Hypertension and Confusion

Clinical Course ◽

Severe Hypertension ◽

Vasogenic Edema ◽

Blurred Vision ◽

Immunosuppressive Medications ◽

Posterior reversible encephalopathy syndrome is a clinical–radiographic syndrome of progressive headaches, blurred vision, confusion, and seizures in the setting of vasogenic edema on brain imaging, which is often localized to the posterior white matter. The symptoms are classically triggered by severe hypertension, pregnancy and the puerperium, or exposure to immunosuppressive medications. The symptoms can be reversible if the offending etiology is quickly removed, but permanent deficits can remain if strokes or hemorrhage complicate the clinical course.

Transient Global Amnesia with Reversible White Matter Lesions: A Variant of Posterior Reversible Encephalopathy Syndrome?

Case Reports in Neurological Medicine ◽

10.1155/2015/541328 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Tomoki Nakamizo ◽

Ippei Tsuzuki ◽

Takashi Koide

Keyword(s):

White Matter ◽

Clinical Course ◽

Vasogenic Edema ◽

White Matter Lesions ◽

Transient Global Amnesia ◽

Subcortical White Matter ◽

Global Amnesia ◽

Transient global amnesia (TGA) is a self-limited disease characterized by isolated amnesia, which resolves within 24 h. In contrast, posterior reversible encephalopathy syndrome (PRES) is a potentially life-threatening disease that usually presents with seizures, altered mental status, headache, and visual disturbances. It is characterized by reversible vasogenic edema that predominantly involves the parieto-occipital subcortical white matter as shown by neuroimaging studies. To date, there have been no reported cases of PRES with a clinical course resembling TGA. Here we report the case of a 58-year-old woman who presented with isolated amnesia and headache. On admission, her blood pressure was 187/100 mmHg. She had complete anterograde amnesia and slight retrograde amnesia without other neurological findings. After the treatment of her hypertension, the amnesia resolved within 24 h. Although the initial magnetic resonance image (MRI) was almost normal, the fluid attenuation inversion recovery (FLAIR) images of the MRI on the next day revealed several small foci of high intensity areas in the fronto-parieto-occipital subcortical white matter, presumed to be vasogenic edema in PRES. The lesions disappeared one month later. This case suggests that PRES can mimic the clinical course of TGA. PRES should be considered in the differential diagnosis for TGA.

Posterior Reversible Encephalopathy Syndrome and Azathioprine

European Journal of Case Reports in Internal Medicine ◽

10.12890/2018_001032 ◽

2019 ◽

Author(s):

Sara Pinto Teixeira Vilas-Boas ◽

Ana Corte-Real

Keyword(s):

Magnetic Resonance Imaging ◽

Status Epilepticus ◽

White Matter ◽

Severe Hypertension ◽

Neurological Manifestations ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

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.

Cognitive Sequelae of Central-Variant Posterior Reversible Encephalopathy Syndrome (PRES)

Case Reports in Neurological Medicine ◽

10.1155/2021/8850316 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Joseph Seemiller ◽

Muhammad Taimur Malik

Keyword(s):

White Matter ◽

Brain Imaging ◽

Cognitive Deficits ◽

Subcortical White Matter ◽

Altered Level ◽

Alteration Of Consciousness ◽

Atypical Presentations ◽

Introduction. Although the posterior reversible encephalopathy syndrome (PRES) is often associated with headache and visual changes, central-variant PRES can be difficult to clinically diagnose in a patient with alteration of consciousness. Central-variant PRES has been previously described in the literature affecting subcortical white matter and the brainstem. Case Presentation. We describe a case presenting with hypertension (192/98) and altered level of consciousness requiring intubation. She was ultimately found to have extensive symmetric cortical and subcortical edema, with extensive involvement of bilateral thalami, consistent with central-variant PRES. Her mentation rapidly improved with blood pressure management. Confirmation of the diagnosis of central-variant PRES was made on repeat brain imaging. Our case is unique in demonstrating dramatic central white matter changes and their reversibility on repeat imaging six days later. Finally, persistent cognitive deficits at follow-up four months later are described. Conclusion. Atypical presentations of PRES, involving alterations in levels of consciousness, can be difficult to clinically diagnose. A thorough differential diagnosis is even more important in cases of PRES with atypical imaging. Recognition of the diagnostic patterns of PRES on brain imaging, with prompt reversal of the causative factors, is crucial for the appropriate care of these patients. The long-term sequelae, which could include cognitive deficits, are poorly studied and understood.

Posterior Reversible Encepalopathy Syndrome in A Child With Post Streptococcal Glomerulonephritis- A Rare Case Report

Med Phoenix ◽

10.3126/medphoenix.v6i1.36781 ◽

2021 ◽

Vol 6 (1) ◽

pp. 50-52

Author(s):

Sunita Ghimire ◽

Shree Krishna Shrestha ◽

Ram Chandra Bastola ◽

Anita Dahal ◽

Pragya Shakya

Keyword(s):

Vasogenic Edema ◽

Female Child ◽

Hypertensive Encephalopathy ◽

Radiological Features ◽

Rare Case Report ◽

Post Streptococcal Glomerulonephritis ◽

Reversible Encephalopathy ◽

Timely Treatment

Posterior reversible encephalopathy syndrome is a condition occurring in majority of case of hypertensive encephalopathy mainly due to vasogenic edema in parieto occipital region in neuroimaging. It is reversible if timely treatment is done .Here we are reporting a 11 year old female child with acute post streptococal glomerulonephrtitis leading to typical clinical and radiological features of posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome: A case report

Vojnosanitetski pregled ◽

10.2298/vsp140529053k ◽

2015 ◽

Vol 72 (8) ◽

pp. 735-739

Author(s):

Dejan Kostic ◽

Biljana Brkic-Georgievski ◽

Aleksandar Jovanovski ◽

Smiljana Kostic ◽

Drazen Ivetic ◽

...

Keyword(s):

Case Report ◽

White Matter ◽

Impaired Consciousness ◽

Neurological Signs ◽

Appropriate Treatment ◽

History Of ◽

Reversible Encephalopathy ◽

The Brain

Posterior reversible encephalopathy syndrome (PRES) is characterized by the following symptoms: seizures, impaired consciousness and/or vision, vomiting, nausea, and focal neurological signs. Diagnostic imaging includes examination by magnetic resonance (MR) and computed tomography (CT), where brain edema is visualized bi-laterally and symmetrically, predominantly posteriorly, parietally, and occipitally. Case report. We presented a 73-year-old patient with the years-long medical history of hipertension and renal insufficiency, who developed PRES with the symptomatology of the rear cranium. CT and MR verified changes in the white matter involving all lobes on both sides of the brain. After a two-week treatment (antihypertensive, hypolipemic and rehydration therapy) clinical improvement with no complications occurred, with complete resolution of changes in the white matter observed on CT and MR. Conclusion. PRES is a reversible syndrome in which the symptoms withdraw after several days to several weeks if early diagnosis is made and appropriate treatment started without delay.

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 ◽

Neurological Symptoms ◽

Normal Blood Pressure ◽

Blurred Vision ◽

Case Presentation ◽

Medical Background ◽

Neurological Finding ◽

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.

Transient increase of fractional anisotropy in reversible vasogenic edema

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x16630556 ◽

2016 ◽

Vol 36 (10) ◽

pp. 1731-1743 ◽

Cited By ~ 12

Author(s):

Shihoko Kimura-Ohba ◽

Yi Yang ◽

Jeffrey Thompson ◽

Tomonori Kimura ◽

Victor M Salayandia ◽

...

Keyword(s):

Fractional Anisotropy ◽

Acute Phase ◽

Cyclosporine A ◽

Pathological Condition ◽

Neurological Diseases ◽

Vasogenic Edema ◽

High Dose ◽

Brain vasogenic edema, involving disruption of the blood-brain barrier, is a common pathological condition in several neurological diseases, with a heterogeneous prognosis. It is sometimes reversible, as in posterior reversible encephalopathy syndrome, but often irreversible and our current clinical tools are insufficient to reveal its reversibility. Here, we show that increased fractional anisotropy in magnetic resonance imaging is associated with the reversibility of vasogenic edema. Spontaneously, hypertensive rats-stroke prone demonstrated posterior reversible encephalopathy syndrome-like acute encephalopathy in response to high-dose cyclosporine A treatment; the deteriorating neurological symptoms and worsening scores in behavioral tests, which were seen in acute phase, dissappered after recovery by cessation of cyclosporine A. In the acute phase of encephalopathy, the fractional anisotropy and apparent diffusion coefficient increased in areas with IgG leakage. This increase of fractional anisotropy occurred in the absence of demyelination: fluid leakage into the myelinated space increased the axial, but not the radial, diffusivity, resulting in the increased fractional anisotropy. This increased fractional anisotropy returned to pre-encephalopathy values in the recovery phase. Our results highlight the importance of the fractional anisotropy increase as a marker for the reversibility of brain edema, which can delineate the brain areas for which recovery is possible.

Posterior reversible encephalopathy syndrome (PRES) presenting as Status Epilepticus in a case of Autoimmune Hemolytic Anemia (AIHA): A Case report

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i6.33817 ◽

2021 ◽

Vol 12 (6) ◽

pp. 102-106

Author(s):

Sameera Dronamraju ◽

Shilpa Gaidhane ◽

Aayush Somani ◽

Sourya Acharya

Keyword(s):

Status Epilepticus ◽

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Vasogenic Edema ◽

Complete Recovery ◽

Young Female ◽

Oral Steroids ◽

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, caused by imbalance in autoregulation of posterior cerebral circulation. We report a case of young female, presented at emergency department with complains of nausea, vomiting and generalized tonic clonic seizures prior to admission. During the course of hospital stay patient landed in status epilepticus which was treated appropriately. Patient’s magnetic resonance imaging (MRI) was done which had classical features of vasogenic edema in occipital and parietal region, suggestive of PRES. She was a known case of autoimmune hemolytic anemia thatwas treated with multiple blood transfusions and low dose oral steroids. She was discharged after complete resolution of symptoms with the advice to follow up in medicine outpatient department. Our case describes about autoimmune hemolytic anemia in which occurrence of PRES is uncommon. Early diagnosis and robust treatment can prevent permanent damage to the brain, and is often associated with complete recovery.

Posterior Reversible Encephalopathy Syndrome Secondary to Hypertensive Encephalopathy Brought on by a MAO Inhibitor: A Case Report

Journal of Primary Care & Community Health ◽

10.1177/2150132719869539 ◽

2019 ◽

Vol 10 ◽

pp. 215013271986953 ◽

Cited By ~ 1

Author(s):

Robert Strother ◽

Hailon Wong ◽

Nathaniel E. Miller

Keyword(s):

White Matter ◽

Mental Status ◽

Altered Mental Status ◽

Hypertensive Encephalopathy ◽

Inpatient Service ◽

Mao Inhibitor ◽

Radiographic Findings ◽

An elderly woman was admitted to the Family Medicine inpatient service for altered mental status after being brought to the emergency room by a concerned neighbor, who had come across the patient speaking incoherently. Initial evaluation was notable for elevated blood pressures, but extensive lab testing and head computed tomographic imaging were within normal limits. However, subsequent magnetic resonance imaging showed white matter changes consistent with posterior reversible encephalopathy syndrome (PRES), a neurologic syndrome characterized by headache, altered mental status, loss of vision, and seizures as well as radiographic findings of posterior cerebral white matter edema. Multiple etiologies of PRES have been described and include hypertensive encephalopathy, immunosuppressant medications, and eclampsia. This case describes an episode of PRES secondary to hypertensive encephalopathy brought about by an inappropriate dose of a monoamine oxidase (MAO) inhibitor. The patient had significant improvement in symptoms with removal of the offending agent and control of her blood pressure. While PRES generally has a good prognosis, prompt recognition, and management are important in preventing significant disease morbidity and mortality.

Posterior reversible encephalopathy syndrome following post-streptococcal glomerulonephritis

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v12i3.13323 ◽

2013 ◽

Vol 12 (3) ◽

pp. 341-343

Author(s):

Giordano Rafael Tronco Alves ◽

Isadora Cristina Olesiak Cordenonsi ◽

Régis Vinícius de Andrade Silva ◽

Carlos Jesus Pereira Haygert

Keyword(s):

Chronic Renal Disease ◽

Vasogenic Edema ◽

Medical Science ◽

Clonic Seizure ◽

Imaging Features ◽

Inflammatory Conditions ◽

Post Streptococcal Glomerulonephritis ◽

Posterior reversible encephalopathy syndrome (PRES) comprises a unique pattern of brain vasogenic edema that is seen in the setting of a neurotoxic status. Besides many etiologies have been already associated with PRES development, such as chronic renal disease, use of chemotherapy agents and inflammatory conditions, the imaging features are very suggestive and helpful for an appropriate diagnosis. We report here a case of PRES secondary to post-streptococcal glomerulonephritis (PSGN), which evolved successfully after clinical management. An 11-year-old boy was admitted with a typical history and findings of PSGN, associated with sensory alterations, headache and recent tonic-clonic seizure. Computed tomography (CT) scan of the head has revealed bilateral and symmetric hypodense areas, remarkably located at posterior cerebral regions, indicating PRES. Patient received support therapy with diuretics, and antibiotics prescription after discharge. At ambulatory follow-ups, the patient remains asymptomatic, with complete clinical and radiological improvement.Bangladesh Journal of Medical Science Vol. 12 No. 03 July 13 Page 341-343 DOI: http://dx.doi.org/10.3329/bjms.v12i3.13323