scholarly journals Management of Posterior Reversible Syndrome in Preeclamptic Women

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
S. Poma ◽  
M. P. Delmonte ◽  
C. Gigliuto ◽  
R. Imberti ◽  
M. Delmonte ◽  
...  
Keyword(s):  
Computed Tomography ◽  
White Matter ◽  
Magnetic Resonance ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Anesthetic Management ◽  
Cerebral Hemispheres ◽  
Posterior Reversible Encephalopathy ◽  
Alteration Of Consciousness ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome associated with a number of conditions including preeclampsia. It is characterized by seizures, alteration of consciousness, visual disturbances, and symmetric white matter abnormalities, typically in the posterior parietooccipital regions of the cerebral hemispheres, at computed tomography (CT) and magnetic resonance (MRI). We report three new cases of PRES in preeclamptic patients and describe the management of these patients. We present a brief review of other cases in the literature, with particular attention to the anesthetic management.

scholarly journals Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

2016 ◽  
Vol 29 (9) ◽  
pp. 567 ◽  
Author(s):  
Vítor Magno Pereira ◽  
Luís Marote Correia ◽  
Tiago Rodrigues ◽  
Gorete Serrão Faria
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Emergency Department ◽  
Magnetic Resonance ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Epigastric Pain ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

The posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visual disturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the case of a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergency department for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headache for two hours. His physical examination was remarkable for a blood pressure of 190/100 mmHg and tenderness in epigastrium. His analytical results revealed emphasis on amylase 193 U/L and lipase 934 U/L. During the observation in the emergency department,he presented a generalized tonic-clonic seizure. Abdominal ultrasonography was performed and suggestive of pancreatitis withoutgallstones signals. Head computed tomography showed subarachnoid haemorrhage and a small right frontal cortical haemorrhage. The brain magnetic resonance imaging done one week after admission showed areas of a bilateral and symmetrical T2 / FLAIR hyperintensities in the subcortical white matter of the parietal and superior frontal regions, suggesting a diagnosis of posterior reversible encephalopathy syndrome. Abdominal computed tomography (10 days after admission) demonstrated a thickened pancreas in connection with inflammation and two small hypodense foci in the anterior part of the pancreas body, translating small foci of necrosis. The investigation of a thrombophilic defect revealed a heterozygous G20210A prothrombin gene mutation. The patient was discharged without neurological sequelae and asymptomatic. The follow-up brain magnetic resonance imaging confirmed the reversal of the lesions, confirming the diagnosis.

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

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Joseph Seemiller ◽  
Muhammad Taimur Malik
Keyword(s):  
White Matter ◽  
Brain Imaging ◽  
Cognitive Deficits ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Subcortical White Matter ◽  
Altered Level ◽  
Posterior Reversible Encephalopathy ◽  
Alteration Of Consciousness ◽  
Atypical Presentations ◽  
Reversible Encephalopathy

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 Encephalopathy Syndrome: A Review

2017 ◽  
Vol 68 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Jai Shankar ◽  
Jillian Banfield
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Early Diagnosis ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Immunosuppressive Treatment ◽  
Magnetic Resonance Images ◽  
Diagnosis And Treatment ◽  
Imaging Findings ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

Radiologists may be the first to suggest the diagnosis of posterior reversible encephalopathy syndrome (PRES). PRES is associated with many diverse clinical entities, the most common of which are eclampsia, hypertension, and immunosuppressive treatment. Radiologists should be aware of the spectrum of imaging findings in PRES. When promptly recognized and treated, the symptoms and radiological abnormalities can be completely reversed. When unrecognized, patients can progress to ischemia, massive infarction, and death. In this review, we present an overview of the unique signs observed on computed tomography and magnetic resonance images in PRES that can help in the early diagnosis and treatment that is highly effective in this syndrome.

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.

Posterior Reversible Encephalopathy Syndrome (PRES) in Palliative Medicine: Case Report and Discussion

2021 ◽  
pp. 104990912110304
Author(s):  
Jade Willey ◽  
Steven J. Baumrucker
Keyword(s):  
Case Report ◽  
Mental Status ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Palliative Medicine ◽  
Altered Mental Status ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

Posterior reversible encephalopathy syndrome (PRES) is associated with seizures, visual disturbances, headache, and altered mental status. Given its presentation, the diagnosis can be mistaken for other severe conditions. Palliative medicine consultants should be aware of PRES and be prepared to counsel families on the treatment and prognosis of this syndrome.

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

2019 ◽  
Vol 10 ◽  
pp. 215013271986953 ◽  
Author(s):  
Robert Strother ◽  
Hailon Wong ◽  
Nathaniel E. Miller
Keyword(s):  
White Matter ◽  
Mental Status ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Altered Mental Status ◽  
Hypertensive Encephalopathy ◽  
Inpatient Service ◽  
Mao Inhibitor ◽  
Radiographic Findings ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

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.

Hypertension and Confusion

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
White Matter ◽  
Brain Imaging ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Course ◽  
Severe Hypertension ◽  
Vasogenic Edema ◽  
Blurred Vision ◽  
Posterior Reversible Encephalopathy ◽  
Immunosuppressive Medications ◽  
Reversible Encephalopathy

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.

scholarly journals Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine

2020 ◽  
Vol 13 (2) ◽  
pp. e229319 ◽  
Author(s):  
Ines Gil ◽  
Filipa Serrazina ◽  
Miguel Pinto ◽  
Miguel Viana-Baptista
Keyword(s):  
Blood Pressure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Grey Matter ◽  
Rare Complication ◽  
Chemotherapeutic Agents ◽  
Posterior Reversible Encephalopathy ◽  
Parietal Lobes ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

The posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by a combination of headache, encephalopathy, seizures and visual disturbances, associated with high-intensity abnormalities on T2-weighted images affecting subcortical white and grey matter of the occipital and parietal lobes. Among other causes, PRES has been associated with the use of several medications including chemotherapeutic agents. Here we report a case of a 65-year-old patient with squamous cell carcinoma of the lung treated with cisplatin/vinorelbine. Following the second administration of vinorelbine, she was admitted to the hospital for a generalised seizure. Blood pressure was just slightly elevated and, except for drowsiness, she had a near-normal neurological examination. MRI corroborated the diagnosis. Vinorelbine-induced PRES has been reported only once in the literature, also in association with cisplatin. Our case underlines the role of vinorelbine and suggests that its association with cisplatin in this setting may enhance the risk of PRES.

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