Dengue-Associated Posterior Reversible Encephalopathy Syndrome

2020 ◽  
Author(s):  
Sharath M. Manya ◽  
Soundarya Mahalingam ◽  
Fathima Raeesa ◽  
Sathya Srivatsav
Keyword(s):  
Dengue Fever ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Seizure Freedom ◽  
Resonance Imaging ◽  
Cranial Nerve Involvement ◽  
Posterior Reversible Encephalopathy ◽  
Intracranial Bleed ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

AbstractDengue fever has been associated with a myriad of complications, due to widespread inflammation in the various afflicted organs. Central nervous system (CNS) complications include encephalitis, encephalopathy, intracranial bleed, and spinal and cranial nerve involvement with varied outcomes. We report a case of an adolescent girl who presented with dengue fever and significant hypotension requiring intravenous fluids and vasopressors, and developed seizures on the third day of admission. Magnetic resonance imaging (MRI) of brain showed features suggestive of posterior reversible encephalopathy syndrome. She was managed conservatively with antiepileptics. She showed complete clinical recovery over the next 3 days and remained normal with seizure freedom at a recent follow-up after tapering antiepileptics.

scholarly journals Posterior reversible encephalopathy syndrome mimicking cerebral metastasis: contraindication for biopsy

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Dukagjin Morina ◽  
Georgios Ntoulias ◽  
Homajoun Maslehaty ◽  
Martin Scholz ◽  
Athanasios K. Petridis
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Resonance Imaging ◽  
Open Biopsy ◽  
Posterior Reversible Encephalopathy ◽  
Typical Appearance ◽  
Magnetic Resonance Imaging Mri ◽  
Immunosupressive Therapy ◽  
Reversible Encephalopathy ◽  
Radiologic Features

The posterior reversible encephalopathy syndrome (PRES) is a well described entity of white matter pathology. PRES is triggered by numerous different factors such as acute elevated arterial hypertension, immunosupressive therapy, chemotherapy, etc. The case of a 67-year old woman is presented. The patient was treated for breast cancer 10 months ago and because of acute disorientation a magnetic resonance imaging (MRI) was performed. In the MRI biparieto-occipital hyperintense lesions were seen. Brain metastases were suspected. After chemothe - rapy and hypertonia and the typical appearance of the lesions in the MRI, PRES was also suspected. Before initializing the surgery for an open biopsy a follow-up MRI had been performed (2 weeks after initial MRI). In follow-up MRI the lesions disappeared completely proving the diagnosis of PRES. PRES can be misdiagnosed as a tumour and surgery could be mistakenly performed. It’s important to keep the differential diagnosis of PRES in mind when radiologic features of the syndrome are present.

scholarly journals Posterior Reversible Encephalopathy Syndrome and Azathioprine

2019 ◽  
Author(s):  
Sara Pinto Teixeira Vilas-Boas ◽  
Ana Corte-Real
Keyword(s):  
Magnetic Resonance Imaging ◽  
Status Epilepticus ◽  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Severe Hypertension ◽  
Neurological Manifestations ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome that presents with neurological manifestations, often associated with arterial hypertension. Magnetic resonance imaging (MRI) shows bilateral white matter oedema in the posterior vascular territories. Immunosuppression, (pre) eclampsia and autoimmune diseases can be implicated. A 27-year-old woman, with mixed connective tissue disease under azathioprine, was admitted in the emergency room in status epilepticus and with severe hypertension. The MRI showed bilateral oedema in a pattern compatible with PRES. There was clinical improvement after azathioprine suspension. PRES is typically reversible with prompt recognition of the syndrome and its trigger. The association with azathioprine is rare.

scholarly journals Malignant Posterior Reversible Encephalopathy Syndrome—An Exacting Challenge for Neurocritical Care Physicians

2017 ◽  
Vol 7 (4) ◽  
pp. 196-199 ◽  
Author(s):  
Shahvaiz Magsi ◽  
Atif Zafar
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Neurocritical Care ◽  
Bowel Resection ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Resolution Of Imaging ◽  
Tomography Scan ◽  
Caucasian Female

We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.

scholarly journals Good outcome after posterior reversible encephalopathy syndrome (PRES) despite elevated cerebral lactate: a case report

2015 ◽  
Vol 4 (6) ◽  
pp. 205846011557832 ◽  
Author(s):  
Caroline Ewertsen ◽  
Daniel Kondziella ◽  
Else R Danielsen ◽  
Carsten Thomsen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vasogenic Edema ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Irreversible Brain Damage ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
The Brain ◽  
Elevated Lactate

Posterior reversible encephalopathy syndrome (PRES) may cause irreversible brain damage. The diagnosis is confirmed by magnetic resonance imaging (MRI), where vasogenic edema may be seen especially in the posterior parts of the brain. MR spectroscopy (MRS) may be included to help predict the outcome by measuring selected metabolites for instance lactate. Usually lactate is immeasurable in brain tissue, but elevates in cases of hypoxia, and it has been associated with poor outcome. We report a case of a patient with eclampsia and PRES, who had elevated lactate initially, but complete remission clinically and on MRI.

scholarly journals Reversible cerebral vasoconstriction syndrome presenting as convexity subarachnoid haemorrhage and posterior reversible encephalopathy syndrome during postpartum: a case report and literature review

2019 ◽  
Author(s):  
Junliang Yuan ◽  
Zejin Jia ◽  
Wei Qin ◽  
Wenli Hu
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Signs And Symptoms ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Case Presentation ◽  
Posterior Reversible Encephalopathy ◽  
Cerebral Vasoconstriction ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Abstract Background Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache and reversible cerebral vasoconstriction, with other neurologic signs and symptoms. To the best of our knowledge, there were only a few cases of RCVS presenting both as both convexity subarachnoid haemorrhage (cSAH) and posterior reversible encephalopathy syndrome (PRES). Case presentation Herein, We report a case of a 32-year-old woman with RCVS who presented with recurrent thunderclap headaches that occurred 50 days after delivery, with cSAH and PRES on magnetic resonance imaging (MRI). She had significant clinical and radiological recover with 3 months’ follow-up. Conclusions The clinical coexistence of cSAH and PRES in our case with RCVS is quite rare. This case further raises the importance of the early diagnosis of RCVS, and clinical physicians should be well recognized when initial brain and vascular imaging are normal.

scholarly journals A Case of Antibiotic-Induced Posterior Reversible Encephalopathy Syndrome

2019 ◽  
Vol 55 (5) ◽  
pp. 338-341 ◽  
Author(s):  
Brian Wesley Gilbert ◽  
Ali Gabriel ◽  
Laura Velazquez
Keyword(s):  
Magnetic Resonance Imaging ◽  
Emergency Department ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Final Diagnosis ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Computed Tomographic ◽  
Reversible Encephalopathy ◽  
Resonance Imaging Scan

Purpose: To report a case of posterior reversible encephalopathy syndrome (PRES) in a 75 year-old patient who was taking concomitant ciprofloxacin and metronidazole. Method: Case report Results: A patient had been prescribed ciprofloxacin and metronidazole during a recent hospitalization and continued this regimen outpatient. Two weeks after discharge and 3 weeks after initiation of her regimen, she was brought to the emergency department after developing acute weakness and lightheadedness. After admission, the patient declined more rapidly and began seizing with subsequent intubation. Initial computed tomographic (CT) imaging showed no acute neurological abnormalities, and a sepsis workup was initiated. After negative CT, a magnetic resonance imaging scan was performed that showed a T2 flair and hyperdensity consistent with PRES. The final diagnosis was considered to be PRES secondary to ciprofloxacin/metronidazole utilization. Conclusion: Antibiotic induced PRES is a condition that needs to be explored more thoroughly.

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