scholarly journals Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mohamad-Sherif Mogawer ◽  
Mostafa EL-Shazly ◽  
Ayman Salah ◽  
Amany Abdel-Maqsod ◽  
Omar Abdelaziz ◽  
...  
Keyword(s):  
Upper Limb ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Early Recognition ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Posterior Reversible Encephalopathy ◽  
Donor Liver Transplantation ◽  
Uncommon Presentation ◽  
Reversible Encephalopathy

Abstract Background To report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES). Case presentation We report a case of a 64-year-old male patient on tacrolimus treatment following LDLT. On day 11, during his post-operative routine follow-up. The patient developed sudden onset of left upper limb monoplegia associated with attacks of convulsions and sudden bilateral blindness. MRI revealed multiple, bilateral cortical, and subcortical areas of high T2 and FLAIR signal intensity that did not show restricted diffusion. Findings were suggestive of posterior reversible encephalopathy syndrome (PRES). After the cessation of tacrolimus, vision was completely regained and all other neurologic symptoms were resolved, and follow-up MRI was normal. This case represents an uncommon presentation of tacrolimus toxicity. Conclusion Tacrolimus toxicity may present with PRES. Neurological deficits may be fully reversible with discontinuation of the drug; therefore, the early recognition and prompt management of this condition are of utmost importance.

scholarly journals Posterior Reversible Encephalopathy Syndrome: An Uncommon Presentation of Celiac Disease

2016 ◽  
Vol 3 (4) ◽  
pp. 159-161
Author(s):  
Harish Kumar ◽  
Veer Bahadur Singh ◽  
Babu Lal Meena ◽  
Subhash Gaur ◽  
Sharif Haji Mohammed M. ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Uncommon Presentation ◽  
Reversible Encephalopathy

scholarly journals Clinical spectrum of patients with posterior reversible encephalopathy syndrome

2020 ◽  
Vol 7 (10) ◽  
pp. 1537
Author(s):  
Sriramchandra Rahul Pulavarty ◽  
Nagabhushana Midathala
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Tertiary Care ◽  
Severe Anaemia ◽  
Sudden Onset ◽  
Common Symptom ◽  
Care Hospital ◽  
Imaging Features ◽  
Posterior Reversible Encephalopathy ◽  
Altered Sensorium ◽  
Reversible Encephalopathy

Background: Posterior reversible encephalopathy syndrome is a neurological disorder which can present with sudden onset headache, visual disturbances, seizures and altered sensorium which is potentially reversible with early detection and treatment of the precipitating factor. The range of presentations is being constantly widened and this endeavour is a step towards understanding the wide array of presentation and primary etiology.Methods: This is a prospective observational study of 25 patients presenting to a tertiary care hospital with symptoms and imaging features suggestive of PRES. Thorough clinical examination and MRI brain were performed in all patients.Results: Out of the 25 patients, 18 (72%) were females and 7 (28%) were males. Most common symptom was headache (84%) followed by seizures (56%), nausea (40%), visual blurring (36%) and altered sensorium (20%). In patients presenting with seizure, 28.57% had recurrent seizures.The most common precipitating cause was postpartum state without hypertension (40%) followed by accelerated hypertension (28%), eclampsia (16%), chronic kidney disease (12%) and one patient of chronic severe anaemia had PRES following blood transfusion (4%). Most of the patients improved with no residual neurological deficit.Conclusions: Good neurological outcomes can be achieved by early diagnosis and appropriate imaging in patients with PRES. In pregnant and postpartum patients, PRES should be always considered even with normal blood pressure. Rapid correction of chronic severe anaemia is a rare but preventable cause of PRES.

Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus

2011 ◽  
Vol 38 (8) ◽  
pp. 1607-1611 ◽  
Author(s):  
IRLAPATI RAJENDRA VARAPRASAD ◽  
SUMEET AGRAWAL ◽  
VADIVELMURUGAN NAGASUBRAMANI NAGA PRABU ◽  
LIZA RAJASEKHAR ◽  
MEENA ANGAMUTHU KANIKANNAN ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Lupus Erythematosus ◽  
Neurological Deficits ◽  
Systemic Lupus ◽  
Posterior Reversible Encephalopathy ◽  
Major Organ ◽  
Organ Manifestations ◽  
Reversible Encephalopathy

Objective.To study the clinical profile of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE) and analyze the risk factors and outcomes associated with it.Methods.We identified patients with SLE and PRES from January 2006 to October 2010. Data were collected on demographic details, lupus characteristics, PRES-related features, laboratory abnormalities, treatment details, and outcomes.Results.We studied 13 patients (all female) ages 14–37 years (median 23 yrs; 4 were aged < 18 yrs with juvenile SLE). Duration of lupus ranged from 1.5 to 36 months (median 6 mo). Six patients had PRES as a part of their initial presentation of lupus. All had active lupus and hypertension; 9 had nephritis. Four patients were on treatment with cyclophosphamide therapy when they developed PRES. Antihypertensives and antiepileptics were the mainstay of treatment along with supportive care. Immunosuppressive therapy was guided by lupus-related major organ manifestations. Two patients had focal neurological deficits; one had persistent hemiparesis at followup. One patient died.Conclusion.PRES occurs in young lupus patients and in the early part of the disease. Focal deficits are not uncommon. It can be the presenting manifestation of lupus. Management is predominantly symptomatic. Immunosuppression is directed by other major organ manifestations. Early diagnosis and appropriate management is productive.

scholarly journals Postpartum Reversible Cerebral Vasoconstriction with Cortical Subarachnoid Hemorrhage and　Posterior　Reversible　Encephalopathy Syndrome Concomitant with Vertebral Artery Dissection Diagnosed by MRI MSDE Method; A Case Report and Review of Literature.

2021 ◽  
Author(s):  
Kenshi Sano ◽  
Atsushi Kuge ◽  
Rei Kondo ◽  
Tetsu Yamaki ◽  
Hiroshi Homma ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Spin Echo ◽  
Vertebral Artery Dissection ◽  
Sudden Onset ◽  
Artery Dissection ◽  
Posterior Reversible Encephalopathy ◽  
Cerebral Vasoconstriction ◽  
Sequencing Method ◽  
Reversible Encephalopathy

Abstract Background: Headache is one of the most common symptoms that are encountered in the postpartum period. We experienced a rare case of multiple phenomena of postpartum stroke occurred at the same time. Case: A 38-year-old woman experienced sudden onset of thunderclap headache after delivery. We diagnosed cervicocephalic arterial dissection (CAD), and posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) with cortical subarachnoid hemorrhage on the basis of clinical course and neuroradiological findings. Conclusion: Our case was rare in that multiple phenomena of postpartum stroke occurred at the same time. What is remarkable about this case was the confirmation of the reversibility of these pathological conditions through multifaceted evaluations, including the MRI motion-sensitized driven equilibrium 3D turbo spin echo (MSDE) sequencing method.

scholarly journals Posterior reversible encephalopathy syndrome (PRES), an acute neurological syndrome due to reversible multifactorial brain edema: a case report

2013 ◽  
pp. 37-42
Author(s):  
Camilla Cicognani ◽  
Chiara Vezzadini ◽  
Stella Battaglia ◽  
Anna F. Marliani ◽  
Roberto Zoni
Keyword(s):  
Case Report ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical History ◽  
Immunosuppressive Drugs ◽  
Hypertensive Encephalopathy ◽  
Neurological Deficits ◽  
Posterior Reversible Encephalopathy ◽  
Missed Diagnosis ◽  
Reversible Encephalopathy ◽  
Clinical Conditions

Background: The essential features of Posterior Reversible Encephalopathy Syndrome (PRES) are headache, mental changes, seizures, visual symptoms and often arterial hypertension. Brain RMN typically shows cortico-sottocortical parieto-occipital edema, with a bilateral and symmetric distribution. PRES develops in clinical conditions as hypertensive encephalopathy, preeclampsia/ eclampsia, autoimmune diseases, after transplantation, infections and as an adverse effect of immunosuppressive drugs or chemotherapy. It usually completely reverses with treatment, although permanent sequelae are possible in case of delayed or missed diagnosis. Case report: We describe the case of a transsexual (M!F) and tetraplegic patient, admitted for neck and low back pain. She suddenly developed headache, confusion, seizures and severe hypertension with normal blood tests. RMN showed multiple cortico-sottocortical areas of vasogenic and citotoxic edema in temporo-occipital, parietal, frontal, and cerebellar regions. Soon after the beginning of the antihypertensive therapy, clinical recovery was observed, as well as the disappearance of edema at RMN. Discussion and conclusions: Although PRES is usually associated with definite pathological conditions, it is not always the case, as was for the patient here described, who had no predisposing factors in her past clinical history, and presented hypertension only in the acute phase of the syndrome. Since, moreover, PRES usually presents with acute non specific features and it can be misdiagnosed with other serious diseases, the clinician will be helped by the knowledge of this syndrome to promptly start diagnostic workup and treatments, and avoid permanent neurological deficits.

scholarly journals Posterior reversible encephalopathy syndrome as a complication of pre-eclampsia in the early postpartum period

2019 ◽  
Vol 12 (7) ◽  
pp. e228954
Author(s):  
Julie Verhaegen ◽  
Frederik Peeters ◽  
Patrick Debois ◽  
Yves Jacquemyn
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Postpartum Period ◽  
Early Recognition ◽  
Rare Complication ◽  
Good Prognosis ◽  
Neurological Symptoms ◽  
Posterior Reversible Encephalopathy ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Reversible Encephalopathy

We present the case of a 30-year-old woman with posterior reversible encephalopathy syndrome (PRES) as a complication of pre-eclampsia in the early postpartum period. PRES is a rare neurological disorder which causes non-specific neurological symptoms such as headache, seizures and visual disturbances. It generally has a good prognosis, but severe complications can arise. Therefore, early recognition and treatment are paramount. Pre-eclampsia is a multiorgan disease and is associated with both maternal and foetal morbidity and mortality. Neurological symptoms occurring in the postpartum period indicate pre-eclampsia until proven otherwise. This case report was written to stress the attention on this rare complication of pre-eclampsia. When a patient in the postpartum period presents with a combination of seizures, disturbed vision and headache, PRES should always be kept in mind.

Steroid Sensitive Nephrotic Syndrome Presented as Posterior Reversible Encephalopathy Syndrome - A Rare Case Report

2020 ◽  
Vol 40 (2) ◽  
pp. 142-145
Author(s):  
Abhishek Abhinay ◽  
Jata Shankar ◽  
Sunil Kumar Rao ◽  
Om Prakash Mishra
Keyword(s):  
Nephrotic Syndrome ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Posterior Reversible Encephalopathy ◽  
Rare Case Report ◽  
Steroid Sensitive Nephrotic Syndrome ◽  
Adults And Children ◽  
Steroid Sensitive ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a rare serious syndrome of central nervous system that can develop in both adults and children. It is characterised by acute onset of headache, confusion, seizures, or focal neurological deficits along with radiological abnormalities in the parietal and occipital lobes. In the past, this syndrome has been mainly described in adults but rare in children. However, it is not uncommon in paediatric nephrology. Hypertension, renal disease, immunosuppression, and chemotherapy of malignancies are triggers for PRES. Here, we report a case of 12 years old boy with steroid-sensitive nephrotic syndrome presenting as PRES.

scholarly journals Posterior reversible encephalopathy syndrome mimicking cerebral metastasis: contraindication for biopsy

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Dukagjin Morina ◽  
Georgios Ntoulias ◽  
Homajoun Maslehaty ◽  
Martin Scholz ◽  
Athanasios K. Petridis
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Resonance Imaging ◽  
Open Biopsy ◽  
Posterior Reversible Encephalopathy ◽  
Typical Appearance ◽  
Magnetic Resonance Imaging Mri ◽  
Immunosupressive Therapy ◽  
Reversible Encephalopathy ◽  
Radiologic Features

The posterior reversible encephalopathy syndrome (PRES) is a well described entity of white matter pathology. PRES is triggered by numerous different factors such as acute elevated arterial hypertension, immunosupressive therapy, chemotherapy, etc. The case of a 67-year old woman is presented. The patient was treated for breast cancer 10 months ago and because of acute disorientation a magnetic resonance imaging (MRI) was performed. In the MRI biparieto-occipital hyperintense lesions were seen. Brain metastases were suspected. After chemothe - rapy and hypertonia and the typical appearance of the lesions in the MRI, PRES was also suspected. Before initializing the surgery for an open biopsy a follow-up MRI had been performed (2 weeks after initial MRI). In follow-up MRI the lesions disappeared completely proving the diagnosis of PRES. PRES can be misdiagnosed as a tumour and surgery could be mistakenly performed. It’s important to keep the differential diagnosis of PRES in mind when radiologic features of the syndrome are present.

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