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Sadeghi A, Bakhshandeh Moghadam I, Hekmatdoost A, Salehi N, Zali MR. A case of posterior reversible encephalopathy syndrome during endoscopic retrograde cholangiopancreatography after anesthesia. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2022; 15:179-183. [PMID: 35845302 PMCID: PMC9275746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/12/2022] [Indexed: 10/26/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder that occurs following cerebral vasogenic edema. It has diverse clinical presentations from headache and vomiting to seizure and mental status alteration. Herein, we report a 54-year-old woman with no prior disease who developed PRES in the parieto-occipital lobes and brain stem after a second attempt endoscopic retrograde cholangiopancreatography (ERCP). To our knowledge, no case of PRES during ERCP has been reported to date. This case reminds us of unusual complications that are likely to occur after ERCP. It is believed that blood pressure fluctuations and anesthetic medications, fentanyl in particular, were the main precipitating factors causing the syndrome in the current case. Even if there is no specific treatment for this condition, a diagnosis is critical to start supportive treatment.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Bakhshandeh Moghadam
- Department of Neurology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Salehi
- Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Miller R, Wagner S, Hammond J, Roberts N, Marshall K, Barth B. Posterior reversible encephalopathy syndrome in the emergency department: A single center retrospective study. Am J Emerg Med 2021; 45:61-64. [PMID: 33667750 DOI: 10.1016/j.ajem.2021.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Posterior Reversible Encephalopathy Syndrome (PRES) and the related term Reversible Posterior Leukoencephalopathy Syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. These symptoms may include headache, altered mental status, visual changes, and seizures. PRES is a rare condition and remains a challenging diagnosis to make in the emergency department. Data on risk factors and clinical presentation are limited, and there is no recent literature-supported diagnostic criteria. Our primary objective was to identify initial symptoms, clinical presentation, and risk factors that should guide the emergency clinician to consider a diagnosis of PRES. A secondary objective was to identify associations between risk factors and the outcomes of mortality and ICU admissions. METHODS This was a retrospective, observational study that evaluated patients seen in the Emergency Department (ED) in an urban tertiary care center with the diagnosis of PRES or RPLS from 1/1/2008 to 1/1/2018. The Health System's Electronic Medical Record was used to collect data. Search criteria included any patient diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) or Reversible Posterior Leukoencephalopathy Syndrome (RPLS), and excluded patients under 18 years of age, transfer patients, or patients that were not evaluated in our emergency department. RESULTS We identified 98 patients based on our initial search criteria. After a chart review, 27 patients met our predefined eligibility criteria. In patients with confirmed diagnosis of PRES, the majority were female (70%) and 37% were either on an immunomodulator or undergoing chemotherapy at the time of presentation. 67% of patients presented with altered mental status, 41% had a focal neurologic deficit, and 37% had a witnessed seizure prior to diagnosis. Headache (48%), nausea (33%), and vision changes (30%) were the next most common reported symptoms. The majority of patients were hypertensive at time of presentation (82%) and many had a past medical history of hypertension (78%); twelve were given anti-hypertensive medications. 33% of the patients were admitted to the ICU and 26% died. There were no statistical associations found between documented ED interventions and the outcome of mortality. CONCLUSION PRES is difficult to identify and diagnose in the emergency department. Significant risk factors such as female gender, hypertension, and those currently undergoing active immunotherapy/chemotherapy are associated with PRES. Common presenting complaints and exam findings include headache, altered mental status, and neurologic deficits. Emergency providers should consider PRES in patients presenting with altered mental status with significant risk factors, especially with neurologic deficits for which stroke has been ruled out.
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Affiliation(s)
- Ross Miller
- University of Kansas Medical Center, Kansas City, KS, USA.
| | - Samuel Wagner
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Jordan Hammond
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Nathan Roberts
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ken Marshall
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley Barth
- University of Kansas Medical Center, Kansas City, KS, USA
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Leucoencefalopatía posterior reversible tras sobredosis de carbimida. Neurologia 2020; 35:67-68. [DOI: 10.1016/j.nrl.2017.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/21/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022] Open
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Willard N, Honce JM, Kleinschmidt-DeMasters BK. PRES: Review of Histological Features. J Neuropathol Exp Neurol 2019; 77:100-118. [PMID: 29325172 DOI: 10.1093/jnen/nlx112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Posterior reversible encephalopathy syndrome was described in 1996 as a clinical-neuroimaging entity characterized by parieto-occipital watershed-region edema without overt infarction. It has been linked to hypertension, eclampsia, immunosuppressive therapies, infections, and autoimmune disorders. The condition usually has an acute onset, presents with seizures, and ameliorates within days. There have been few neuropathological studies, but in some cases, tissue damage may be more permanent.
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Affiliation(s)
- Nicholas Willard
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Justin M Honce
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - B K Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado.,Departments of Neurology and Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
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Influential factors and clinical significance of an atypical presentation of posterior reversible encephalopathy syndrome in patients with eclampsia. Neurol Sci 2018; 40:377-384. [PMID: 30478719 DOI: 10.1007/s10072-018-3642-5] [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: 08/28/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity for which eclampsia is one of the most common predisposing conditions. Despite the imaging changes typically reported, the predisposing factors and clinical implications of atypical presentations have yet to be fully clarified. METHODS A total of 56 patients with PRES were selected for study. Demographic, clinical, and laboratory data were analyzed, focusing on atypical presentations of PRES. Multiple logistic regression was applied to identify factors impacting such atypical presentations, and functional outcomes were assessed upon patient discharge. RESULTS Overall, 22 of the 56 patients (39.3%) displayed features of atypical PRES. By multiple logistic regression, headache (OR = 5.39; 95% CI, 1.24-23.51; p = 0.025) and frequent convulsions (OR = 4.41; 95% CI, 1.09-17.91; p = 0.038) proved to be independent factors associated with atypical PRES. Ultimately, outcomes of 18 patients were gauged as poor, based on the modified Rankin Scale (mRS). Logistic regression indicated that visual disturbances (OR = 9.02; 95% CI, 1.37-59.35; p = 0.02), frequent convulsions (OR = 9.47; 95% CI, 1.67-53.63; p = 0.01), and restricted diffusion on imaging (OR = 11.96; 95% CI, 1.76-81.11; p = 0.01) were independently associated with poor outcomes in patients with eclampsia-related PRES. CONCLUSION Headache and frequent convulsions are independently associated with atypical presentations of PRES. If present, restricted diffusion may help in predicting poor outcomes of such patients upon discharge.
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Lio CF, Lee YH, Chan HY, Yu CC, Peng NJ, Chan HP. Posterior reversible encephalopathy syndrome in a postpartum hemorrhagic woman without hypertension: A case report. Medicine (Baltimore) 2017; 96:e6690. [PMID: 28422884 PMCID: PMC5406100 DOI: 10.1097/md.0000000000006690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Posterior reversible encephalopathy syndrome (PRES), which diagnosis is based on clinical symptoms and radiological features, is a neurotoxic disease characterized by a set of clinical manifestations, such as seizure, headache, visual, and/or consciousness disturbance. It is the first case of PRES followed by postpartum hemorrhage (PPH) without underlying disease. PATIENT CONCERNS A 37-year-old healthy woman had PPH after caesarean section. Six days after delivery, headache occurred suddenly, followed by episodes of clonus seizure. DIAGNOSES Brain computed tomography showed ischemic stroke. However, magnetic resonance imaging revealed characteristics consistent with PRES. INTERVENTIONS The patient received phenytoin for seizure control. OUTCOMES Seizure was under good control over the following days. Three months later, repeated magnetic resonance imaging showed complete remission. LESSONS PRES may be triggered by PPH and is not necessarily secondary to typical predisposing factors such as hypertension or pre/eclampsia. Hormone fluctuation, increased blood pressure variation, and massive blood transfusion may be contributed to the development of PRES in our case. Also, it is necessary to rule out those life-threatening diseases, such as cavernoma hemorrhage, cerebral venous thrombosis, and ischemic stroke before the diagnosis of PRES.
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Affiliation(s)
- Chon-Fu Lio
- Centro Hospitalar Conde de São Januário, Macao, China
| | - Ying-Hua Lee
- Department of Medicine, National Defense Medical Center, Taipei City
| | - Hung-Yen Chan
- Department of Emergency, E-Da Hospital, Kaohsiung City
| | - Chang-Ching Yu
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Nan-Jing Peng
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Hung-Pin Chan
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
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Hayashi Y, Kimura A, Nakamura H, Mimuro M, Iwasaki Y, Hara A, Yoshida M, Inuzuka T. Neuropathological findings from an autopsied case showing posterior reversible encephalopathy syndrome-like neuroradiological findings associated with premedication including tacrolimus for autologous peripheral blood stem cell transplantation. J Neurol Sci 2017; 375:382-387. [PMID: 28320172 DOI: 10.1016/j.jns.2017.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 12/27/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is diagnosed based on neuroradiological findings. Typically, PRES is reversible and presents with a good outcome; however, fatal outcomes have been reported. We report an autopsied case showing PRES-like neuroradiological findings associated with premedication including tacrolimus for autologous peripheral blood stem cell transplantation in a 28-year-old woman with a 2-year history of acute myeloid sarcoma/acute myeloid leukemia. Neurological examination revealed disturbed consciousness, muscle weakness in all extremities, and bilaterally diminished tendon reflexes. Brain fluid attenuated inversion recovery MRI showed multiple bilateral hyper-intensity areas in the posterior white matter and left corona radiate. She died of respiratory arrest within 24h after PRES diagnosis. Neuropathological examination revealed diffuse cerebral edema, multiple cerebral hematomas that extended into the lateral ventricles and subarachnoid cavities, and multiple microbleeds predominantly in the inferior surface of the occipital white matter. Microscopic findings revealed paler myelin sheaths, enlargement of the vascular endothelium, leakage of plasma components and red blood cells, and clasmatodendrosis within the occipital white matter. Cerebral herniation and diffuse cerebral edema due to vascular endothelial dysfunction were concluded to be the cause of death. These pathological findings may aid in the pathophysiological recognition of acute-stage PRES.
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Affiliation(s)
- Yuichi Hayashi
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Akio Kimura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Hiroshi Nakamura
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Maya Mimuro
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute 480-1195, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute 480-1195, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute 480-1195, Japan
| | - Takashi Inuzuka
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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Aracki-Trenkić A, Stojanov D, Trenkić M, Radovanović Z, Ignjatović J, Ristić S, Trenkić-Bozinović M. Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients. Bosn J Basic Med Sci 2016; 16:180-6. [PMID: 27322924 DOI: 10.17305/bjbms.2016.1201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/16/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an obstetric emergency frequently occurring in a pregnant or puerperal woman, manifested with an acute headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem and basal ganglia. Since magnetic resonance imaging (MRI) is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image.
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Van Aalst J, Teernstra OP, Weber WE, Rijkers K. An unusual case of posterior reversible encephalopathy syndrome in a patient being weaned from intrathecal morphine. Int Med Case Rep J 2016; 9:117-20. [PMID: 27274314 PMCID: PMC4876847 DOI: 10.2147/imcrj.s98569] [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] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity based on clinical signs, including headache, visual abnormalities, and seizures, and radiological abnormalities mostly consisting of vasogenic brain edema predominantly in the posterior parietal-temporal-occipital regions. PRES typically develops in the setting of a significant “ systemic process”, including preeclampsia, transplantation, infection/sepsis/shock, autoimmune disease, and cancer chemotherapy, in which hypertension often plays an important role. We present a case of PRES in a 63-year-old female patient with an infected intrathecal morphine pump on a cocktail of antibiotics, morphine, clonidine, diazepam, and amitriptyline. It is the first PRES case in a chronic pain patient, which illustrates that PRES can occur in the absence of any of the established risk factors. We hypothesize it may have been caused by antibiotic treatment in our patient.
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Affiliation(s)
- Jasper Van Aalst
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Onno P Teernstra
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Wim E Weber
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands
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Aracki-Trenkić A, Stojanov D, Trenkić M, Benedeto-Stojanov D, Đorđević M, Ignjatović J, Tasić A, Lazović L. IMAGING CHARACTERISTICS OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES). ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Babi MA, Gorman MJ, Cipolla MJ, Allen G, Al Jerdi S, Clouser R, Commichau C. Ondansetron-related hemorrhagic posterior reversible encephalopathy syndrome (PRES) following gastric bypass. SPRINGERPLUS 2016; 5:18. [PMID: 26759757 PMCID: PMC4703598 DOI: 10.1186/s40064-015-1644-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/20/2015] [Indexed: 02/06/2023]
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome formally recognized in 1996, which describes specific changes noted on neuroimaging thought to be related to impaired cerebral blood flow autoregulation and endothelial dysfunction. We report a case of PRES in the setting of increased ingestion of ondansetron; complicated by hemorrhagic transformation and refractory intracranial hypertension. We hypothesize an association of 5-HT3 antagonism and PRES. Findings This is a case study report; with review of previously published literature through PubMed search. We describe the case of a 25 year old man following bariatric surgery who increased his ingestion of ondansetron, taking up to 40 tablets/day due to excessive nausea and vomiting. The patient was hospitalized for progressively more severe headache of 1 week’s duration. Computed tomography (CT) revealed bilateral cerebral edema in the parietal and occipital lobes in the setting of elevated blood pressure (BP). Three days into his admission, following improvement in his BP with oral anti-hypertensive but continued use of the ondansetron, the patient developed near complete blindness. CT head imaging revealed progression of the posterior cerebral edema and intraparenchymal hemorrhage. He was admitted to our ICU and despite supportive treatment, his neurological examination worsened while CT head imaging findings remained stable. Invasive multimodality monitoring revealed elevated intracranial pressure. The patient was aggressively treated and after a prolonged hospitalization and rehabilitation course, made a significant recovery. Conclusion This case highlights a very rare potential neurological complication of ondansetron, a commonly used medication. We hypothesize an underlying association between PRES and 5-HT3 antagonism, via the latter’s potential role in endothelial dysfunction. Prompt recognition and treatment of PRES is essential, in order to prevent secondary cerebral injury and the associated potentially grave consequences.
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Affiliation(s)
- M Alain Babi
- Department of Neurological Sciences, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA ; Division of Neuro-critical care, Department of Neurology, Duke University Hospital, DUMC 2900, Durham, NC 27710 USA
| | - Mark J Gorman
- Department of Neurological Sciences, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA
| | - Marilyn J Cipolla
- Department of Neurological Sciences, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA
| | - Gilman Allen
- Department of Medicine, Division of Pulmonary Medicine and Critical Care, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA
| | - Salman Al Jerdi
- Department of Neurological Sciences, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA
| | - Ryan Clouser
- Department of Medicine, Division of Pulmonary Medicine and Critical Care, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA
| | - Christopher Commichau
- Department of Neurological Sciences, The University of Vermont Medical Center and the University of Vermont College of Medicine, Burlington, VT 05405 USA
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Zhou J, Zheng H, Zhong X, Wu D, Wang M, Tang X, Li Q. Reversible posterior encephalopathy syndrome in children with nephrotic syndrome. Nephrology (Carlton) 2015; 20:849-54. [DOI: 10.1111/nep.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Juan Zhou
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Helin Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Xuefei Zhong
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Daoqi Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Mo Wang
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Xuemei Tang
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Qiu Li
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
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Thompson RJ, Sharp B, Pothof J, Hamedani A. Posterior reversible encephalopathy syndrome in the emergency department: case series and literature review. West J Emerg Med 2015; 16:5-10. [PMID: 25671001 PMCID: PMC4307725 DOI: 10.5811/westjem.2014.12.24126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 11/15/2022] Open
Abstract
Introduction Posterior Reversible Encephalopathy Syndrome (PRES) often has variable presentations and causes, with common radiographic features—namely posterior white matter changes on magnetic resonance (MRI). As MRI becomes a more frequently utilized imaging modality in the Emergency Department, PRES will become an entity that the Emergency Physician must be aware of and be able to diagnose. Case Report We report three cases of PRES, all of which presented to the emergency department of a single academic medical center over a short period of time, including a 53-year-old woman with only relative hypertension, a 69-year-old woman who ultimately died, and a 46-year-old woman who had a subsequent intraparenchymal hemorrhage. Conclusion PRES is likely much more common than previously thought and is a diagnosis that should be considered in a wide variety of emergency department patient presentations.
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Affiliation(s)
- Ryan J Thompson
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Brian Sharp
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Jeffery Pothof
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Azita Hamedani
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
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Zhang Y, Zhou J, Chen Y. Posterior reversible encephalopathy syndrome in a child with steroid-resistant nephrotic syndrome: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:4433-4437. [PMID: 25120830 PMCID: PMC4129065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/28/2014] [Indexed: 06/03/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare and serious syndrome of central nervous system that can develop in both adults and children. It is characterized by acute onset of headache, confusion, seizures or focal neurological deficits along with radiological findings of white matter abnormalities in the parietal and occipital lobes. In the past ten years, this syndrome has been described mainly in adults, rare in children. Here, we report a case of PRES presenting in a 12-year-old girl with steroid-resistant nephrotic syndrome. Her neurological symptom was rapidly recovered after control of hypertension without discontinuation of cyclosporine A.
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Affiliation(s)
- Yu Zhang
- Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
| | - Jianhua Zhou
- Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
| | - Yu Chen
- Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
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Síndrome de encefalopatía posterior reversible: 5 casos relacionados con quimioterapia. An Pediatr (Barc) 2014; 80:117-21. [DOI: 10.1016/j.anpedi.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 11/21/2022] Open
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Posterior reversible encephalopathy syndrome as the first presentation of chronic kidney disease. Am J Emerg Med 2013; 32:489.e1-3. [PMID: 24342863 DOI: 10.1016/j.ajem.2013.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 11/07/2013] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinicoradiologic syndrome characterized by seizure, headache, nausea, vomiting, altered mental status, visual disturbance, or visual loss, together with radiologic findings. Herein we reported a patient who was a 27-year-old foreign workman brought to the emergency ward with blurred vision in both eyes, neck pain, somnolence, and altered mental status. He had no known medical or family history. On his physical examination, his blood pressure was 190/100 mmHg and visual acuity of both eyes was decreased (visual acuity = 20/40 for both eyes). Although blood pressure was controlled by intravenous labetalol bolus, his symptoms did not improve. The result of his brain computed tomographic scan was normal, but in the brain magnetic resonance imaging, there were hyperintensities in the occipital lobe and right cerebellar hemisphere, suggesting posterior reversible encephalopathy syndrome. The findings from a complete blood count, biochemical testing, and renal, pelvic and abdominal ultrasound and also the calculated glomerular filtration rate values revealed that all were in favor of chronic kidney disease (hemoglobin level, 10.3 mg/dL; blood urea nitrogen, 90 mg/dL; Cr, 6.8 mg/dL; potassium, 5 mEq/L; sodium, 140 mEq/L; Cockcroft-Gault glomerular filtration rate, 15; weight, 65 kg). The hemodialysis was performed by which the sign and symptoms and radiologic findings resolved within 24 hours. Although PRES is described to be in association with many medical conditions, as mentioned in many available articles, we came to a conclusion that PRES could be the first presentation of a condition such as chronic kidney disease in our case.
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