosis, cryptococcal meningitis, malignant infiltration of optic nerve, Crouzon's syndrome, calvarial thickening and traumatic occipital gliosis- 1 (1.6%) case each, idiopathic intracranial hypertension, pituitary adenoma, acute disseminated encephalomyelitis, posterior reversible leukoencephalopathy- 3 (4.8%) cases each, cortical venous thrombosis 5 (7.9%), subacute scleroing panencephalitis- 4 (6.3%) cases. CONCLUSIONS The diseases of anterior visual pathway were much more common than cortical vision loss. A majority of our patients had severe impairment of vision at presentation.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Mani Gupta
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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Haughey D, Narsipur SS. Posterior reversible encephalopathy syndrome after renal transplant: a simple solution for a complicated patient. Case Rep Nephrol Dial 2014; 5:20-5. [PMID: 25849670 PMCID: PMC4294450 DOI: 10.1159/000366554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by an acute neurologic dysfunction coupled with characteristic findings on brain imaging. PRES occurs in the setting of hypertensive emergencies, eclampsia and as a neurotoxic effect of immunosuppressive agents. While overwhelmingly reversible without residual deficits when promptly recognized, vague symptomatology may delay the diagnosis of PRES. Results/Summary A 50-year-old man who had undergone a recent kidney transplant was admitted to our clinic due to multiple episodes of seizure. He had no prior history of seizures or alcoholism. His transplantation had been without complication; he was discharged and given prednisone, tacrolimus, mycophenolate, acyclovir, trimethoprim-sulfamethoxazole, atenolol and enalapril. On the day of presentation, he experienced a severe headache, blurred vision and tonic-clonic seizure-like activity. His neurologic examination was limited by sedation, although no focal deficits were evident. Laboratory studies were unremarkable. A lumbar puncture revealed normal opening pressure, negative Gram stain, benign CSF analysis and India ink preparation. An MRI of the brain revealed bilateral enhancing parietal-occipital lesions, seen prominently on FLAIR sequence. Tacrolimus and all other medications were continued. The patient remained afebrile and normotensive and was extubated on the second hospital day. The patient reported no neurologic symptoms and was discharged on the third hospital day after a full recovery. Conclusions While the outcome of PRES is typically benign, a delay in diagnosis may lead to permanent neurologic deficits, and misdiagnosis can be lethal. The cornerstone of treatment is removal of the offending agent or treatment of the underlying etiology. A clinical picture of headache, visual abnormalities, altered mentation and seizures is sufficient to prompt an empiric discontinuation of agents known to cause PRES. Calcineurin inhibitors such as tacrolimus are known to cause PRES, and in our patient, discontinuation led to a complete clinical resolution.
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Suzuki D, Kobayashi R, Iguchi A, Sano H, Kishimoto K, Yasuda K, Kobayashi K. Tumor lysis syndrome as a risk factor for posterior reversible encephalopathy syndrome in children with hematological malignancies. Int J Hematol 2014; 100:485-9. [PMID: 25216697 DOI: 10.1007/s12185-014-1658-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by seizures, altered mental status and visual disorders, along with characteristic radiological findings. It is strongly related to hypertension induced by steroids and other immunosuppressive agents. There are an increasing number of reports regarding PRES arising during the course of chemotherapy for hematological malignancies. To clarify the risk factors for this phenomenon, we retrospectively analyzed pediatric patients undergoing treatment for hematological malignancies. Of 161 patients, six patients (3.7%) developed PRES with characteristic clinical and radiographic findings. Univariate analysis revealed that tumor lysis syndrome (TLS) was a significant risk factor for the onset of PRES. TLS is a significant risk factor for the development of PRES in pediatric patients receiving chemotherapy for hematological malignancies.
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Affiliation(s)
- Daisuke Suzuki
- Department of Pediatrics, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishiku, Sapporo, 003-0006, Japan,
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Dedić Plavetić N, Rakušić Z, Ozretić D, Simetić L, Krpan AM, Bišof V. Fatal outcome of posterior "reversible" encephalopathy syndrome in metastatic colorectal carcinoma after irinotecan and fluoropyrimidine chemotherapy regimen. World J Surg Oncol 2014; 12:264. [PMID: 25142792 PMCID: PMC4143544 DOI: 10.1186/1477-7819-12-264] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity characterized by headaches, altered mental status, seizures, and visual disturbances. It can occur in many different clinical entities such as severe hypertension and pre-eclampsia, or due to cytotoxic or immunosuppressive therapies. The pathogenesis of PRES is unclear, with dysregulated cerebral auto-regulation and endothelial dysfunction as important mechanisms proposed. Endothelial dysfunction is important especially in cases associated with cytotoxic therapies. Herein, we describe a patient with PRES with fatal outcome, who presented 5 days after the infusion of cycle 1 of irinotecan hydrochloride, leucovorin calcium, and fluorouracil (FOLFIRI) regimen chemotherapy, without prior hypertension and other comorbidity, suggesting a link between PRES and FOLFIRI regimen. To our knowledge, this case report is the first describing PRES after FOLFIRI regimen, although others have described PRES after FOLFIRI with bevacizumab in colonic cancer patients.
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Affiliation(s)
- Natalija Dedić Plavetić
- Department of Oncology, University Hospital Center, Kišpatićeva 12, HR-10000 Zagreb, Croatia.
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Abe T, Tokuda Y. Recurrent posterior reversible encephalopathy syndrome of the brainstem in a hypertensive patient with end-stage renal disease. J Emerg Trauma Shock 2014; 7:242-3. [PMID: 25114439 PMCID: PMC4126129 DOI: 10.4103/0974-2700.136876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/21/2013] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man with end-stage renal disease was brought to our emergency department with complaints of headache, nausea, dysarthria, tic, and weakness involving the bilateral arms and legs. He had the similar episode 4 month before, when he was treated elsewhere. The patient had received hemodialysis three times per week. His medications included for hypertension. On examination at his arrival, he was alert with reduced concentration and incoherent thoughts. The blood pressure was 181/87 mmHg and other vital signs were normal. Neurological findings showed slight dysarthria and slow movements but no other abnormalities. Laboratory data showed increased serum creatinine and potassium presumably for a session of periodical hemodialysis but normal sodium concentration. His cerebrospinal fluid examination was normal. We treated him by hemodialysis. Diagnosis of PRES was most likely because of the clinical features and the MRI findings. His symptoms had disappeared immediately and completely after we controlled high blood pressure. MRI on 13 days after admission showed the improvement of the abnormal findings. Although the pathophysiology of PRES is incompletely understood, renal failure was known as one of the risk factors. A relative lack of sympathetic innervation of posterior circulation could not protect the area when severe hypertension makes auto-regulatory control collapsed. However, PRES of the brainstem is uncommon although the posterior circulation involves it. Because control of his hypertension was not appropriate in the outpatient settings before this event, it could have contributed to the recurrence in this patient.
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Affiliation(s)
- Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Yasuharu Tokuda
- Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
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O'Kane M, Elhalwagy H, Kumar S, Badawi C. Unusual presentation of PRES in the postnatal period. BMJ Case Rep 2014; 2014:bcr-2013-203406. [PMID: 25008333 DOI: 10.1136/bcr-2013-203406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity, associated with a vast array of medical conditions and a variety of presenting symptoms. There is a characteristic pattern of radiographic features alongside suggestive clinical manifestations, which lead to a diagnosis of PRES. This report describes the case of a 39 years old, previously normotensive woman, who presented on day 7 postpartum with generalised tonic clonic seizures, reduced conscious level and a history of blurred vision and headache. She was treated immediately as eclamptic and transferred to the intensive care unit for stabilisation. Following an inconclusive CT result, an MRI was performed 2 days after presentation, which demonstrated white matter changes consistent with those found in PRES. She made a full recovery and a repeat MRI scan 7 weeks later showed no progression of the lesions noted on the original scan.
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Affiliation(s)
- Miriam O'Kane
- Department of O&G, Conquest Hospital, St Leonards-on-Sea, UK
| | - Hosam Elhalwagy
- Department of O&G, Conquest Hospital, St Leonards-on-Sea, UK
| | - Sathish Kumar
- Department of O&G, Conquest Hospital, St Leonards-on-Sea, UK
| | - Claire Badawi
- Department of O&G, Conquest Hospital, St Leonards-on-Sea, UK
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Hacihamdioğlu DÖ, Gökhan A, Cihan M, Mul K, Ferhan K, Süleymanoğlu S. Cyclosporin A-induced posterior reversible encephalopathy syndrome in an adolescent with steroid-resistant nephrotic syndrome. Int Urol Nephrol 2014; 46:2055-6. [DOI: 10.1007/s11255-014-0754-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
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Ungprasert P. An uncommon cause of alteration of consciousness in a patient with systemic lupus erythematosus. Am J Emerg Med 2014; 32:1155.e1-2. [PMID: 24680012 DOI: 10.1016/j.ajem.2014.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Patompong Ungprasert
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University Bangkok, Thailand.
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Le EM, Loghin ME. Posterior Reversible Encephalopathy Syndrome: A Neurologic Phenomenon in Cancer Patients. Curr Oncol Rep 2014; 16:383. [DOI: 10.1007/s11912-014-0383-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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