Black stone poisoning with a unique complication of posterior reversible encephalopathy syndrome (PRES)

2021 ◽  
Vol 14 (6) ◽  
pp. e240851
Author(s):  
Safia Akhlaq ◽  
Adil Aziz
Keyword(s):  
Fluid Resuscitation ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Spontaneous Breathing Trial ◽  
Kidney Injury ◽  
Hair Dye ◽  
Posterior Reversible Encephalopathy ◽  
Black Stone ◽  
High Dependency ◽  
Antiepileptic Medication ◽  
Reversible Encephalopathy

A 25-year-old woman presented to the emergency department with difficulty in breathing, within 12 hours of intentional black stone ingestion, that is, para-phenylenediamine (p-PD), a chemical component of hair dye. Video laryngoscopy was done which showed laryngeal oedema and got intubated immediately to prevent respiratory failure. She got admitted to the intensive care unit and rigorous fluid resuscitation was done due to acute kidney injury secondary to rhabdomyolysis. On the 5th day, she got extubated after a successful spontaneous breathing trial, and step down to the high dependency unit, where she had four episodes of seizures in a day. After antiepileptic medication initiation, seizures were settled, brain imaging done to rule out stroke showed a finding suggestive of posterior reversible encephalopathy syndrome. Adequate intravenous fluid resuscitation was performed and blood pressure monitored closely. She remained vitally stable and clinically better hence discharge home with clinic follow-up on the 9th day of hospitalisation.

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.

scholarly journals Heat Stroke with Status Epilepticus Secondary to Posterior Reversible Encephalopathy Syndrome (PRES)

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Y. H. Koh
Keyword(s):  
Status Epilepticus ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Core Body Temperature ◽  
Heat Stroke ◽  
Kidney Injury ◽  
Organ Damage ◽  
Multisystem Disorder ◽  
Posterior Reversible Encephalopathy ◽  
Central Nervous System Dysfunction ◽  
Reversible Encephalopathy

Heat stroke is a life threatening, multisystem disorder characterized by severe hyperthermia (core body temperature > 41.1°C) with central nervous system dysfunction and/or other end organ damage. Neurological complications, such as disturbances of consciousness, convulsion, profound mental change, disorientation, or even prolonged coma, were present in almost all cases of exertional heat stroke (EHS). We present a case of EHS with severe rhabdomyolysis and acute oliguric kidney injury in a 20-year-old healthy marathon runner, who developed status epilepticus on Day 4 of his admission. The patient was managed in ICU with renal replacement therapy and aggressive seizure control. He made a full recovery after 2 weeks of ICU stay. Diagnosis of EHS with posterior reversible encephalopathy syndrome (PRES) secondary to acute kidney injury was made.

scholarly journals A Complicated Case of Posterior Reversible Encephalopathy Syndrome (PRES) Secondary to Severe Hypercalcemia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A175-A176
Author(s):  
Sura Alqaisi ◽  
Aisha Rasool Saand ◽  
Neel Tapryal ◽  
Mahmoud Alwakeel ◽  
Bassel Akbik
Keyword(s):  
Serum Calcium ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Calcium Supplementation ◽  
Stable Condition ◽  
Kidney Injury ◽  
Rare Presentation ◽  
Severe Condition ◽  
Posterior Reversible Encephalopathy ◽  
Severe Hypercalcemia ◽  
Reversible Encephalopathy

Abstract Background:PRES is a rare but severe condition with highly variable neurologic manifestations ranging from headaches to seizures, coma and radiologic findings of focal vasogenic edema1. It is commonly caused by hypertension, chronic renal failure, preeclampsia / eclampsia and immunosuppressants. We are reporting a rare presentation of PRES caused by severe hypercalcemia. Clinical Case: A 29- year old female presented with frontal headaches, visual disturbance, emesis and confusion. Her medical history was relevant for hyperthyroidism treated with partial thyroidectomy (on methimazole) and complicated by iatrogenic hypoparathyroidism. The resulting hypocalcemia was managed with calcitriol and calcium supplementation. On presentation, the patient was awake but disoriented. Physical examination was remarkable for right-sided hemianopsia. Admission blood pressure (BP) was 192/127 suggestive of hypertensive emergency. Initial laboratory tests revealed severe hypercalcemia (calcium: 18.7 mg/dL, ionized: 2.1 mmol/L), acute kidney injury (creatinine of 2.5 mg/dL, (baseline = <1), elevated 1, 25-dihydoxy vitamin D: 65.1 pg/mL, PTH <1 pg/mL, and negative urine toxicology. Head CT without contrast revealed symmetric bilateral parieto-occipital parenchymal hypoattenuation and MRI confirmed the aforementioned findings to be consistent with PRES. The patient was admitted to the ICU and started on Nicardipine intravenous (IV) infusion, IV fluids and calcitonin. Other causes of severe hypercalcemia such as multiple myeloma and hypercalcemia of malignancy were ruled out. Home calcium and calcitriol supplements were discontinued due to suspicion of intoxication. After correction of serum calcium levels her encephalopathy, hypertension and AKI resolved. She was subsequently transferred to the medical floor in stable condition. Calcium supplementation was resumed when serum calcium level normalized and calcitriol was held until further follow up of calcium levels as outpatient. Conclusion: Severe hypercalcemia is a rare cause of PRES secondary its effect on vascular smooth muscle vasoconstriction and increased vascular resistance leading to severe hypertension. Thus, it is imperative to establish a prompt diagnosis and rule out hypercalcemia in all patients presenting with PRES to prevent its devastating neurologic complications. Reference: Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015 Sep;14(9):914–925. doi: 10.1016/S1474-4422(15)00111-8. Epub 2015 Jul 13. Erratum in: Lancet Neurol. 2015 Sep;14(9):874. PMID: 26184985.

scholarly journals Late onset postpartum eclampsia complicated with posterior reversible encephalopathy syndrome

2020 ◽  
Vol 24 (2) ◽  
pp. 234-236
Author(s):  
Ejaz Khan ◽  
Rovnat Babazade
Keyword(s):  
Acute Kidney Injury ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Late Onset ◽  
Kidney Injury ◽  
Resonance Imaging ◽  
Unique Case ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy ◽  
Hypertensive Episode ◽  
Visual Disturbances

Posterior reversible encephalopathy syndrome (PRES) is a rare entity characterized by headache, vomiting, visual disturbances, seizure and unconsciousness with characteristic magnetic resonance imaging. Late onset postpartum eclampsia complicated by PRES has been reported in the literature, We report a unique case of 23-year-old patient who developed late onset postpartum eclampsia complicated by PRES and acute kidney injury requiring renal replacement therapy. The case report emphasizes the need to continue antihypertensive medication in hypertensive parturients during postpartum period for at least 6 weeks as frequency of late postpartum eclampsia is high. The medication should be tapered off slowly to avoid reactive hypertensive episode which might trigger PRES and acute kidney injury.

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