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 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.

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 A broad spectrum of posterior reversible encephalopathy syndrome - a case series with clinical and paraclinical characterisation, and histopathological findings

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatme Seval Ismail ◽  
Johannes van de Nes ◽  
Ilka Kleffner
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Symptoms ◽  
Brain Mri ◽  
Case Series ◽  
Epileptic Seizures ◽  
Retrospective Case ◽  
Posterior Reversible Encephalopathy ◽  
Histopathological Findings ◽  
Delay In Diagnosis ◽  
Reversible Encephalopathy

Abstract Background Posterior reversible encephalopathy syndrome (PRES) is clinical-neuroradiologically defined and potentially reversible, so there are limited data about histopathological findings. We aimed to describe the clinical and paraclinical features of patients with PRES with regard to its reversibility. Methods This retrospective case series encompasses 15 PRES cases out of 1300 evaluated patients from a single German center between January 1, 2010, and June 15, 2020. PRES was established according to the diagnostic criteria as proposed by the Berlin PRES Study 2012. One of the cases studied was subject to brain autopsy. Results From the 15 patients studied (median age 53 years, range 17–73; 11 female), 67 % presented with epileptic seizures, 40 % suffered from encephalopathy with reduced consciousness and 53 % developed delirium, while 47 % had headache and visual disturbances. Subcortical brain MRI abnormalities related to PRES were observed in all patients. One patient developed spinal ischemia and another Guillain-Barré syndrome in addition to PRES. Hypertensive blood pressure was the main underlying/trigger condition in all patients. Clinical symptoms and MRI changes were not reversible in 42 %, even progressive in 3 out of these 5 patients. Median time from symptom onset to diagnosis in these non-reversible cases was 7 days (range 0–13), while the median delay in diagnosis in the reversible group was 1 day (range 0–3). Cerebellar/brain stem involvement and status epilepticus were more frequently in patients with non-reversible disease course. Mortality due to PRES occurred in 13 % of these patients. Neuropathological examination of the brain of a 57-year-old female patient revealed major leukencephalopathic changes, fibrinoid necrosis of endothelial cells and fresh petechial hemorrhages in accordance with PRES. Conclusions Our case series demonstrates that PRES was not reversible in 42 % of the studied patients. Delay in diagnosis seems to contribute to limited reversibility and poor outcome.

Posterior Reversible Encephalopathy Syndrome Following Diabetic Ketoacidosis: A Case Report

2021 ◽  
Author(s):  
Meng-Ko Tsai ◽  
Chao-Hung Lai ◽  
Tsung-Ju Chuang
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Blood Sugar ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Posterior Reversible Encephalopathy ◽  
First Case ◽  
Aged Woman ◽  
Adequate Hydration ◽  
Reversible Encephalopathy

Abstract Background Posterior reversible encephalopathy syndrome (PRES) following the development of diabetic ketoacidosis (DKA) is rare and usually occurs in children. This is the first case of DKA following PRES that we know of that occurred in an adult.Case report We encountered a middle-aged woman with a one-day history of nausea and vomiting who presented with DKA and seizure, along with hallucinations. On presentation, we performed physical examinations and blood biochemistry tests to ascertain the cause of these symptoms. We also performed magnetic resonance imaging (MRI) of her brain, which showed typical brain edema in the bilateral occipital and parietal regions, which indicated PRES. We treated the patient’s symptoms by administering adequate hydration and administering an infusion of insulin of 30 U after breakfast and 15 U after dinner to bring her blood sugar levels under control.The brain MRI we performed showed hyperintensity of the bilateral occipital and parietal cortexes on a fluid-attenuated inversion recovery T2 weighted image, after which the patient was diagnosed with PRES. The patient was discharged thirteen days after admission with stable blood sugar and blood pressure levels. Conclusions Physicians should keep this condition in mind as a possible complication of DKA and treat it quickly and efficiently in order to attain a good patient outcome.This is the first report of DKA-induced PRES in an adult, and physicians should keep this condition in mind as a possible complication of DKA, which is treatable and may have a good prognosis.

scholarly journals Posterior Reversible Encephalopathy Syndrome with Stroke in Puerperal Woman with High Titer of Anti-Phospholipid IgM Antibody

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Hiroto Hirashima ◽  
Masahiro Iwamoto ◽  
Tadashi Ozawa ◽  
Shigeyoshi Kijima ◽  
Shigeki Matsubara ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
High Titer ◽  
Male Infant ◽  
Clonic Seizure ◽  
Posterior Reversible Encephalopathy ◽  
Igm Antibody ◽  
Disturbance Of Consciousness ◽  
Puerperal Woman ◽  
The Right ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome with stroke is very rare in puerperal women. A 36-year-old nulliparous woman with both rheumatoid arthritis and recurrent pregnancy loss, probably due to a high titer of anti-phospholipid IgM antibody, was referred at 10 weeks of gestation. Low-dose aspirin at 100 mg/day and heparin calcium subcutaneous injection at 10,000 units/day were started before pregnancy and stopped at 35+6 and 40+2 weeks, respectively. She transabdominally delivered a male infant weighing 3,344 g at 40+5 weeks. A tonic-clonic seizure abruptly occurred without either hypertension or proteinuria 5 days after delivery. Intracerebral hemorrhage involving an area of 2 cm in diameter in the right frontal lobe and subarachnoid hemorrhage with PRES were confirmed. Seizure recurred 2 days after the initial episode. She showed severe headache and mild disturbance of consciousness but no neurological findings. We suggested that a high titer of anti-phospholipid IgM antibody might be associated with stroke.

scholarly journals Posterior Reversible Encephalopathy Syndrome Secondary to CSF Leak and Intracranial Hypotension: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Tariq Hammad ◽  
Alison DeDent ◽  
Rami Algahtani ◽  
Yaseen Alastal ◽  
Lawrence Elmer ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Intracranial Hypotension ◽  
Mechanistic Model ◽  
Brain Mri ◽  
Pressure Control ◽  
Csf Leak ◽  
Dural Defect ◽  
Posterior Reversible Encephalopathy ◽  
Posterior Leukoencephalopathy ◽  
Reversible Encephalopathy

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical neuroradiological condition characterized by insidious onset of neurological symptoms associated with radiological findings indicating posterior leukoencephalopathy. PRES secondary to cerebrospinal fluid (CSF) leak leading to intracranial hypotension is not well recognized etiology of this condition. Herein, we report a case of PRES that occurred in the setting of CSF leak due to inadvertent dural puncture. Patient underwent suturing of the dural defect. Subsequently, his symptoms resolved and a repeated brain MRI showed resolution of brain lesions. The pathophysiology and mechanistic model for developing PRES in the setting of intracranial hypotension were discussed. We further highlighted the importance of tight blood pressure control in patients with CSF leak and suspected intracranial hypotension because they are more vulnerable to develop PRES with normal or slightly elevated bleed pressure values.

scholarly journals Posterior Reversible Encephalopathy Syndrome in Pregnancy

2015 ◽  
Vol 7 (3) ◽  
pp. 205-206
Author(s):  
N Sundari ◽  
Asha Swaroop ◽  
BM Krupa ◽  
BK Madhusudhan ◽  
S Chaitra
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Delayed Diagnosis ◽  
Acute Onset ◽  
Posterior Reversible Encephalopathy ◽  
Complete Reversal ◽  
The Common ◽  
T2 Hyperintensity ◽  
Reversible Encephalopathy ◽  
Visual Disturbances ◽  
In Pregnancy

ABSTRACT Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity characterized by several symptoms of varied etiologies. The common symptoms are headache, confusion, seizures, cortical visual disturbances or blindness. Here, we report a 22 years old lady with 32 weeks of gestation who presented with complaints of acute onset of headache, sudden loss of vision with elevated blood pressure (BP), whose magnetic resonance venogram (MR venogram) revealed bilateral occipital T2 hyperintensity with restriction of diffusion suggestive of PRES. Early identification and treatment usually results in complete reversal of the deficits and delayed diagnosis and improper management can lead to irreversible sequelae. How to cite this article Krupa BM, Sundari N, Madhusudhan BK, Swaroop A, Chaitra S. Posterior Reversible Encephalopathy Syndrome in Pregnancy. J South Asian Feder Obst Gynae 2015;7(3):205-206.

scholarly journals Association of Posterior Reversible Encephalopathy Syndrome and Transient Apical Ballooning Syndrome (Takotsubo): First Case Report of a Man and Review of the Literature

2017 ◽  
Vol 9 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Stephan Grimaldi ◽  
Emilie Doche ◽  
Caroline Rey ◽  
Nadia Laksiri ◽  
Salah Boussen ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Apical Ballooning Syndrome ◽  
Ventricular Ejection Fraction ◽  
Posterior Reversible Encephalopathy ◽  
First Case ◽  
Reversible Encephalopathy

Introduction: An association of posterior reversible encephalopathy syndrome (PRES) and takotsubo is rare. We present the first case of a male patient. Case Report: A 69-year-old man presented to the hospital in a persistent comatose state following a generalized tonic-clonic seizure with high blood pressure. The electrocardiogram revealed transient left bundle branch block. Troponin and BNP were elevated. Cardiac ultrasound showed large apical akinesia with altered left ventricular ejection fraction, and the left ventriculogram showed characteristic regional wall motion abnormalities involving the mid and apical segments. Brain MRI showed bilateral, cortical, and subcortical vasogenic edema predominant in the posterior right hemisphere. The lumbar puncture and cerebral angiography were normal. Paraclinical abnormalities were reversible within 2 weeks with a clinical recovery in 3 months, confirming the takotsubo and the PRES diagnoses. Discussion: Several theories hypothesize the underlying pathophysiology of takotsubo or PRES. Circulating catecholamines are up to 3 times higher in patients with takotsubo causing impaired microcirculation and apical hypokinesia. An association of both takotsubo and asthma crisis and PRES and asthma crisis underlines the role of catecholamines in the occurrence of these disorders. Conclusion: Early recognition of this rare association, in which heart and neurological damage may require rapid intensive care support, is needed.

scholarly journals Posterior Reversible Encephalopathy Syndrome Associated with FOLFOX Chemotherapy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Luiz Carlos Porcello Marrone ◽  
Bianca Fontana Marrone ◽  
Tharick Ali Pascoal ◽  
Lucas Porcello Schilling ◽  
Ricardo Bernardi Soder ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Mental Status ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Visual Loss ◽  
Brain Mri ◽  
Altered Mental Status ◽  
Posterior Reversible Encephalopathy ◽  
Characteristic Imaging ◽  
Folfox Chemotherapy ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity characterized by headaches, altered mental status, seizures, visual loss, and characteristic imaging pattern in brain MRI. The cause of PRES is not yet understood. We report a case of a 27-year-old woman that developed PRES after the use of FOLFOX 5 (oxaliplatin/5-Fluoracil/Leucovorin) chemotherapy for a colorectal cancer.

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.

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