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.

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

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Tomoki Nakamizo ◽  
Ippei Tsuzuki ◽  
Takashi Koide
Keyword(s):  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Course ◽  
Vasogenic Edema ◽  
White Matter Lesions ◽  
Transient Global Amnesia ◽  
Subcortical White Matter ◽  
Posterior Reversible Encephalopathy ◽  
Global Amnesia ◽  
Reversible Encephalopathy

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.

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.

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.

scholarly journals Posterior Reversible Encephalopathy Syndrome and Azathioprine

2019 ◽  
Author(s):  
Sara Pinto Teixeira Vilas-Boas ◽  
Ana Corte-Real
Keyword(s):  
Magnetic Resonance Imaging ◽  
Status Epilepticus ◽  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Severe Hypertension ◽  
Neurological Manifestations ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

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.

scholarly journals Posterior reversible encephalopathy syndrome in systemic lupus erythematosus

2019 ◽  
pp. 39-43
Author(s):  
V. Castro ◽  
D. Yucra ◽  
G. Garate ◽  
R. Balcázar ◽  
A. Hamaui ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Lupus Erythematosus ◽  
Occipital Lobe ◽  
Systemic Lupus ◽  
Altered Level ◽  
Posterior Reversible Encephalopathy ◽  
Level Of Consciousness ◽  
Reversible Encephalopathy ◽  
Reversible Condition

Posterior reversible encephalopathy syndrome (PRES) is a poorly recognized and reversible condition in systemic lupus erythematosus (SLE) that could mimic neuropsychiatric lupus. The manifestations of PRES are headache, seizures, altered level of consciousness and blindness. In most cases, computed tomography of the brain shows hypodense lesions in the parieto-occipital lobe. Although this syndrome is rare, rapid and accurate recognition allows early treatment with favorable results. We present a case report of a patient with the onset of SLE following the episode of eclampsia, and who during the late puerperium presented sustained hypertension associated with seizures and deterioration of the level of consciousness in the context of PRES.

scholarly journals Posterior Reversible Encephalopathy Syndrome with Extensive Deep White Matter Lesions Including the Temporal Pole

2016 ◽  
Vol 55 (23) ◽  
pp. 3529-3533 ◽  
Author(s):  
Junichiro Ohira ◽  
Nobuyuki Mori ◽  
Shunsuke Kajikawa ◽  
Takeshi Nakamura ◽  
Tetsuya Arisato ◽  
...  
Keyword(s):  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
White Matter Lesions ◽  
Posterior Reversible Encephalopathy ◽  
Deep White Matter ◽  
Temporal Pole ◽  
Reversible Encephalopathy

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.

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