ASYMPTOMATIC SPINAL CORD INVOLVEMENT IN POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME

The Spectrum of Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome consists of acute to subacute symptoms which include seizures, encephalopathy, headaches, visual hallucinations or visual loss, and focal neurologic deficits in the setting of vasogenic brain edema. Both the clinical and radiographic findings are reversible in most, leading to a favorable neurologic prognosis. Less commonly, patients may have residual neurologic sequelae, often in cases with associated structural injury such as intracranial hemorrhage or stroke. A minority of patients develop a severe form, "malignant PRES" which can be fatal and may require intensive care unit care with aggressive therapies such as intubation, hyperosmolar therapy, ventriculostomy placement, or decompressive surgery.

PRES with asymptomatic spinal cord involvement. Is this scenario more common than we know?

INTRODUCTION

Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by neurologic symptoms such as headaches, altered mental status, seizures and visual changes, and it is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain.

CASE REPORT

A 19-year-old patient developed PRES after the use of chemotherapy for a testicular teratocarcinoma and after the development of a blood pressure elevation.

DISCUSSION

Few cases described the involvement of the spinal cord in this syndrome. In the majority of these cases, the spinal cord involvement was asymptomatic or with few symptoms of spinal cord disease.

Posterior reversible encephalopathy syndrome with spinal cord involvement (PRES-SCI): A case report

Posterior reversible encephalopathy syndrome with spinal cord involvement (PRES-SCI) is a recently described entity with a handful of cases reported in literature. We describe a case of PRES in setting of Henoch-Schönlein purpura (HSP) with involvement of brain stem and spinal cord.

Posterior reversible encephalopathy syndrome with involvement of the cervical cord and medulla: a case report

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, which is associated with symmetrical subcortical areas of vasogenic oedema that are preferentially parieto-occipital, and it typically resolves within a few weeks after appropriate treatment, We hereby report a case of a female with adrenal tumour presenting with PRES, who was featured by a very rare neuroimaging manifestation, the involvement of cervical cord and medulla.

Posterior reversible encephalopathy syndrome masquerading as progressive multifocal leukoencephalopathy in rituximab treated neuromyelitis optica

Both progressive multifocal leukoencephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) have been reported as complications of rituximab therapy. These disorders may appear indistinguishable on magnetic resonance imaging (MRI). We report on a 42 year old woman with neuromyelitis optica (NMO) of 10 years duration who developed extensive white matter disease affecting chiefly both parietal lobes 6 months after her first and only dose of rituximab. The MRI findings suggested the diagnosis of PML, but her history was more consistent with PRES. Ultimately, a brain biopsy was performed which was consistent with the diagnosis of PRES. PRES and PML may have overlapping symptomatology and be indistinguishable on MRI. An approach to distinguishing between these two disorders is addressed.