scholarly journals Tumour-like presentation of atypical posterior reversible encephalopathy syndrome with prominent brainstem involvement

2020 ◽  
Vol 13 (1) ◽  
pp. e231687
Author(s):  
Vincenzo Di Stefano ◽  
Marianna Gabriella Rispoli ◽  
Marco Onofrj ◽  
Maria Vittoria De Angelis
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Posterior Reversible Encephalopathy ◽  
Hyperintense Signal ◽  
The Right ◽  
Persistent Headache ◽  
Reversible Encephalopathy ◽  
Weighted Sequences

Typical posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterised by bilateral white matter oedema, which is usually symmetrical and totally reversible in 2–3 weeks. A 46-year-old man presented with a persistent headache and visual blurring in the right eye. On admission, the clinical examination revealed minimal unsteadiness of gait and elevated blood pressure. A brain MRI showed a hyperintense signal on T2-weighted sequences in the whole brainstem, extended to the spinal cord (C2–C6), the left insula and the right cerebellum. When his blood pressure was controlled, his symptoms gradually improved. The follow-up MRI scan at 3 weeks revealed a dramatic regression of the hyperintense lesions on T2-weighted sequences. The differential diagnosis of PRES is very wide, especially in the case of conspicuous brainstem involvement. Treatable causes of white matter oedema should be always kept in mind to avoid misdiagnosis and prevent complications, such as intracranial haemorrhage.

Optic pathways and brainstem involvement in posterior reversible encephalopathy syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. e239130
Author(s):  
Sofia Grenho Rodrigues ◽  
Paulo Saraiva ◽  
Inês Brás Marques
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Vasogenic Oedema ◽  
Posterior Reversible Encephalopathy ◽  
Ischaemic Optic Neuropathy ◽  
Complete Reversal ◽  
Optic Pathways ◽  
The Right ◽  
Persistent Headache ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome manifesting with acute focal signs, and concomitant neuroimaging findings of vasogenic oedema. It affects the parieto-occipital regions in a vast majority of cases, although atypical variants have been described comprising the brainstem, basal ganglia or spinal cord. We report the case of a 41-year-old woman, admitted for persistent headache and inferior altitudinal field defect in the right eye. She presented with severe, non-medicated, hypertension. Brain MRI showed findings compatible with atypical PRES, involving the brainstem and optic pathways. With antihypertensive therapy the headache remitted, although visual field remained and was interpreted in the context of a vascular aetiology—non-arteritic anterior ischaemic optic neuropathy. MRI was repeated 3 weeks later and showed almost complete reversal of the previous changes.

scholarly journals A Grave Outcome of Posterior Reversible Encephalopathy Syndrome in a Patient Receiving Avastin (Bevacizumab) for Metastatic High-Grade Serous Ovarian Cancer

2015 ◽  
Vol 8 (2) ◽  
pp. 290-294 ◽  
Author(s):  
Hind H. Elmalik ◽  
Shereen ElAzzazy ◽  
Khaled S. Salem ◽  
Salha Bujassoum
Keyword(s):  
Blood Pressure ◽  
Ovarian Cancer ◽  
Diastolic Blood Pressure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
High Grade ◽  
Serous Ovarian Cancer ◽  
Posterior Reversible Encephalopathy ◽  
Presenting Symptoms ◽  
Reversible Encephalopathy

A 45-year-old female developed neurological symptoms and elevated diastolic blood pressure while on bevacizumab (Avastin) and gemcitabine for recurrent carboplatin-resistant high-grade serous ovarian cancer. A brain MRI diagnosed our patient with posterior reversible encephalopathy syndrome. We are discussing her presenting symptoms in this paper as well as the management and the outcome. We emphasize the importance of keeping this rare but very serious complication in all patients receiving bevacizumab.

Posterior reversible encephalopathy syndrome in acute pancreatitis: a rare stroke mimic

2020 ◽  
Vol 13 (9) ◽  
pp. e232228
Author(s):  
Luke John Bonavia ◽  
Justin Jackson ◽  
Richard Jurevics
Keyword(s):  
Blood Pressure ◽  
Acute Pancreatitis ◽  
Acute Stroke ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Limb Weakness ◽  
Posterior Reversible Encephalopathy ◽  
Fluid Attenuated Inversion Recovery ◽  
Stroke Mimic ◽  
Reversible Encephalopathy

We report a 71-year-old woman who presented with Posterior Reversible Encephalopathy Syndrome (PRES) in the setting of acute pancreatitis. On day 3 of her admission, she developed transient right-sided upper and lower limb weakness, reduced visual acuity and encephalopathy, initially regarded as an acute stroke. Brain MRI fluid-attenuated inversion recovery (FLAIR) T2 imaging performed the same day confirmed occipital and parietal hyperdensities consistent with PRES. Her blood pressure never exceeded 150/75 mm Hg throughout the course of the admission. Our case demonstrates PRES in the setting of acute pancreatitis with only a relatively moderate elevation in blood pressure. In order to prevent unnecessary intervention in the setting of presumed acute stroke, it is important to consider the potential differential diagnoses including PRES as rare masquerade of acute stroke or transient ischaemic attack.

scholarly journals Posterior Reversible Encephalopathy Syndrome Caused by Fioricet (Butalbital-Acetaminophen-Caffeine)

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Naomi Cret ◽  
Madalina Halalau ◽  
Shahab Rezvani ◽  
Alexandra Halalau
Keyword(s):  
Blood Pressure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Parietal Lobe ◽  
Brain Mri ◽  
Occipital Lobe ◽  
Subcortical White Matter ◽  
Common Side Effect ◽  
Posterior Reversible Encephalopathy ◽  
Constant Pain ◽  
Reversible Encephalopathy

A common side effect of Fioricet (butalbital-acetaminophen-caffeine) is high blood pressure caused by the caffeine content. We report a case of a 54-year-old female who developed the worst headache of her life after taking 2 tablets of butalbital-acetaminophen-caffeine every six hours for three days before presenting to the emergency department, where her blood pressure was 178/87 mmHg. A brain MRI showed edema in the subcortical white matter of the right occipital lobe, right parietal lobe, and left occipital lobe. Posterior reversible encephalopathy syndrome (PRES) was diagnosed. The patient returned within the week with severe headaches, visual hallucinations, and a blood pressure of 150/80 mmHg. Repeat brain MRI showed slight improvement of edema. Her brain imaging studies completely normalized at 10 months after diagnosis. Although the patient received appropriate treatment, she was unable to make full recovery. Due to her inability to work and the constant pain, the patient continues to struggle with depression.

scholarly journals Posterior Reversible Encephalopathy Syndrome Presenting with Atypical Findings: Report of Two Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Paolo Cerrone ◽  
Patrizia Sucapane ◽  
Rocco Totaro ◽  
Simona Sacco ◽  
Antonio Carolei ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Brain Mri ◽  
Asymmetric Distribution ◽  
Mri Findings ◽  
Posterior Reversible Encephalopathy ◽  
Atypical Symptoms ◽  
Severe Impairment ◽  
Reversible Encephalopathy ◽  
Weighted Sequences

Background. Posterior reversible encephalopathy syndrome (PRES) is characterized by a variable association of symptoms including headache, consciousness impairment, visual disturbances, seizures, and focal neurological signs. Treating the underlying cause usually leads to partial or complete resolution of symptoms within days or weeks. Brain MRI findings include hyperintensities on T2-weighted sequences and their reversibility on follow-up exams. We describe two patients, one with an atypical clinical presentation characterized by a severe and prolonged impairment of consciousness and the other with atypical neuroimaging findings. Case Presentation. The first patient was a 42-year-old woman, with a negative medical history, presenting with seizures, lethargy, and left hemiparesis, 60 hours after uncomplicated delivery. Brain MRI showed an atypical pattern of alterations, with patchy asymmetric distribution in all lobes. Symptoms completely resolved after twelve days. The second patient was a 59-year-old woman with a history of hypertension, presenting with severe impairment of consciousness, vision loss, and seizures. Symptoms partially resolved after three weeks. Conclusion. PRES is characterized by reversible symptoms and radiological findings. Brain MRI usually shows widespread oedema in white matter with typical patterns. The cases we described suggest that PRES may presents with atypical symptoms and radiological manifestations, mimicking other neurological conditions.

scholarly journals A rare case of posterior reversible encephalopathy syndrome in a patient with severe leptospirosis complicated with rhabdomyolysis and acute kidney injury; a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jayawardane Pathiranage Roneesha Lakmali ◽  
Kanapathipillei Thirumavalavan ◽  
Danapala Dissanayake
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Blood Pressure Control ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Kidney Injury ◽  
Pressure Control ◽  
Posterior Reversible Encephalopathy ◽  
Peripheral Nerve Involvement ◽  
Reversible Encephalopathy

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.

Posterior reversible encephalopathy syndrome following Miller-Fisher syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242231
Author(s):  
Catarina Bernardes ◽  
Cristiana Silva ◽  
Gustavo Santo ◽  
Inês Correia
Keyword(s):  
Intravenous Immunoglobulin ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Clonic Seizure ◽  
Miller Fisher Syndrome ◽  
Fisher Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Fluid Analysis ◽  
Immunoglobulin Treatment ◽  
Reversible Encephalopathy

A 71-year-old woman presented to the emergency room with dysphonia, diplopia, dysphagia and generalised weakness since that day. Neurological examination revealed eye adduction limitation, ptosis, hypoactive reflexes and gait ataxia. Blood and cerebrospinal fluid analysis and brain CT were normal. Electromyography revealed a sensory axonal polyneuropathy. She was diagnosed with Miller-Fisher syndrome (MFS) and started on intravenous immunoglobulin. Two days after intravenous immunoglobulin treatment was completed, she developed a sustained hypertensive profile and presented a generalised tonic-clonic seizure. Brain MRI was suggestive of posterior reversible encephalopathy syndrome (PRES) and supportive treatment was implemented with progressive improvement. PRES may be a possible complication of MFS not only due to autonomic and inflammatory dysfunctions, but also as a consequence of its treatment. Patients with MFS should be maintained under close surveillance, especially in the first days and preferably in intermediate care units.

scholarly journals Posterior reversible encephalopathy syndrome: A case report

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 ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Impaired Consciousness ◽  
Posterior Reversible Encephalopathy ◽  
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.

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