Acute onset of blindness associated with posterior reversible encephalopathy syndrome: a HELLP syndrome case report

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Gokcen Orgul ◽  
Hasan Uckan ◽  
Fatih Aktoz ◽  
Ozgur Deren
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Hellp Syndrome ◽  
Vision Loss ◽  
Clinical Laboratory ◽  
Clinical Findings ◽  
Acute Onset ◽  
Fetal Demise ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

Abstract Posterior reversible encephalopathy syndrome (PRES) is an uncommon disorder. PRES presents with clinical findings such as headache, seizures, visual disturbances, and altered consciousness. Here, we present a PRES case in the second trimester of pregnancy with intrauterine fetal demise. A 40-year-old woman, gravida 4 para 3, was diagnosed with HELLP syndrome based on the clinical and laboratorial findings. An emergent caesarean section was performed under magnesium sulphate (MgSO4) treatment. She had suffered vision loss with normal fundoscopic findings at postpartum period. All the clinical, laboratory and imaging findings (MRI) confirmed the diagnosis of PRES. Careful observation of the clinical findings and prompt treatment is necessary for pregnancies complicated by PRES to prevent undesirable outcomes.

scholarly journals Posterior Reversible Encephalopathy Syndrome in Pregnancy

2015 ◽  
Vol 7 (3) ◽  
pp. 205-206
Author(s):  
N Sundari ◽  
Asha Swaroop ◽  
BM Krupa ◽  
BK Madhusudhan ◽  
S Chaitra
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Delayed Diagnosis ◽  
Acute Onset ◽  
Posterior Reversible Encephalopathy ◽  
Complete Reversal ◽  
The Common ◽  
T2 Hyperintensity ◽  
Reversible Encephalopathy ◽  
Visual Disturbances ◽  
In Pregnancy

ABSTRACT Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity characterized by several symptoms of varied etiologies. The common symptoms are headache, confusion, seizures, cortical visual disturbances or blindness. Here, we report a 22 years old lady with 32 weeks of gestation who presented with complaints of acute onset of headache, sudden loss of vision with elevated blood pressure (BP), whose magnetic resonance venogram (MR venogram) revealed bilateral occipital T2 hyperintensity with restriction of diffusion suggestive of PRES. Early identification and treatment usually results in complete reversal of the deficits and delayed diagnosis and improper management can lead to irreversible sequelae. How to cite this article Krupa BM, Sundari N, Madhusudhan BK, Swaroop A, Chaitra S. Posterior Reversible Encephalopathy Syndrome in Pregnancy. J South Asian Feder Obst Gynae 2015;7(3):205-206.

scholarly journals Microcirculation Approach in HELLP Syndrome Complicated by Posterior Reversible Encephalopathy Syndrome and Massive Hepatic Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Stephanno Gomes Pereira Sarmento ◽  
Eduardo Feliz Martins Santana ◽  
Felipe Favorette Campanharo ◽  
Edward Araujo Júnior ◽  
Flavia Ribeiro Machado ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Hellp Syndrome ◽  
Dark Field ◽  
Third Trimester ◽  
Sidestream Dark Field ◽  
Severe Condition ◽  
Posterior Reversible Encephalopathy ◽  
Hepatic Infarction ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

HELLP syndrome is a complication of severe forms of preeclampsia and occurs mainly in the third trimester of pregnancy. In extreme cases, it may evolve unfavorably and substantially increase maternal mortality. We present the case of an 18-year-old pregnant woman who was admitted to our emergency service in her 31st week, presenting with headache, visual disturbances, and epigastralgia, with progression to a severe condition of HELLP syndrome followed by posterior reversible encephalopathy syndrome (PRES) and hepatic infarction. We highlight the approach taken towards this patient and the case management, in which, in addition to the imaging examinations routinely available, we also used the sidestream dark field (SDF) technique to evaluate the systemic microcirculation.

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.

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 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.

scholarly journals Seizure and Acute Vision Loss in a Filipino Lupus Patient: A Case of Posterior Reversible Encephalopathy Syndrome with Intraparenchymal Hemorrhage

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Deonne Thaddeus V. Gauiran ◽  
Therese Eileen B. Lladoc-Natividad ◽  
Ida Ingrid I. Rocha ◽  
Bernadette Heizel Manapat-Reyes
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Lupus Erythematosus ◽  
Vision Loss ◽  
Parietal Lobe ◽  
Vasogenic Edema ◽  
High Dose ◽  
Timely Initiation ◽  
Posterior Reversible Encephalopathy ◽  
Number Of Patients ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a rare and poorly understood neurologic condition that has been described in some patients with systemic lupus erythematosus (SLE). Intracerebral hemorrhage is a unique and atypical presentation of PRES and has been described only in a small number of patients with SLE. We present the case of a 33-year-old female, diagnosed with SLE and active nephritis, who was admitted for seizures. She had acute-onset headache, confusion, and bilateral vision loss associated with severe hypertension. CT scan revealed right occipital and parietal lobe hemorrhage. MRI showed vasogenic edema and hyperintense foci in bilateral cortical and subcortical regions of the occipital and posterior parietal lobes which are consistent with posterior reversible encephalopathy syndrome (PRES). Strict blood pressure control and medical ICP-lowering treatment were immediately instituted, while maintaining her on anticonvulsants, high-dose steroids, and mycophenolate mofetil. The patient was discharged with improvement in vision and resolution of headache. On follow-up, she had gained her premorbid visual acuity and reported no recurrence of headache or seizures. Despite its name, reversibility remains to be conditional in PRES. A high index of suspicion is important, especially among those who present with seizure, headache, and visual loss. Early diagnosis and timely initiation of therapy is recommended, as clinical symptoms are potentially reversible and delayed therapy may result in life-threatening complications, such as coma or death.

scholarly journals Posterior Reversible Encephalopathy Syndrome after Heart Transplantation: Diagnosis and Immunosuppressive Therapy

2017 ◽  
Vol 44 (3) ◽  
pp. 205-208 ◽  
Author(s):  
Aniruddh Kapoor ◽  
Emma Birks ◽  
Andrew Lenneman ◽  
Kelly McCants
Keyword(s):  
Adverse Effects ◽  
Acute Rejection ◽  
Heart Transplantation ◽  
Immunosuppressive Therapy ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Orthotopic Heart Transplantation ◽  
Mental Function ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

Posterior reversible encephalopathy syndrome, an infrequent neurotoxicity associated with the use of tacrolimus, was first described in 1996, as a reversible syndrome manifested by headache, altered mental function, seizures, and visual disturbances. We describe the case of a 37-year-old woman who developed neurologic symptoms consistent with encephalopathy after treatment with tacrolimus, which was prescribed to maintain immunosuppression after orthotopic heart transplantation. This report also discusses the imaging methods used in the diagnosis of posterior reversible encephalopathy and highlights the difficulty of maintaining immunosuppression and managing medication-related adverse effects, while taking into account the risk of acute rejection after transplantation.

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