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Greco F, Buoso A, Cea L, D’Andrea V, Bernetti C, Beomonte Zobel B, Mallio CA. Magnetic Resonance Imaging in Uremic Encephalopathy: Identifying Key Imaging Patterns and Clinical Correlations. J Clin Med 2024; 13:4092. [PMID: 39064132 PMCID: PMC11278456 DOI: 10.3390/jcm13144092] [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: 06/04/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Magnetic Resonance Imaging (MRI) is essential in diagnosing neurological conditions, offering detailed insights into brain pathology. Uremic encephalopathy (UE) is a severe neurological disorder resulting from renal failure, characterized by cognitive impairments and brain abnormalities due to the accumulation of uremic toxins (UTs). Despite extensive research on UTs, there is a significant gap in the detailed characterization of MRI findings in UE patients. This study aims to bridge this gap by conducting a comprehensive literature review of cerebral MRI findings in UE. We hypothesize that specific MRI patterns correlate with the severity and clinical manifestations of UE, thereby enhancing diagnostic accuracy and improving patient outcomes. Methods: A literature review was performed using PubMed, Cochrane Library, and Google Scholar. The search terms included "uremic encephalopathy MRI", "uremia and kidney failure MRI", and "toxic and metabolic or acquired encephalopathies MRI". The inclusion criteria were original articles on UE and MRI findings published in English. Results: Common MRI sequences include T1-weighted, T2-weighted, FLAIR, and DWI. Frequent MRI findings in UE are cytotoxic and vasogenic brain edema in regions such as the basal ganglia and periventricular white matter. Patterns like the "lentiform fork sign" and basal ganglia involvement are key indicators of UE. Conclusions: MRI plays a crucial role in diagnosing UE by identifying characteristic brain edema and specific patterns. A comprehensive diagnostic approach, incorporating clinical, laboratory, and imaging data, is essential for accurate diagnosis and management. The study calls for larger well-designed cohorts with long-term follow-up to improve the understanding and treatment of UE.
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Affiliation(s)
- Federico Greco
- Department of Radiology, Cittadella della Salute, Azienda Sanitaria Locale di Lecce, Piazza Filippo Bottazzi, 2, 73100 Lecce, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
| | - Andrea Buoso
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Laura Cea
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Valerio D’Andrea
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Caterina Bernetti
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Bruno Beomonte Zobel
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Carlo Augusto Mallio
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; (A.B.); (L.C.); (V.D.); (C.B.); (C.A.M.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
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Rossi S, Rinaldi R, Asioli GM, Barone V, Pianta P, Cescon M, Morelli MC, Faccioli L, Spinardi L, Cortelli P, Guarino M. Tacrolimus-associated neurotoxicity isolated to the brainstem: two illustrative cases and a systematic review of the literature. Neurol Sci 2024; 45:3107-3115. [PMID: 38460049 DOI: 10.1007/s10072-024-07433-8] [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: 01/25/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Tacrolimus-associated neurotoxicity (TAN) manifests with wide clinical spectrum, ranging from mild tremors to severe encephalopathy. The isolated involvement of the brainstem is a rarely documented presentation of TAN, and its clinical and diagnostic characteristics are unclear. METHODS We report two cases of brainstem-isolated TAN (bi-TAN). Moreover, we performed a systematic review of the literature on bi-TAN and extracted data concerning demographics, clinical characteristics, radiological features, and management. The systematic literature search followed PRISMA guidelines and a pre-defined protocol. RESULTS Eleven patients, including our two, were identified (mean age: 41.3 years, ± 18.8; five males, 45%). Speech disturbance was the most common clinical presentation (45%). The mean latency from Tacrolimus initiation to bi-TAN onset was 26 days (± 30.8). Tacrolimus serum level tested above the reference range in three patients (mean: 26.83 ± 5.48). Brain MRI showed T2-FLAIR hyperintensities; three showed restricted diffusion on ADC maps. Neurological symptoms resolved completely in seven patients (63%) after Tacrolimus withdrawal or dose reduction. CONCLUSIONS Our findings suggest that bi-TAN could represent a brainstem variant of posterior reversible encephalopathy syndrome. Recognition of bi-TAN as a potential cause of isolated brainstem lesions is crucial to disentangle the diagnostic work-up and ensure prompt withdrawal or reduction of the offending agent.
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Affiliation(s)
- Simone Rossi
- UOC Clinica Neurologica - Rete Neurologica Metropolitana (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
| | - Rita Rinaldi
- UOC Clinica Neurologica - Rete Neurologica Metropolitana (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Gian Maria Asioli
- UOC Clinica Neurologica - Rete Neurologica Metropolitana (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Valentina Barone
- UOC Clinica Neurologica - Rete Neurologica Metropolitana (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Paolo Pianta
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Matteo Cescon
- Hepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Luca Faccioli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Luca Spinardi
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pietro Cortelli
- UOC Clinica Neurologica - Rete Neurologica Metropolitana (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, Bologna, Italy
| | - Maria Guarino
- UOC Clinica Neurologica - Rete Neurologica Metropolitana (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
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Core D, Vervaeke H, Leethy K, Cooper D, Zoorob D. Eclampsia, HELLP and PRES in a 16-week partial molar pregnancy. BMJ Case Rep 2024; 17:e258188. [PMID: 38890113 PMCID: PMC11191011 DOI: 10.1136/bcr-2023-258188] [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] [Accepted: 04/10/2024] [Indexed: 06/20/2024] Open
Abstract
Eclampsia spectrum disorders are a set of serious complications of pregnancy that commonly present after 20 weeks of gestation. There is an association between molar pregnancy, a gestational trophoblastic disease resulting from abnormal fertilisation and gametogenesis, and eclampsia spectrum disorders which can result in manifestation of pre-eclamptic symptomatology earlier than 20 weeks of gestation. We report a case of a gravida 1 para 0 in her mid 20s at 16-weeks gestation presenting with partial hydatidiform mole who developed eclampsia, haemolysis, elevated liver enzymes and low platelets syndrome and posterior reversible encephalopathy syndrome. Ultrasound findings were consistent with molar pregnancy and pathology confirmed partial molar pregnancy with triploid 69, XYY karyotype. This case highlights the early onset potential of eclampsia spectrum disorders in molar pregnancies while suggesting screening such patients for hypertensive disorders.
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Affiliation(s)
- Daniel Core
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Hayley Vervaeke
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Kenna Leethy
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Danielle Cooper
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Dani Zoorob
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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Govaert P, Arena R, Dudink J, Steggerda S, Agut T, Marissens G, Hoebeek F. Developmental anatomy of the thalamus, perinatal lesions, and neurological development. Dev Med Child Neurol 2024. [PMID: 38875159 DOI: 10.1111/dmcn.15992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
The thalamic nuclei develop before a viable preterm age. GABAergic neuronal migration is especially active in the third trimester. Thalamic axons meet cortical axons during subplate activation and create the definitive cortical plate in the second and third trimesters. Default higher-order cortical driver connections to the thalamus are then replaced by the maturing sensory networks, in a process that is driven by first-order thalamic neurons. Surface electroencephalographic activity, generated first in the subplate and later in the cortical plate, gradually show oscillations based on the interaction of the cortex with thalamus, which is controlled by the thalamic reticular nucleus. In viable newborn infants, in addition to sensorimotor networks, the thalamus already contributes to visual, auditory, and pain processing, and to arousal and sleep. Isolated thalamic lesions may present as clinical seizures. In addition to asphyxia and stroke, infection and network injury are also common. Cranial ultrasound can be used to classify neonatal thalamic injuries based on functional parcelling of the mature thalamus. We provide ample illustration and a detailed description of the impact of neonatal focal thalamic injury on neurological development, and discuss the potential for neuroprotection based on thalamocortical plasticity.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Roberta Arena
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Jeroen Dudink
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Thais Agut
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Freek Hoebeek
- Department for Developmental Origins of Disease/Brain Centre, Division Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Kaufmann J, Buecke P, Meinel T, Beyeler M, Scutelnic A, Kaesmacher J, Mujanović A, Dobrocky T, Arsany H, Peters N, Z'Graggen W, Jung S, Seiffge D. Frequency of ischaemic stroke and intracranial haemorrhage in patients with reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) - A systematic review. Eur J Neurol 2024; 31:e16246. [PMID: 38470001 PMCID: PMC11235994 DOI: 10.1111/ene.16246] [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: 07/09/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) may cause ischaemic stroke and intracranial haemorrhage. The aim of our study was to assess the frequency of the afore-mentioned outcomes. METHODS We performed a PROSPERO-registered (CRD42022355704) systematic review and meta-analysis accessing PubMed until 7 November 2022. The inclusion criteria were: (1) original publication, (2) adult patients (≥18 years), (3) enrolling patients with PRES and/or RCVS, (4) English language and (5) outcome information. Outcomes were frequency of (1) ischaemic stroke and (2) intracranial haemorrhage, divided into subarachnoid haemorrhage (SAH) and intraparenchymal haemorrhage (IPH). The Cochrane Risk of Bias tool was used. RESULTS We identified 848 studies and included 48 relevant studies after reviewing titles, abstracts and full text. We found 11 studies on RCVS (unselected patients), reporting on 2746 patients. Among the patients analysed, 15.9% (95% CI 9.6%-23.4%) had ischaemic stroke and 22.1% (95% CI 10%-39.6%) had intracranial haemorrhage. A further 20.3% (95% CI 11.2%-31.2%) had SAH and 6.7% (95% CI 3.6%-10.7%) had IPH. Furthermore, we found 28 studies on PRES (unselected patients), reporting on 1385 patients. Among the patients analysed, 11.2% (95% CI 7.9%-15%) had ischaemic stroke and 16.1% (95% CI 12.3%-20.3%) had intracranial haemorrhage. Further, 7% (95% CI 4.7%-9.9%) had SAH and 9.7% (95% CI 5.4%-15%) had IPH. CONCLUSIONS Intracranial haemorrhage and ischaemic stroke are common outcomes in PRES and RCVS. The frequency reported in the individual studies varied considerably.
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Affiliation(s)
- Jana Kaufmann
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
| | - Philipp Buecke
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
| | - Thomas Meinel
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
| | - Morin Beyeler
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
| | - Adrian Scutelnic
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional NeuroradiologyInselspital University Hospital and University of BernBernSwitzerland
| | - Adnan Mujanović
- Institute of Diagnostic and Interventional NeuroradiologyInselspital University Hospital and University of BernBernSwitzerland
| | - Thomas Dobrocky
- Institute of Diagnostic and Interventional NeuroradiologyInselspital University Hospital and University of BernBernSwitzerland
| | - Hakim Arsany
- Institute of Diagnostic and Interventional NeuroradiologyInselspital University Hospital and University of BernBernSwitzerland
| | - Nils Peters
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix PlatterUniversity of BaselBaselSwitzerland
- Stroke CenterHirslanden ClinicZurichSwitzerland
| | - Werner Z'Graggen
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
- Department of NeurosurgeryInselspital University Hospital and University of BernBernSwitzerland
| | - Simon Jung
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
| | - David Seiffge
- Department of NeurologyInselspital University Hospital and University of BernBernSwitzerland
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Ludovichetti R, Nierobisch N, Achangwa NR, De Vere-Tyndall A, Fierstra J, Reimann R, Togni C, Terziev R, Galovic M, Kulcsar Z, Hainc N. The split apparent diffusion coefficient sign: A novel magnetic resonance imaging biomarker for cortical pathology with possible implications in autoimmune encephalitis. Neuroradiol J 2024; 37:206-213. [PMID: 38146643 DOI: 10.1177/19714009231224416] [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] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION MRI is the imaging modality of choice for assessing patients with encephalopathy. In this context, we discuss a novel biomarker, the "split ADC sign," where the cerebral cortex demonstrates restricted diffusion (high DWI signal and low ADC) and the underlying white matter demonstrates facilitated diffusion (high or low DWI signal and high ADC). We hypothesize that this sign can be used as a biomarker to suggest either acute encephalitis onset or to raise the possibility of an autoimmune etiology. MATERIALS AND METHODS A full-text radiological information system search of radiological reports was performed for all entities known to produce restricted diffusion in the cortex excluding stroke between January 2012 and June 2022. Initial MRI studies performed upon onset of clinical symptoms were screened for the split ADC sign. RESULTS 25 subjects were encountered with a positive split ADC sign (15 female; median age = 57 years, range 18-82). Diagnosis included six herpes simplex encephalitis, three peri-ictal MRI changes, eight PRES, two MELAS, and six autoimmune (3 anti-GABAAR, two seronegative, and one anti-Ma2/Ta). Subjects were imaged at a mean 1.8 days after the onset of symptoms (range 0-8). DISCUSSION We present a novel visual MRI biomarker, the split ADC sign, and highlight its potential usefulness in subjects with encephalopathy to suggest acute disease onset or to raise the possibility of an autoimmune etiology when location-based criteria are applied. When positive, the sign was present on the initial MRI and can therefore be used to help focus further clinical and laboratory workup.
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Affiliation(s)
- Riccardo Ludovichetti
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nathalie Nierobisch
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Ngwe Rawlings Achangwa
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Anthony De Vere-Tyndall
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Regina Reimann
- Institute of Neuropathology, University Hospital of Zurich, University of Zurich, Switzerland
| | - Claudio Togni
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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Makkawi S, Khojah O, Baeshen SK, Ahmed ME. Clinical and Radiological Features of Unilateral Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report. Cureus 2024; 16:e58774. [PMID: 38784364 PMCID: PMC11111322 DOI: 10.7759/cureus.58774] [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] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by reversible vasogenic edema predominantly affecting the posterior regions of the cerebral hemispheres. However, unilateral presentation of PRES is an exceptionally rare manifestation. We describe the case of a 34-year-old woman who presented with left-sided hemiparesis, hemisensory loss, headache, and focal motor seizures. Brain CT revealed right anterior and posterior hypodensities in the right frontal and parietal subcortical locations, brain MRI showed vasogenic edema in the subcortical right cerebral hemisphere, and cerebral angiogram revealed diffuse narrowing of the left internal carotid artery just distal to the carotid bifurcation with no flow of contrast beyond the ophthalmic segment. The patient's symptoms resolved during her admission, MRI findings improved on repeated imaging, and she was ultimately diagnosed with unilateral PRES. Unilateral PRES is a complex and challenging diagnosis, and this case sheds light on the atypical radiological features of unilateral PRES possibly intricately linked with contralateral steno-occlusive disease of the carotid artery. It is essential to maintain the atypical variants of PRES as part of the differential diagnosis when encountering acute neurological symptoms and vasogenic edema on imaging in the context of contralateral steno-occlusive disease of the carotid artery.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Salem K Baeshen
- Department of Neurology, King Fahad General Hospital, Jeddah, SAU
| | - Muhammad E Ahmed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Radiology, Ministry of the National Guard-Health Affairs, Jeddah, SAU
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Bonduelle T, Ollivier M, Gradel A, Aupy J. Brain MRI in status epilepticus: Relevance of findings. Rev Neurol (Paris) 2024:S0035-3787(24)00423-5. [PMID: 38472033 DOI: 10.1016/j.neurol.2023.12.011] [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: 07/17/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 03/14/2024]
Abstract
Status epilepticus (SE) represents one of the most common neurological emergencies, associated with high mortality and an important risk of functional sequelae in survivors. Magnetic resonance imaging (MRI) offers the possibility of early and noninvasive observation of seizure-induced parenchymal disturbances secondary to the epileptic process. In the present review, we propose a descriptive and comprehensive understanding of current knowledge concerning seizure-induced MRI abnormalities in SE, also called peri-ictal MRI abnormalities (PMAs). We then discuss how PMAs, as a noninvasive biomarker, could be helpful to optimize patient prognostication in SE management. Finally, we discuss alternative promising MRI approaches, including arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), dynamic contrast-enhanced (DCE) MRI and dynamic susceptibility contrast (DSC) MRI that could refine our understanding of SE, particularly in non-convulsive form.
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Affiliation(s)
- T Bonduelle
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - M Ollivier
- Department of Neuroimaging, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - A Gradel
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - J Aupy
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; CNRS, IMN, UMR 5293, Université de Bordeaux, Bordeaux, France
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Zedde M, Grisendi I, Assenza F, Vandelli G, Napoli M, Moratti C, Valzania F, Pascarella R. Posterior reversible encephalopathy syndrome and acute ischemic stroke: an underreported association. Neurol Sci 2024; 45:1249-1254. [PMID: 38044394 DOI: 10.1007/s10072-023-07223-8] [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: 08/03/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a rare and complex disorder with variable clinical presentation and a typical magnetic resonance imaging (MRI) pattern of vasogenic edema with typical and atypical locations. It is often triggered by other diseases and drugs and the most prototypical association is with persistently elevated arterial pressure values. Among the potential cerebrovascular complications, intracranial bleeding has been described, but ischemic stroke is uncommonly reported. METHODS We are presenting a case of a male patient with prolonged and sustained arterial hypertension acutely presenting with lacunar ischemic stroke involving the right corona radiata and composite MRI findings with the association of chronic small vessel disease (SVD) markers, acute symptomatic lacunar stroke, and atypical, central variant, posterior fossa dominant PRES. In the MRI follow-up, the white matter hyperintensities in T2-fluid attenuated inversion recovery (FLAIR sequences) due to PRES. DISCUSSION The pathophysiology of PRES is not yet fully known, but the association with markedly increased values of arterial pressure is typical. In this context, ischemic stroke has not been considered in the clinical and neuroradiological manifestations of PRES and it has been only occasionally reported in the literature. In this case, the main hypothesis is that sustained hypertension may have triggered both manifestations, PRES, and ischemic stroke and the last one allowed to diagnose the first one. CONCLUSIONS Atypical variants of PRES are not so rare and it may also occur in typical triggering situations. The association with ischemic stroke is even rarer and it may add some clues to the pathomechanisms of PRES.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Gabriele Vandelli
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
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Kalēja K, Sokolovskis A, Ziemele I. Hemorrhagic Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient With Acute Lymphoblastic Leukemia: A Case Report. Cureus 2024; 16:e57158. [PMID: 38681433 PMCID: PMC11056006 DOI: 10.7759/cureus.57158] [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] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon yet severe neurological disorder characterized by a combination of clinical and radiological features. Common clinical presentations of PRES include headaches, seizures, altered mental status ranging from lethargy to coma, visual disturbances, and behavior changes. This case report outlines the occurrence of hemorrhagic PRES in an 11-year-old girl with B-cell acute lymphoblastic leukemia (ALL) relapse. Hospitalized for ALL relapse, the patient underwent reinduction chemotherapy. On the ninth day of admission, she had a generalized tonic-clonic seizure with a blood pressure peak of 170/120 mmHg. Magnetic resonance imaging (MRI) and a seizure episode suggested PRES. Initially, after the first tonic-clonic seizure, the neurological examination was normal, but after the second seizure, the meningeal symptoms were negative, and gaze palsy and right-sided homonymous hemianopsia were observed; muscle strength was symmetrically reduced in the upper and lower extremities and reflexes were symmetrical and diminished. A bilateral Babinski reflex was observed at the time of examination; the patient had mild motor aphasia, and she opened her eyes only in response to tactile stimulation. A follow-up MRI four days after the second seizure episode showed extensive PRES damage with hemorrhagic changes. Over two weeks, the patient's neurological status and blood pressure gradually improved, with persistent changes in the visual field. Subsequent MRI revealed a significant reduction in PRES lesions, but residual hemorrhage measuring 6x4 cm remained evident.
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Affiliation(s)
| | | | - Inga Ziemele
- Department of Pediatrics, Faculty of Medicine, Riga Stradins University, Riga, LVA
- Department of Pediatric Infectious Diseases, Children's Clinical University Hospital, Riga, LVA
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11
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Largeau B, Bergeron S, Auger F, Salmon Gandonnière C, Jonville-Béra AP, Ehrmann S, Gautier S, Bordet R. Experimental Models of Posterior Reversible Encephalopathy Syndrome: A Review From Pathophysiology to Therapeutic Targets. Stroke 2024; 55:484-493. [PMID: 38126184 DOI: 10.1161/strokeaha.123.044533] [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] [Indexed: 12/23/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized by nonspecific symptomatology (eg, headache, visual disturbances, encephalopathy, and seizures) and classically cortical and subcortical vasogenic edema predominantly affecting the parietooccipital region. PRES etiologies are usually dichotomized into toxic PRES (eg, antineoplastic drugs, illicit drugs) and clinical condition-associated PRES (eg, acute hypertension, dysimmune disorders). Although the pathophysiology of PRES remains elusive, 2 main pathogenic hypotheses have been suggested: cerebral hyperperfusion due to acute hypertension and cerebral hypoperfusion related to endothelial dysfunction. Research into the pathogenesis of PRES has emerged through the development of animal models in the last decade. The motivation for developing a suitable PRES model is 2-fold: to fill in knowledge gaps of the pathophysiological mechanisms involved, and to open new perspectives for clinical assessment of pharmacological targets to improve therapeutic management of PRES. All current models of PRES have a hypertensive background, on which other triggers (acute hypertension, inflammatory, drug toxicity) have been added to address specific facets of PRES (eg, seizures). The initial model consisted in inducing a reduced uterine perfusion pressure that mimics preeclampsia, a leading cause of PRES. More recently, a model of stroke-prone spontaneously hypertensive rats on high-salt diet, originally developed for hypertensive small vessel disease and vascular cognitive impairment, has been studied in PRES. This review aims to discuss, depending on the research objective, the benefits and limitations of current experimental approaches and thus to define the desirable characteristics for studying the pathophysiology of PRES and developing new therapies.
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Affiliation(s)
- Bérenger Largeau
- CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France (B.L.)
| | - Sandrine Bergeron
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille Neuroscience & Cognition, Unité Mixte de Recherche (UMR) 1172, équipe Troubles Cognitifs Dégénératifs et Vasculaires, Centre Hospitalier Universitaire (CHU) de Lille, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, France (S.B., S.G., R.B.)
| | - Florent Auger
- Université de Lille, Centre National de la Recherche Scientifique (CNRS), INSERM, CHU Lille, Institut Pasteur de Lille, US 41, Unités Mixtes de Service 2014, Plateformes Lilloises en Biologie et Santé, Lille, France (F.A.)
| | - Charlotte Salmon Gandonnière
- CHRU de Tours, Service de Médecine Intensive Réanimation, réseau CRICS-TRIGGERSEP F-CRIN (Clinical Research in Intensive Care Sepsis Trial Group for Global Evaluation Research in Sepsis, a French Clinical Research Infrastructure Network) Research Network, Tours, France (C.S.G.)
| | - Annie-Pierre Jonville-Béra
- Université de Tours, Université de Nantes, INSERM, Methods in Patients-Centered Outcomes and Health Research (SPHERE), UMR 1246, CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France (A.-P.J.-B.)
| | - Stephan Ehrmann
- Université de Tours, INSERM, Centre d'étude des Pathologies Respiratoires (CEPR), UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC 1415, réseau CRICS-TRIGGERSEP F-CRIN Research Network, Tours, France (S.E.)
| | - Sophie Gautier
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille Neuroscience & Cognition, Unité Mixte de Recherche (UMR) 1172, équipe Troubles Cognitifs Dégénératifs et Vasculaires, Centre Hospitalier Universitaire (CHU) de Lille, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, France (S.B., S.G., R.B.)
| | - Régis Bordet
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille Neuroscience & Cognition, Unité Mixte de Recherche (UMR) 1172, équipe Troubles Cognitifs Dégénératifs et Vasculaires, Centre Hospitalier Universitaire (CHU) de Lille, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, France (S.B., S.G., R.B.)
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12
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Battal B, Castillo M. Imaging of Reversible Cerebral Vasoconstriction Syndrome and Posterior Reversible Encephalopathy Syndrome. Neuroimaging Clin N Am 2024; 34:129-147. [PMID: 37951698 DOI: 10.1016/j.nic.2023.07.004] [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] [Indexed: 11/14/2023]
Abstract
PRES and RCVS are increasingly recognized due to the wider use of brain MRI and increasing clinical awareness. Imaging plays a crucial role in confirming the diagnosis and guiding clinical management for PRES and RCVS. Imaging also has a pivotal role in determining the temporal progression of these entities, detecting complications, and predicting prognosis. In this review, we aim to describe PRES and RCVS, discuss their possible pathophysiological mechanisms, and discuss imaging methods that are useful in the diagnosis, management, and follow-up of patients.
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Affiliation(s)
- Bilal Battal
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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13
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Dehdab R, Afat S. COVID-19-related posterior reversible encephalopathy syndrome: insights from a clinical case. ENCEPHALITIS 2024; 4:18-22. [PMID: 38053343 PMCID: PMC11007401 DOI: 10.47936/encephalitis.2023.00115] [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: 07/22/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 12/07/2023] Open
Abstract
In the present case report, a 50-year-old female presented with hemiparesis and blurred vision and was subsequently diagnosed with posterior reversible encephalopathy syndrome (PRES) associated with coronavirus disease 2019 (COVID-19). Magnetic resonance imaging revealed cortico-subcortical edema with hyperintensities bilaterally in the frontoparietal and bi-occipital regions. Although PRES is a neurotoxic disorder that typically affects white matter of the brain and often is associated with hypertension, renal failure, and autoimmune disorders, recent studies have suggested that COVID-19 increases the risk of PRES. This case report presents a unique instance of COVID-19-related PRES. Unlike most previously reported cases occurring during the acute phase of severe COVID-19, our patient experienced PRES during the recovery phase with mild initial symptoms, such as fatigue and mild fever. The article discusses the pathophysiology of PRES, the potential mechanisms by which COVID-19 leads to PRES, and the treatment and outcome of the patient.
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Affiliation(s)
- Reza Dehdab
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany
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14
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Nada MG, Libda YI, Gohary MM, Dessouky R. Pediatric posterior reversible encephalopathy syndrome: Can MR imaging features predict outcomes in non-oncologic patients? Eur J Radiol 2024; 170:111214. [PMID: 38007856 DOI: 10.1016/j.ejrad.2023.111214] [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: 05/20/2023] [Revised: 08/09/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Identify MR features predictive of poor outcomes in non-oncologic pediatric PRES. METHOD A six-year search of all non-oncologic pediatric patients with clinical and MR features of PRES was performed. Modified Rankin scores were used to classify clinical outcomes into good versus poor, then clinical and MR features were compared among groups. Univariate and multivariate analysis was performed to identify MR predictors of poor outcomes for various imaging features, and p-values < 0.05 were considered statistically significant. RESULTS One hundred and forty-one patients (mean age 10.1 ± 3.0 years, male to female ratio 1:1.1) were included. Clinically, nephrotic syndrome (p = 0.03), focal deficits (p = 0.04), longer hospitalization (p < 0.001), and mechanical ventilation (p < 0.001) were significantly associated with poor outcomes. Univariate analysis revealed that deep grey matter nuclei (OR = 5.29, 95 % CI: 1.6-18.0) and cerebellar edema patterns (OR = 3.49, 95 % CI: 1.3-9.5), cytotoxic edema (OR = 63.6, 95 % CI:16.5-244.2), hemorrhage (OR = 16.58, 95 % CI: 4.3-64.2), and severe PRES patterns (OR = 11.0, 95 % CI: 3.5-34.7) on MR were all significantly associated with poor outcomes (p-values = 0.008 and 0.014, <0.001, <0.001, and < 0.001, respectively). This remained true for cytotoxic edema (OR = 84.26, 95 % CI: 17.3-410.9, p-value < 0.001) and hemorrhage (OR = 44.56, 95 % CI: 6.9-289.7, p-value < 0.001) on multivariate analysis. CONCLUSION Diffusion restriction and hemorrhage on initial MR scans were the two independent predictors of poor outcomes in non-oncologic pediatric patients.
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Affiliation(s)
- Mohamad Gamal Nada
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yasmin Ibrahim Libda
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud M Gohary
- Pediatric Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Riham Dessouky
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
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Mengstu A, Chakko MN, Salisbury B, Fateh J. Posterior Reversible Encephalopathy Syndrome (PRES) and the Uncommon Sequela: Mesial Temporal Sclerosis. Cureus 2024; 16:e52380. [PMID: 38361717 PMCID: PMC10868631 DOI: 10.7759/cureus.52380] [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] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Posterior reversible encephalopathy syndrome is often linked to conditions like hypertension and is characterized by reversible brain edema. The development of mesial temporal sclerosis as a consequence of posterior reversible encephalopathy syndrome is an uncommon clinical outcome. We report a 48-year-old female who initially presented with severe iron deficiency anemia, hypertension, and septic tenosynovitis requiring surgical drainage with subsequent development of posterior reversible encephalopathy syndrome accompanied by endocarditis. Although there was a question of one seizure episode during one of her hospital days, the patient experienced multiple seizure episodes three months after she left the hospital. Subsequent MRI demonstrated atrophy of the left mesial temporal lobe suggesting mesial temporal sclerosis. The temporal development of mesial temporal sclerosis in a patient with posterior reversible encephalopathy syndrome highlights mesial temporal sclerosis as a potential long-term consequence of posterior reversible encephalopathy syndrome, and the need for imaging surveillance in patients diagnosed with posterior reversible encephalopathy syndrome.
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Affiliation(s)
- Abraham Mengstu
- Radiology, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, USA
| | - Mathew N Chakko
- Neuroradiology, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, USA
| | - Blake Salisbury
- Radiology, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, USA
| | - Jibran Fateh
- Radiology, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, USA
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Teixeira B, Gonçalves V, Cardoso AL, Ribeiro Fernandes S, Rocha L, Garrido C, Sarmento A. Posterior Reversible Encephalopathy Syndrome in a Pediatric Intensive Care Unit: A Case Series. Cureus 2023; 15:e50658. [PMID: 38229800 PMCID: PMC10790602 DOI: 10.7759/cureus.50658] [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] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a reversible clinical-radiographic abnormality. It is characterized by headache, altered consciousness, seizures, and visual disruption, in addition to characteristic white matter edema lesions in the parieto-occipital areas of the brain. Early detection and treatment are crucial to prevent irreversible damage. This paper presents the cases of three patients with PRES with concurrent diagnoses of glomerulonephritis, Guillain-Barré syndrome, and sickle cell disease. All patients experienced systemic hypertension, seizures, and altered consciousness. All patients were admitted to intensive care for decreased level of awareness or status epilepticus requiring invasive mechanical ventilation. Anticonvulsants and antihypertensive therapy were essential. No chronic complications were recorded.
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Affiliation(s)
- Beatriz Teixeira
- Paediatric Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Vera Gonçalves
- Paediatric Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | - Ana Lúcia Cardoso
- Paediatric Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Sofia Ribeiro Fernandes
- Paediatric Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Liliana Rocha
- Paediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Cristina Garrido
- Paediatric Neurology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Alzira Sarmento
- Paediatric Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Alzahrani Y. Pediatric Posterior Reversible Encephalopathy Syndrome: A Review With Emphasis on Neuroimaging Characteristics. Cureus 2023; 15:e51216. [PMID: 38283439 PMCID: PMC10821201 DOI: 10.7759/cureus.51216] [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] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by the sudden onset of seizures, headaches, and visual disturbances. Its exact cause is unknown, but several triggers and associated conditions are identified, including high blood pressure, kidney dysfunction, and various medications. Magnetic resonance imaging (MRI) plays a crucial role in diagnosis due to its high sensitivity and specificity for detecting characteristic features. Pediatric PRES exhibit age-dependent differences in triggers, radiological findings, and clinical course. The lesions typically involve the posterior cortical and subcortical white matter, but atypical locations and features are also observed. While generally reversible with appropriate treatment, PRES carries a risk of permanent neurological damage. Despite increasing cases, the current literature on pediatric PRES remains limited. This review highlights the need for further research to understand the mechanisms, delineate distinct clinical and radiological features, and develop precise diagnostic and management strategies for pediatric patients.
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18
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Dekeyzer S, Vanden Bossche S, De Cocker L. Anything but Little: a Pictorial Review on Anatomy and Pathology of the Cerebellum. Clin Neuroradiol 2023; 33:907-929. [PMID: 37410171 DOI: 10.1007/s00062-023-01326-7] [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: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
Despite its small size the cerebellum is an anatomically complex and functionally important part of the brain. Traditionally the cerebellum is viewed as a motor control structure entirely devoted to motor control and learning, but recent functional magnetic resonance imaging (fMRI) studies demonstrated significant involvement of the cerebellum in higher order cognitive functions. The anatomical complexity of the cerebellum is reflected by the several nomenclature systems that exist for the description of cerebellar anatomy. The cerebellum can be affected by a variety of pathological processes, including congenital, infectious and inflammatory, neoplastic, vascular, degenerative and toxic metabolic diseases. The purpose of this pictorial review is to (1) provide a general overview of cerebellar anatomy and function, (2) demonstrate normal cerebellar anatomy on imaging studies, and (3) illustrate both common as well as rare pathological conditions affecting the cerebellum.
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Affiliation(s)
- Sven Dekeyzer
- Department of Radiology and Medical Imaging, Ghent University Hospital (UZG), Corneel Heymanslaan 10, 9000, Gent, Belgium.
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Stephanie Vanden Bossche
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
- Department of Radiology, AZ Sint Jan Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Laurens De Cocker
- Department of Radiology, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000, Gent, Belgium
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Sadamoto Y. A Case of Reversible Posterior Leukoencephalopathy Syndrome (PRES) With a History of Migraine and Onset With Initial Visual Aura and Migraine-Like Headache, With a Significant Response to Lasmiditan: A Case Report. Cureus 2023; 15:e49311. [PMID: 38024055 PMCID: PMC10667572 DOI: 10.7759/cureus.49311] [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] [Accepted: 11/23/2023] [Indexed: 12/01/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological disease that presents with various neurological symptoms and is often accompanied by elevated blood pressure at onset. Neuroimaging, especially magnetic resonance imaging (MRI), often shows a characteristic parieto-occipital pattern with a symmetrical distribution of changes, reflecting vasogenic edema. Hypertension and endothelial cell damage are the most common causes of PRES. An association between migraine and endothelial cell damage has been suggested, but the relationship between migraine and PRES is unknown. Reports on PRES triggered by migraines are scarce. We report a case of PRES in a 59-year-old woman with migraine without aura. At the onset, the patient experienced a first-ever visual aura and a migraine-like headache. In this case, it was also difficult to distinguish between PRES headache and headache caused by a pre-existing migraine; however, lasmiditan, an acute migraine treatment without vasoconstrictive properties, was remarkably effective for headaches.
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Xie L. Posterior reversible encephalopathy syndrome triggered by FLOT (5-fluorouracil, oxaliplatin, docetaxel, and calcium levofolinate) chemotherapy and thrombocytopenia (docetaxel and cisplatin) chemotherapy. J Oncol Pharm Pract 2023; 29:1503-1509. [PMID: 37218162 DOI: 10.1177/10781552231177597] [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] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome is a clinical and imaging syndrome characterized by endothelial dysfunction, blood-brain barrier disruption, and vasogenic edema. The common clinical symptoms of posterior reversible encephalopathy syndrome include headache, altered consciousness, visual disturbances, and seizures, among which headache and seizures are the most common. The classic imaging patterns usually reveal vasogenic edema. CASE REPORT We describe the case of a middle-aged woman with gastric cancer. She was under treatment by fluorouracil, leucovorin, oxaliplatin, and docetaxel regimen and thrombocytopenia regimen after tumor progression, but developed unconsciousness, irritability, and headache shortly after initiation of treatment. Her magnetic resonance imaging in our hospital shows abnormal signals in bilateral frontal parietal occipital lobes with hyperintensities on T2-weighted magnetic resonance imaging and fluid-attenuated inversion recovery imaging, accompanied by the increased value of apparent diffusion coefficient. And T1-weighted images illustrate hypointense foci, with increased diffusion-weighted imaging signals. MANAGEMENT AND OUTCOME After admission, she was treated to control blood pressure, reduce brain edema, expand blood vessels, improve consciousness, and symptomatic support treatment. 3 days after the onset of the disease, her headache symptoms and state of consciousness gradually improved, and her blood pressure can be controlled at about 130/80 mmHg. DISCUSSION This is the first report that posterior reversible encephalopathy syndrome is caused by a thrombocytopenia regimen, and our case highlights the pathogenic role of a thrombocytopenia regimen in posterior reversible encephalopathy syndrome. However, the association between the thrombocytopenia regimen and previous fluorouracil, leucovorin, oxaliplatin, and docetaxel regimens needs further study.
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Affiliation(s)
- LinLin Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Shandong, China
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21
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Mendes PFS, Baia-da-Silva DC, Melo WWP, Bittencourt LO, Souza-Rodrigues RD, Fernandes LMP, Maia CDSF, Lima RR. Neurotoxicology of alcohol: a bibliometric and science mapping analysis. Front Pharmacol 2023; 14:1209616. [PMID: 37593178 PMCID: PMC10427875 DOI: 10.3389/fphar.2023.1209616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
Alcohol consumption is common in many societies and has increased considerably, resulting in many socioeconomic and public health problems. In this sense, studies have been carried out in order to understand the mechanisms involved in alcohol consumption and related harmful effects. This study aimed to identify and map the knowledge and to perform bibliometric analysis of the neurotoxicology of alcohol based on the 100 most cited articles. A search was carried out in the Web of Science Core Collection database and information was extracted regarding the journal, authors, keywords, year of publication, number of citations, country and continent of the corresponding author. For each selected manuscript, the study design, alcohol exposure model, dose, period of exposure, and effect on the central nervous system and research hotspots were mapped. The journal with the highest number of publications was Alcoholism: Clinical and Experimental Research (n = 11 papers), the author who contributed the most was Crews FT (n = 8 papers), the studies had a total of 288 keywords and 75% of the publications were from the United States of America. The experimental studies evaluated the effects of prenatal and postnatal exposure and were conducted in rats and mice using doses ranging from 2.5 to 14 g/kg/day, with administration by subcutaneous, intraperitoneal, intragastric, or inhalation route or with free access through drinking bottles. Among the studies mapped, the oldest one (1989) aimed to understand the systemic damage and mechanisms of action involved, while the most recent focused on understanding the receptors and mechanisms involved in addiction, as well as genetic factors. Our results show the panorama of the most widespread scientific production in the scientific community on the neurotoxicology of ethanol, a high prevalence was observed in studies that addressed fetal alcohol syndrome and/or the effects of ethanol on neurodevelopment.
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Affiliation(s)
- Paulo Fernando Santos Mendes
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Daiane Claydes Baia-da-Silva
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Wallacy Watson Pereira Melo
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Leonardo Oliveira Bittencourt
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Renata Duarte Souza-Rodrigues
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Luanna Melo Pereira Fernandes
- Department of Morphology and Physiological Sciences, Center of Sciences Biological and Health, State University of Pará, Belém, Brazil
| | | | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
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22
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Hwang J, Cho WH, Cha SH, Ko JK. Posterior reversible encephalopathy syndrome following uneventful clipping of an unruptured intracranial aneurysm: A case report. World J Clin Cases 2023; 11:4723-4728. [PMID: 37469736 PMCID: PMC10353519 DOI: 10.12998/wjcc.v11.i19.4723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is characterized mainly by occipital and parietal lobe involvement, which can be reversible within a few days. Herein, we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm (UIA).
CASE SUMMARY A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery. Clipping surgery was performed uneventfully, and he regained consciousness quickly immediately after the surgery. At the 4th hour after surgery, he developed a disorder of consciousness and aphasia. Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal, occipital, and frontal lobes ipsilaterally, without restricted diffusion, consistent with unilateral PRES. With conservative treatment, his symptoms and radiological findings almost completely disappeared within weeks. In our case, the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.
CONCLUSION Our unique case highlights that, to our knowledge, this is the second report of PRES developing after craniotomy for the treatment of UIA. Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.
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Affiliation(s)
- Joseph Hwang
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Won-Ho Cho
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Seung-Heon Cha
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
| | - Jun-Kyueng Ko
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
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Martínez Camblor L, Peña Suárez JM, Martínez-Cachero García M, Santamarta Liébana E, Rodríguez Castro J, Saiz Ayala A. Cerebral microbleeds. Utility of SWI sequences. RADIOLOGIA 2023; 65:362-375. [PMID: 37516489 DOI: 10.1016/j.rxeng.2022.12.006] [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: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 07/31/2023]
Abstract
OBJECTIVES Define the concept of cerebral microbleeds (CMBs) and describe the most useful MRI sequences for detecting this finding. Review the entities that most frequently present with CMBs and that may benefit from the use of susceptibility-weighted imaging (SWI) sequences. CONCLUSIONS SWI is a useful MRI sequence for the detection and characterization of microhemorrhages, venous structures and other sources of susceptibility in imaging. SWI is particularly sensitive to local magnetic field inhomogeneities generated by certain substances and is superior to T2* GRE sequences for this assessment. CMBs may be seen in different neurologic conditions, in certain infrequent clinical contexts and have a key role as a biomarker status in gliomas (ITTS) and as a marker of inflammatory activity in multiple sclerosis.
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Affiliation(s)
- L Martínez Camblor
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - J M Peña Suárez
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - E Santamarta Liébana
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Rodríguez Castro
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Saiz Ayala
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
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24
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Affiliation(s)
- Romergryko G Geocadin
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
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25
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Chionatos RA, Lerner DP, Burns JD, Ramineni A. Alcohol-related posterior reversible encephalopathy syndrome: a case report of a patient managed with a benzodiazepine-sparing regimen for alcohol withdrawal. Neurocase 2023; 29:75-80. [PMID: 38700146 DOI: 10.1080/13554794.2024.2346365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
We report a case of posterior reversible encephalopathy syndrome (PRES) during treatment for alcohol withdrawal syndrome with gabapentin and clonidine. The patient developed severe hypertension, confusion and tremor, culminating in bilateral vision loss and a seizure. Imaging revealed posterior cerebral edema. Treatment with benzodiazepines, antihypertensives, and anti-seizure medications led to resolution. One year later, imaging showed resolution of the findings. We review the associated literature and propose the recognition of a PRES sub-entity, Alcohol-Related PRES (ARPRES), which can appear in the setting of alcohol withdrawal syndrome, chronic alcohol use, and acute alcohol intoxication, with or without hypertension.
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Affiliation(s)
- Rafail A Chionatos
- Department of Neurology, Tufts University School of Medicine, Boston, USA
| | - David P Lerner
- Department of Neurology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Joseph D Burns
- Department of Neurology, Tufts University School of Medicine, Boston, USA
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, USA
- Department of Neurosurgery, Tufts University School of Medicine, Boston, USA
| | - Anil Ramineni
- Department of Neurology, Tufts University School of Medicine, Boston, USA
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, USA
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26
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Odoma VA, Zahedi I, Haq H, Lopez Pantoja SC, Onyejide EC, Rahman F. Malignant Hypercalcemia: A Rare Etiology of Posterior Reversible Encephalopathy Syndrome. Cureus 2023; 15:e41229. [PMID: 37529521 PMCID: PMC10387446 DOI: 10.7759/cureus.41229] [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] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare and severe neurotoxic encephalopathic state characterized by variable neurologic manifestations ranging from headache and confusion to seizures, coma, and reversible subcortical vasogenic edema on imaging. PRES is commonly induced by chronic renal failure, hypertension, chemotherapeutic drugs, and eclampsia. PRES induced by hypercalcemia is uncommon and not widely underlined in the literature. We underline a case of a 61-year-old female diagnosed with advanced breast carcinoma presented with altered sensorium and generalized limb weakness. She was found to have malignant hypercalcemia, and brain imaging demonstrated subcortical vasogenic edema in the occipital and frontal lobe, suggestive of PRES. Her condition gradually improved after the treatment of hypercalcemia.
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Affiliation(s)
- Victor A Odoma
- Cardiology/Oncology, Indiana University (IU) Health, Bloomington, USA
| | - Iman Zahedi
- Internal Medicine, Arrowhead Regional Medical Center, Los Angeles, USA
| | - Hassan Haq
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | - Ezrah C Onyejide
- Family Medicine, Metropolitan University College of Medicine, St. John's, ATG
| | - Farzana Rahman
- Internal Medicine, Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, BGD
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27
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Frati A, Armocida D, Tartara F, Cofano F, Corvino S, Paolini S, Santoro A, Garbossa D. Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication? Brain Sci 2023; 13:brainsci13050706. [PMID: 37239179 DOI: 10.3390/brainsci13050706] [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: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms' onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4-82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases.
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Affiliation(s)
- Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Daniele Armocida
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Human Neurosciences Department, Neurosurgery Division "Sapienza" University, AOU Policlinico Umberto I, 00161 Rome, Italy
| | - Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Fabio Cofano
- Neurosurgery, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Sergio Paolini
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Antonio Santoro
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Diego Garbossa
- Neurosurgery, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
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28
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Velilla Aparicio E, Fernández Yunquera A, Miranda Bautista J, Salcedo M. Posterior reversible encephalopathy syndrome (PRES) in post liver transplantation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:138-140. [PMID: 35469414 DOI: 10.17235/reed.2022.8694/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PRES (posterior reversible encephalopathy syndrome) is a neurological condition characterised by epileptic seizures, altered consciousness, visual disturbances and/or headache with typical neuroimaging showing reversible subcortical vasogenic oedema mainly in parieto-occipital regions. The pathophysiological mechanism is not fully understood. We present a clinical case in the field of liver transplantation where tacrolimus neurotoxicity may play a relevant role in the development of this syndrome.
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Affiliation(s)
| | | | | | - Magdalena Salcedo
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Spain
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29
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Ajmi H, Brahim J, Mabrouk S, Ben Abdallah A, Zouari N, Majdoub F, Nouir S, Hasni I, Ben Cheikh Y, Chemli J, Jemni H, Abroug S. Clinical and radiological findings of posterior reversible encephalopathy syndrome in children: About 16 children hospitalized in the pediatric department of a Tunisian tertiary care hospital. Eur J Paediatr Neurol 2023; 43:18-26. [PMID: 36871341 DOI: 10.1016/j.ejpn.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/24/2022] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity most frequently described in young- or middle-aged adults with a rare occurrence among children. AIM To determine the clinical, radiological features and outcome of PRES in children admitted to a Tunisian tertiary care pediatric department. METHODS we retrospectively reviewed records of all children under 18 years old diagnosed with PRES and admitted to the PICU of the Pediatric department of Sahloul University Hospital from January 2000 to August 2021. RESULTS Sixteen patients were enrolled in this study. The mean age of the study population at PRES onset was 10 years (range: 4-14 years) and the male female ratio was 3. The most frequent neurological signs were seizures (n = 16 cases), headache (n = 8 cases), and impaired level of consciousness (7 cases). Visual disturbances were found in one patient. Arterial hypertension was the most underlying cause (16 cases). Brain MRI showed vasogenic edema, mostly localized in the parietal (13 cases) and occipital (11 cases) lobes. Moreover, cytotoxic edema (2 cases), pathologic contrast enhancement (1 case), and hemorrhage (3 cases) were isolated on MRI. The outcome after specific management was favorable after the first onset in 13 cases and death occurred in 3 patients. Relapses were observed in 4 patients. CONCLUSION Clinical features presented by children with PRES are variable and non-specific. MRI typically shows reversible posterior cerebral edema. However, in some cases, atypical neuro-imaging findings, such as cytotoxic edema infarction, hemorrhage and contrast enhancement can be observed.
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Affiliation(s)
- Houda Ajmi
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia.
| | - Jawher Brahim
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Sameh Mabrouk
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Amel Ben Abdallah
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Noura Zouari
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Fadoua Majdoub
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Salsabil Nouir
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Ibtissem Hasni
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Yasser Ben Cheikh
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Jalel Chemli
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Hela Jemni
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Saoussan Abroug
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
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30
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Hai PD, Duc VA, Hung VQ, Thang NVV. Posterior reversible encephalopathy syndrome following septicemia in patient with myasthenia gravis. Radiol Case Rep 2023; 18:1549-1551. [PMID: 36815144 PMCID: PMC9939535 DOI: 10.1016/j.radcr.2023.01.050] [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] [Received: 12/14/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinicoradiologic entity characterized by seizure, headaches, visual symptoms, impaired consciousness, and vasogenic cerebral edema of occipital and parietal lobes of the brain. Magnetic resonance imaging (MRI) is the diagnostic gold standard. The pathophysiology of posterior reversible encephalopathy syndrome is still unknown, but it is thought to be closely related to several medical conditions including hypertension, preeclampsia, eclampsia, immunosuppressive agents, transplantation, and sepsis. We report a rare case of posterior reversible encephalopathy syndrome in patient with myasthenia gravis and sepsis. A 22-year-old male was diagnosed with myasthenia gravis combined with sepsis due to pneumonia. During his recovery, the patient suffered multiple generalized convulsions and subsequent loss of consciousness. On cranial MRI, the abnormalities were observed with hyperintense within the subcortical white matter of the temporal, parietal, and bilateral occipital lobes on T2-weighted and T2 FLAIR. Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of posterior reversible encephalopathy syndrome. Early recognition and management of posterior reversible encephalopathy syndrome as a cause of encephalopathy in patients with septicemia and myasthenia gravis is necessary to prevent secondary complications in this condition.
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Affiliation(s)
- Pham Dang Hai
- Medical Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
- Corresponding author.
| | - Vu Anh Duc
- Medical Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Quang Hung
- Medical Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
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31
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Martínez Camblor L, Peña Suárez J, Martínez-Cachero García M, Santamarta Liébana E, Rodríguez Castro J, Saiz Ayala A. Microhemorragias cerebrales. Utilidad de las secuencias de susceptibilidad magnética (SWI). RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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32
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Posterior reversible encephalopathy syndrome (PRES): Should more attention be paid to the atypical forms? Radiol Case Rep 2023; 18:545-549. [DOI: 10.1016/j.radcr.2022.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/09/2022] [Accepted: 10/23/2022] [Indexed: 11/26/2022] Open
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33
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Khalili N, Wang R, Garg T, Ahmed A, Hoseinyazdi M, Sair HI, Luna LP, Intrapiromkul J, Deng F, Yedavalli V. Clinical application of brain perfusion imaging in detecting stroke mimics: A review. J Neuroimaging 2023; 33:44-57. [PMID: 36207276 DOI: 10.1111/jon.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023] Open
Abstract
Stroke mimics constitute a significant proportion of patients with suspected acute ischemic stroke. These conditions may resemble acute ischemic stroke and demonstrate abnormalities on perfusion imaging sequences. The most common stroke mimics include seizure/epilepsy, migraine with aura, brain tumors, functional disorders, infectious encephalopathies, Wernicke's encephalopathy, and metabolic abnormalities. Brain perfusion imaging techniques, particularly computed tomography perfusion and magnetic resonance perfusion, are being widely used in routine clinical practice for treatment selection in patients presenting with large vessel occlusion. At the same time, the utilization of these imaging modalities enables the opportunity to better diagnose patients with stroke mimics in a time-sensitive setting, leading to appropriate management, decision-making, and resource allocation. In this review, we describe patterns of perfusion abnormalities that could discriminate patients with stroke mimics from those with acute ischemic stroke and provide specific case examples to illustrate these perfusion abnormalities. In addition, we discuss the challenges associated with interpretation of perfusion images in stroke-related pathologies. In general, perfusion imaging can provide additional information in some cases-when used in combination with conventional magnetic resonance imaging and computed tomography-and might help in detecting stroke mimics among patients who present with acute onset focal neurological symptoms.
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Affiliation(s)
- Neda Khalili
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Richard Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tushar Garg
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amara Ahmed
- Department of Radiology, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Meisam Hoseinyazdi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Haris I Sair
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Licia P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jarunee Intrapiromkul
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Francis Deng
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vivek Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Yavuz G, Heck S, Sienel W, Irlbeck M, Kneidinger N, Michel S, Forbrig R, Walter J, Zimmermann J, Kovács J, Glück OM, Pan M, Schneider C, Fertmann JM, Hatz RA, Kauke T. Posterior reversible encephalopathy syndrome after lung transplantation: Risk factors and management. Clin Transplant 2023; 37:e14850. [PMID: 36398875 DOI: 10.1111/ctr.14850] [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: 07/30/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome is a rare neurologic complication that can occur under immunosuppressive therapy with CNI after organ transplantation. METHODS We retrospectively reviewed medical records of 545 patients who underwent lung transplantation between 2012 and 2019. Within this group, we identified 30 patients with neurological symptoms typical of PRES and compared the characteristics of patients who were diagnosed with PRES (n = 11) to those who were not (n = 19). RESULTS The incidence of PRES after lung transplantation was 2%. Notably, 73% of the patients with PRES were female and the mean age was 39.2. Seizure (82% vs. 21%, p = .002) was the most common neurological presentation. The risk of developing PRES was significantly associated with age (OR = .92, p < .0001) and having cystic fibrosis (CF) (OP = 10.1, p < .0001). Creatinine level (1.9 vs. 1.1 mg/dl, p = .047) and tacrolimus trough level (19.4 vs. 16.5 ng/ml, p = .048) within 1 week prior to neurological symptoms were significantly higher in patients with PRES. CONCLUSION Renal insufficiency and high tacrolimus levels are associated with PRES. A change of immunosuppressive drug should be done after confirmed PRES diagnosis or immediately in case of severe neurological dysfunction to improve neurological outcomes and minimize the risk of early allograft rejection.
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Affiliation(s)
- Gökce Yavuz
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Suzette Heck
- Department of Neurology, University Hospital of Munich, LMU, Munich, Germany
| | - Wulf Sienel
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, University Hospital of Munich, LMU, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University Hospital of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Department of Cardiac Surgery, University Hospital of Munich, LMU, Munich, Germany.,Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Robert Forbrig
- Department of Neuroradiology, University Hospital of Munich, LMU, Munich, Germany
| | - Julia Walter
- Department of Internal Medicine V, University Hospital of Munich, LMU, Munich, Germany
| | - Julia Zimmermann
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Julia Kovács
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Olaf M Glück
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Ming Pan
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Christian Schneider
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Jan M Fertmann
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Rudolf A Hatz
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany.,Transplant Center, University Hospital of Munich, LMU, Munich, Germany
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35
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Pfaff JAR, Machegger L, Trinka E, Mutzenbach JS. Unilateral delayed post-hypoxic leukoencephalopathy: a case report. J Med Case Rep 2022; 16:480. [PMID: 36567313 PMCID: PMC9791774 DOI: 10.1186/s13256-022-03701-3] [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: 08/17/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Delayed post-hypoxic leukoencephalopathy is a rare entity following hypoxia. Clinical and radiological signs of delayed post-hypoxic leukoencephalopathy have not previously been reported following acute ischemic stroke. CASE PRESENTATION We report a case of an 81-year-old Central European man who presented with a dissection-related occlusion of the left carotid artery. He showed clinical improvement immediately after endovascular stroke therapy, followed by a significant clinical and especially cognitive deterioration thereafter and a clinical recovery after several weeks. The clinical course of the patient was accompanied by morphological changes on magnetic resonance imaging characteristic of delayed post-hypoxic leukoencephalopathy; that is, strictly limited and localized unilaterally to the left anterior circulation. CONCLUSION This case demonstrates that clinical symptoms and morphological changes on magnetic resonance imaging compatible with delayed post-hypoxic leukoencephalopathy do not necessarily only occur with global hypoxia, but can also occur in patients with a large vessel occlusion in the corresponding vascular territories.
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Affiliation(s)
- Johannes A. R. Pfaff
- grid.21604.310000 0004 0523 5263Department of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Lukas Machegger
- grid.21604.310000 0004 0523 5263Department of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Eugen Trinka
- grid.21604.310000 0004 0523 5263Department of Neurology, Centre for Cognitive Neuroscience, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Neuroscience Institute, Centre for Cognitive Neuroscience, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria ,Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria ,Spinal Cord Injury and Tissue Regeneration Centre, Salzburg, Austria
| | - Johannes Sebastian Mutzenbach
- grid.21604.310000 0004 0523 5263Department of Neurology, Centre for Cognitive Neuroscience, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
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36
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Yang B, Guo L, Yang X, Yu N. The pathogenesis and treatment of posterior reversible encephalopathy syndrome after neuromyelitis optica spectrum disorder: a case report and literature review. BMC Neurol 2022; 22:493. [PMID: 36539740 PMCID: PMC9764726 DOI: 10.1186/s12883-022-02985-8] [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: 07/27/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a rare disease characterized by reversible subcortical vasogenic brain edema. Neuromyelitis optica spectrum disorder (NMOSD) is a frequent neurological autoimmune disease that is rarely reported to complicate PRES. CASE PRESENTATION Here, we report a case of neuromyelitis optica (NMO) concurrent with PRES. A 50-year-old woman presented with severe impairment of her health visual acuity, with significantly worsening of the motor weakness in both lower limbs during methylprednisolone therapy after her diagnosis of NMO. MRI showed new-onset brain edematous lesions of the bilateral frontal, occipital, and parietal lobes. PRES was considered. Her vision impairment and weakness of the extremities were alleviated after antihypertensive treatment and dehydration. The edema lesions detected by MRI also completely disappeared. CONCLUSIONS We reviewed 14 cases of NMO with PRES and concluded that the etiology of NMOSD concurrent PRES may be multifactorial, involving pathogenic IgGs against aquaporin-4 (AQP-4) and immunotherapy treatment. Different underlying pathogeneses require different treatment approaches.
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Affiliation(s)
- Bo Yang
- grid.54549.390000 0004 0369 4060Department of Center for Psychosomatic Medicine, Sichuan Provincial Center for Mental Health,Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Guo
- grid.54549.390000 0004 0369 4060Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xu Yang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Leshan, Leshan, China
| | - Nengwei Yu
- grid.54549.390000 0004 0369 4060Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Tai HF, Hua TT, Zhang ZQ, Duan YY, Zhuo ZZ, Wang A, Zhou Y, Liu SC, Lv S. Characteristic cerebral perfusion pattern in neuronal intranuclear inclusion disease. Front Neurosci 2022; 16:1081383. [PMID: 36570826 PMCID: PMC9768440 DOI: 10.3389/fnins.2022.1081383] [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: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Neuronal intranuclear inclusion disease (NIID), which pathogenesis remains largely unclear, is a neurodegenerative disease caused by GGC repeat expansion in NOTCH2NLC gene. As case studies have reported dynamic cortical perfusion changes in NIID, this study aimed to explore the cerebral perfusion pattern in NIID patients. Materials and methods A total of 38 NIID patients and 34 healthy controls (HCs) were recruited, and 2 NIID patients who had had episodic symptoms within 2 months were excluded. Data on demographic characteristics and clinical features were collected. All participants underwent three-dimensional pseudo-continuous arterial spin labeling perfusion magnetic resonance imaging (MRI) scanning. Voxel-based comparisons of cerebral blood flow (CBF) were conducted. Results NIID patients showed decreased perfusion in the cortex but increased perfusion in the deep brain regions compared with HCs. The regions with significant hypoperfusion were distributed in the bilateral frontal, temporal, parietal, and occipital gyri, with the left frontal gyrus being the most prominent. The regions with significant hyperperfusion included the bilateral basal ganglia, midbrain, pons, para-hippocampal, and parts of the bilateral cerebellum, fusiform, lingual, rectus, orbital, and cingulum anterior gyri, which were adjacent to the midline (all FDR-corrected p <0.05). When comparing the mean CBF value of the whole brain, no significant differences were observed between NIID patients and HCs (28.81 ± 10.1 vs. 27.99 ± 5.68 ml/100 g*min, p = 0.666). Voxel-based analysis showed no significant difference in cerebral perfusion between NIID patients with and without episodic symptoms. The perfusion within the bilateral middle frontal and anterior cingulate gyri showed positive correlations with MMSE and MoCA scores using age, sex, and education as covariates (p <0.005 uncorrected). Conclusion NIID patients exhibited characteristic cortical hypoperfusion and deep brain hyperperfusion. The perfusion in the bilateral frontal lobe and cingulate gyrus was correlated with the severity of cognitive dysfunction. Cerebral perfusion change may be involved in NIID pathophysiology and serve as a potential indicator for monitoring NIID severity and progression.
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Affiliation(s)
- Hong-Fei Tai
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tian-Tian Hua
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zai-Qiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China,*Correspondence: Zai-Qiang Zhang,
| | - Yun-Yun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China,Yun-Yun Duan,
| | - Zhi-Zheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China
| | - An Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shao-Cheng Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Lv
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China
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Tarhan G, Karabulut EGT, Karacı R, Sönmez Güngör E, Kaya GK, Ülker M, Domaç SF. Multiorgan dysfunction precipitated by disulfiram use and posterior reversible encephalopathy syndrome with atypical presentation: a case report. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2153758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Güllü Tarhan
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Elif Gözde Türedi Karabulut
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Rahşan Karacı
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ekin Sönmez Güngör
- Department of Psychiatry, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Gökçe Keskin Kaya
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ülker
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Saime Füsun Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
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Hilal K, Khandwala K, Sajjad N, Kaleemi R, Malik AA, Mohsin S, Ibrahim SH. Paediatric posterior reversible encephalopathy syndrome: is there an association of blood pressure with imaging severity and atypical magnetic resonance characteristics? Pediatr Radiol 2022; 52:2610-2619. [PMID: 35723697 DOI: 10.1007/s00247-022-05400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is relatively uncommon in paediatric patients; however, its pathophysiology remains obscure. OBJECTIVE The aims of this study were to find an association or correlation between (1) blood pressures and (2) imaging severity and the presence of atypical imaging features in children with PRES. MATERIALS AND METHODS We performed a retrospective cross-sectional evaluation in children diagnosed with PRES. We reviewed radiologic findings along with each patient's clinical profile and outcome. We categorised imaging severity into mild, moderate and severe, and assessed the MR imaging pattern, enhancement and diffusion restriction for each child. We assessed both associations and correlations between variables using the chi-square test, Cramer V and Kendall tau b. RESULTS A total of 63 children met the inclusion criteria (31 boys; mean age 9.7 years). A total of 42 children (67%) had an elevated blood pressure. Imaging showed parieto-occipital lobe involvement pattern in 24 (38%) children, frontal lobe pattern in 25 (40%) and cerebellar involvement in 12 (19%). Three (5%) had haemorrhage, 15 (24%) had contrast enhancement and 19 (30%) had positive diffusion restriction (cytotoxic oedema). We found no statistically significant association between imaging severity and blood pressures (P=0.11), nor any association between blood pressure and atypical imaging findings such as diffusion restriction (P=0.1), enhancement (P=0.11) or haemorrhage (P=0.33). CONCLUSION According to our results, there is no statistically significant association or correlation between blood pressure and either imaging severity or atypical imaging features in children with PRES. Further prospective studies are warranted.
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Affiliation(s)
- Kiran Hilal
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Kumail Khandwala
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Nida Sajjad
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Raima Kaleemi
- Department of Radiology and Imaging, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Amyn A Malik
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shazia Mohsin
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahnaz H Ibrahim
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Paul A, Bhaumik S, Das SS, Das US, Pramanick G, Banerjee S. Posterior reversible encephalopathy syndrome following coronary angiography. J R Coll Physicians Edinb 2022; 52:324-326. [PMID: 36476109 DOI: 10.1177/14782715221142170] [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] [Indexed: 08/16/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a relatively rare neurotoxic disorder. A 56-year-old male underwent elective coronary angiography. A Few hours postprocedure, the patient developed bilateral painless vision loss, headache, vomiting and hypertension and was subsequently diagnosed with PRES. Possible trigger factors could be contrast agent used, or hypertension. Contrast agent-induced PRES in hypertensive patients is benign and reversible, and a high-grade suspicion about this possibility is critical for precise management. Our patient was successfully treated with supportive management and was doing well on follow-up.
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Affiliation(s)
- Aritra Paul
- Nil Ratan Sircar Medical College & Hospital, Kolkata, West Bengal, India
| | - Sanjay Bhaumik
- Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | | | - Uday Sankar Das
- Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | | | - Suvro Banerjee
- Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
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Muacevic A, Adler JR, Anand S, Upadhyaya A, Taneja R. Posterior Reversible Encephalopathy Syndrome (PRES) in Systemic Lupus Erythematosus: A Rare Presentation. Cureus 2022; 14:e31376. [PMID: 36514640 PMCID: PMC9741921 DOI: 10.7759/cureus.31376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that is characterized by intense headache and neurological deficits such as vision loss which are attributed to the vasogenic edema that occurs in the posterior cerebral cortex involving the occipital and parietal lobes. Although the classical demographies that are affected by the PRES are middle-aged postpartum females and those with renal dysfunction, rarely it is also seen in patients with collagen vascular disorders such as systemic lupus erythematosus (SLE). We report a case of PRES in a 32-year-old SLE patient.
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42
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Balsara C, Shahin A, Baviriseaty N, Czuma R, Sullivan GA. Charles Bonnet Syndrome Associated With Recurrent Hypertensive Crisis. J Psychiatr Pract 2022; 28:509-513. [PMID: 36355592 DOI: 10.1097/pra.0000000000000662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Charles Bonnet syndrome (CBS) is a disorder of visual hallucinations in psychologically normal patients with ocular disease or damage to visual pathways. The etiology of CBS is not fully understood. It is associated with various triggers, with age-related macular degeneration the most common; other triggers are systemic diseases such as stroke, multiple sclerosis, and anemia as well as lighting issues, fatigue, and medical or surgical eye treatments. Visual disturbances such as decreased visual acuity, visual field deficits, or visual hallucinations are common in association with hypertensive encephalopathy. We describe a patient with episodic CBS triggered by recurrent hypertensive crises, which resolved with blood pressure management in the hospital setting.
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Pringle C, Portwood K, Viamonte MA, Rajderkar D. Imaging Findings in Neonatal and Pediatric Posterior Reversible Encephalopathy Syndrome (PRES) Differ From Adults. Pediatr Neurol 2022; 135:6-11. [PMID: 35963074 PMCID: PMC9903994 DOI: 10.1016/j.pediatrneurol.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is classically a reversible clinical radiographic syndrome associated with predominantly posterior leukoencephalopathy on neuroimaging. Magnetic resonance imaging (MRI) in adults demonstrates almost universally reversible parietal-occipital disease. We aimed to demonstrate in a cohort of children that "atypical" distribution is expected, acutely and on follow-up. METHODS A retrospective review of children diagnosed with PRES from 2010 to 2018 at our children's hospital was performed. All had MRI at diagnoses, with over half having follow-up MRIs. Images were reviewed by a neuroradiology-trained pediatric radiologist for confirmation of findings consistent with PRES/identification of involved regions. RESULTS Nineteen patients (aged zero to 18 years, 53% female) were included. Notably, two were infants. Nearly all had seizures; all had altered mental status and hypertension. Fifteen (84%) had MRI described as "atypical." Distribution of MRI findings was anatomically widespread, including nine with frontal findings. Twelve (63%) had follow-up imaging, of which approximately half remained abnormal. CONCLUSIONS Pediatric PRES MRI findings were more often atypical at time of diagnosis. Vasogenic edema related to the acute phases of PRES typically resolved; however, follow-up imaging identified new volume loss in the areas affected. Two of our subjects were younger than 13 months, younger than typically described. Our series demonstrates that imaging distribution in children with PRES does not mirror the classical posterior, reversible distribution described in adults and continues the recent trend of identifying PRES in infants.
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Affiliation(s)
- Charlene Pringle
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.
| | - Katherin Portwood
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Manuel A Viamonte
- Division of Pediatric Critical Care, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Dhanashree Rajderkar
- Division of Pediatric Radiology, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida
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Sina F, Najafi D, Aziz-Ahari A, Shahraki E, Ahimahalle TZ, Namjoo Z, Hassanzadeh S. Uremic encephalopathy: A definite diagnosis by magnetic resonance imaging? Eur J Transl Myol 2022; 32. [PMID: 36036353 PMCID: PMC9580542 DOI: 10.4081/ejtm.2022.10613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate the magnetic resonance imaging (MRI) findings for the diagnose uremic encephalopathy and describe the usefulness of MRI findings in the ultimate diagnosis of uremic encephalopathy (UE). A total of 20 patients with uremic encephalopathy admitted to the hospital were evaluated in this prospective study. The clinical manifestations, laboratory and MRI imaging findings, demographic information, and clinical outcome were analyzed for each patient. We observed that the 20 prospectively reviewed patients with UE had no involvement of the basal ganglia or the lentiform fork sign (LFS). However, two-thirds of the patients had white matter involvement, and 80% of the subjects had cerebral or cortical atrophy. The arterial blood gas (ABG) analysis revealed that 50% of the patients suffered from metabolic acidosis (n=10). The results of the present study demonstrated that although the observation of Lentiform Fork Sign and Basal Ganglia involvement in MRI of UE patients is a specific finding the absence of which does not rule out UE. Thus, simultaneous examination of clinical manifestation and laboratory test analyses, along with imaging findings, should also be taken into account.
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45
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Hiremath SB, Massicotte-Tisluck K, Chakraborty S. Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome. Neurol Sci 2022; 43:6461-6470. [DOI: 10.1007/s10072-022-06271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
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Tokimura R, Ito E, Sugiura Y, Ugawa Y. Nephrotic Syndrome and Atypical Posterior Reversible Encephalopathy Syndrome in a Patient with Parkinson's Disease. Intern Med 2022; 61:2061-2065. [PMID: 34924463 PMCID: PMC9334256 DOI: 10.2169/internalmedicine.8746-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old man with advanced Parkinson's disease treated using levodopa-carbidopa intestinal gel (LCIG) presented with leg edema, hypoalbuminemia, and proteinuria at 1 year after the treatment. He subsequently developed a generalized tonic-clonic seizure, and brain magnetic resonance imaging indicated vasogenic edema in the white matter of the left frontal subcortex. He was diagnosed with nephrotic syndrome (NS) and atypical posterior reversible encephalopathy syndrome (PRES). LCIG cessation and corticosteroid treatment improved the NS. To our knowledge, this is the first case report of NS and atypical PRES in patients with Parkinson's disease. Patients being treated with LCIG should be closely monitored for NS.
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Affiliation(s)
- Ryo Tokimura
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
- Department of Neurology, The University of Tokyo Hospital, Japan
| | - Eiichi Ito
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
| | - Yoshihiro Sugiura
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Japan
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Sharma D, Tomar DS, Gupta S. Non-hypertension-associated Posterior Reversible Encephalopathy Syndrome in COVID-19. Indian J Crit Care Med 2022; 26:641-642. [PMID: 35719457 PMCID: PMC9160627 DOI: 10.5005/jp-journals-10071-24218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Coronavirus disease-2019 (COVID-19) infection-related neurological events are not uncommon but presenting as posterior reversible encephalopathy syndrome (PRES) without hypertension is a very rare presentation and requires a high index of suspicion. Case summary We report a case of a middle-aged female who presented with severe COVID-19 disease with no neurological symptoms. She complained of diminished vision on day 7 of the illness and underwent an MRI brain to rule out an ischemic stroke but the findings were suggestive of PRES. She had no episode of hypertension during the hospital stay. Probably severe COVID-related inflammation was the reason for such a presentation. Conservative management resolved the issue and her symptoms weaned off. Conclusion Severe COVID disease can lead to PRES-like symptoms and requires neuroimaging to validate it. Conservative management is the best treatment for such patients. How to cite this article Sharma D, Tomar DS, Gupta S. Non-hypertension-associated Posterior Reversible Encephalopathy Syndrome in COVID-19. Indian J Crit Care Med 2022;26(5):641–642.
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Affiliation(s)
- Dhruva Sharma
- Department of Critical Care Medicine, Narayana Super-speciality Hospital, Gurugram, Haryana, India
| | - Deeksha S Tomar
- Department of Critical Care Medicine, Narayana Super-speciality Hospital, Gurugram, Haryana, India
| | - Sachin Gupta
- Department of Critical Care Medicine, Narayana Super-speciality Hospital, Gurugram, Haryana, India
- Sachin Gupta, Department of Critical Care Medicine, Narayana Super-speciality Hospital, Gurugram, Haryana, India, Phone: +91 9873240734, e-mail:
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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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Goyal G, Jeswani J. Study of Clinico-radiological Profile in Posterior Reversible Encephalopathy Syndrome: Experience from North India. Indian J Crit Care Med 2022; 26:501-505. [PMID: 35656041 PMCID: PMC9067501 DOI: 10.5005/jp-journals-10071-24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gourav Goyal
- Department of Neurology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
- Gourav Goyal, Department of Neurology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, Phone: +91 8387867414, e-mail:
| | - Jitesh Jeswani
- Department of Nephrology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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50
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Zerbib Y, Gibert L, Bennis Y, Masmoudi K, Maizel J, Brault C. Posterior Reversible Encephalopathy Syndrome After Self-Medication With an Oral Decongestant: A Case Report. Front Med (Lausanne) 2022; 9:837324. [PMID: 35321464 PMCID: PMC8935013 DOI: 10.3389/fmed.2022.837324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder caused by the dysregulation of cerebral perfusion. Case Presentation We report on a 18-year-old female patient with a history of end-stage renal disease and thrice weekly hemodialysis. She was admitted to the emergency department with mental confusion, blurred vision, headaches, and vomiting, following self-medication with an oral decongestant containing pseudoephedrine. We observed hypointense lesions with T1-weighted MRI and hyperintense areas with T2-weighted and fluid-attenuated inversion recovery MRI sequences. The lack of diffusion restriction was consistent with a diagnosis of PRES. A concomitant Enterobacter cloacae hemodialysis catheter-bloodstream infection was also diagnosed. We hypothesize that both sepsis and inappropriate self-medication with oral pseudoephedrine contributed to hypertension, endothelial dysfunction, and vasogenic edema. The patient received intensive care and made a full recovery. Discussion PRES is a life-threatening condition that requires intensive care. Identification of the etiology is the keystone of medical care. Inappropriate self-medication with an oral decongestant might trigger PRES - highlighting the importance of patient education.
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Affiliation(s)
- Yoann Zerbib
- Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Louis Gibert
- Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Youssef Bennis
- Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, UR UPJV 7517, Amiens, France
| | - Kamel Masmoudi
- Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
| | - Julien Maizel
- Intensive Care Unit, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, UR UPJV 7517, Amiens, France
| | - Clément Brault
- Intensive Care Unit, Amiens University Medical Center, Amiens, France
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