Serotonin Syndrome Presenting as a Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient’s neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage.

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Posterior reversible encephalopathy syndrome in systemic lupus erythematosus

Revista Argentina de Reumatología ◽

10.47196/rar.v30i3.446 ◽

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.

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Posterior Reversible Encephalopathy Syndrome: A Case of Hypercalcemia

Acta Médica Portuguesa ◽

10.20344/amp.9714 ◽

2018 ◽

Vol 31 (6) ◽

pp. 338

Author(s):

Ana Ponciano ◽

Vera Vieira ◽

José Leite ◽

Célio Fernandes

Keyword(s):

Renal Failure ◽

Immunosuppressive Therapy ◽

Mental Status ◽

Posterior Reversible Encephalopathy Syndrome ◽

Altered Mental Status ◽

Normotensive Patient ◽

Posterior Reversible Encephalopathy ◽

Severe Hypercalcemia ◽

Reversible Encephalopathy

Posterior reversible encephalopathy syndrome is an encephalopathy that can be clinically characterized by headache, altered mental status and/or seizures. Neuroimaging demonstrates usually reversible bilateral subcortical vasogenic occipital-parietal edema. Exact pathophysiology remains unclear but is commonly associated with hypertension, renal failure, sepsis and use of immunosuppressive therapy. Its development in the setting of severe hypercalcemia is extremely rare. The authors report a case of posterior reversible encephalopathy syndrome in a normotensive patient with severe hypercalcemia as the only identifiable cause.

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

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211030465 ◽

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.

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

Journal of Primary Care & Community Health ◽

10.1177/2150132719869539 ◽

2019 ◽

Vol 10 ◽

pp. 215013271986953 ◽

Cited By ~ 1

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.

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Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.12.peds10299 ◽

2011 ◽

Vol 7 (3) ◽

pp. 235-237 ◽

Cited By ~ 6

Author(s):

Melanie G. Hayden Gephart ◽

Bonnie P. Taft ◽

Anne-Katrin Giese ◽

Raphael Guzman ◽

Michael S. B. Edwards

Keyword(s):

Mr Imaging ◽

Posterior Reversible Encephalopathy Syndrome ◽

Clinical Symptoms ◽

Pediatric Neurosurgery ◽

Altered Mental Status ◽

Hemodynamic Instability ◽

Imaging Features ◽

Posterior Reversible Encephalopathy ◽

Reversible Encephalopathy ◽

Pediatric Neurooncology

Posterior reversible encephalopathy syndrome (PRES) has been described in pediatric neurooncology patients, although it has not been documented perioperatively in pediatric neurosurgery patients not actively receiving chemotherapy. Recently at the authors' facility, 2 cases of PRES were diagnosed perioperatively in children with brainstem ependymoma. Both patients had presented with hypertension, altered mental status, and seizures and demonstrated MR imaging features consistent with PRES. The patients were treated with antiseizure and antihypertension medications, leading to improvement in both clinical symptoms and neuroimaging findings. These cases are the first to document PRES in perioperative pediatric neurosurgery patients not actively receiving chemotherapy. Both patients had ependymoma involving the brainstem, which may have led to intra- and perioperative hemodynamic instability (including hypertension) and predisposed them to this syndrome. An awareness of PRES in similar scenarios will aid in the prevention, diagnosis, and treatment of pediatric neurosurgery patients with this syndrome.

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