Susceptibility-weighted angiography and diffusion-weighted imaging in posterior reversible encephalopathy syndrome – Is there an association between hemorrhage, cytotoxic edema, blood pressure and imaging severity?

Abstract Background Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. Case presentation A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. Conclusion Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.

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Posterior reversible encephalopathy syndrome with extensive cytotoxic edema after blood transfusion: a case report and literature review

BMC Neurology ◽

10.1186/s12883-018-1194-1 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Yoshitsugu Nakamura ◽

Masakazu Sugino ◽

Akihiro Tsukahara ◽

Hiroko Nakazawa ◽

Naomune Yamamoto ◽

...

Keyword(s):

Case Report ◽

Blood Transfusion ◽

Literature Review ◽

Posterior Reversible Encephalopathy Syndrome ◽

Cytotoxic Edema ◽

Posterior Reversible Encephalopathy ◽

Reversible Encephalopathy

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Posterior reversible encephalopathy syndrome due to COVID-19

Journal of Emergency Practice and Trauma ◽

10.34172/jept.2021.11 ◽

2021 ◽

Vol 7 (2) ◽

pp. 143-145

Author(s):

Maythem Abdulhassan Al-Kaisy

Keyword(s):

Blood Pressure ◽

Posterior Reversible Encephalopathy Syndrome ◽

Neurological Symptoms ◽

Normal Blood Pressure ◽

Blurred Vision ◽

Case Presentation ◽

Posterior Reversible Encephalopathy ◽

Medical Background ◽

Neurological Finding ◽

Reversible Encephalopathy

Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological finding and is associated or caused by COVID-19. Case Presentation: A 32-year-old lady, with no medical background had COVID-19 infection and needed mechanical ventilation. After surviving the intensive care, she started to have multiple seizures that required general anesthesia to be aborted. The patient turned out to have PRES. Conclusion: PRES is a neurological syndrome causing seizures, headaches, and blurred vision. It is usually associated with high blood pressure, renal failure, and other risk factors. The patient in this case had nearly normal blood pressure, but still had a diagnosis of PRES. The new reported neurological symptoms associated with COVID-19 infection need further research and attention from the academic society to predict and prevent the morbidity and mortality of COVID-19 patients.

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