scholarly journals A case of PRES following intracranial hypotension, with spontaneous resolution with epidural blood patch

2018 ◽  
Vol 7 (12) ◽  
pp. 5190
Author(s):  
Sarada Murali Mamilla
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Intracranial Hypotension ◽  
Sinus Thrombosis ◽  
Cerebral Haemorrhage ◽  
Clinical Syndrome ◽  
Acute Hypertension ◽  
Posterior Reversible Encephalopathy ◽  
Blood Patch ◽  
Clonic Convulsions ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES (also known as reversible posterior leukoencephalopathy syndrome)) presents with rapid onset of symptoms including headache, seizures, altered consciousness, and visual disturbance. It is often but by no means always associated with acute hypertension. Diffusion-weighted MRI is the most sensitive exam to confirm the diagnosis of PRES. If promptly recognized and treated, the clinical syndrome usually resolves within a week, and the changes seen in magnetic resonance imaging (MRI) resolve over days to weeks. Posterior reversible encephalopathy syndrome is an increasingly recognized disorder, with a wide clinical spectrum of both symptoms and triggers, and yet it remains poorly understood. Differential diagnosis includes venous sinus thrombosis, cerebral haemorrhage, encephalitis, vasculititis and metabolic encephalopathys. No clinical trials have evaluated the management of PRES, but rapid withdrawal of the trigger appears to hasten recovery and to avoid complications: for example, aggressive blood pressure management, withdrawal of the offending drug, or delivery in eclampsia. We report a case of women presenting with severe headache, tonic clonic convulsions 7 days after spinal anaesthesia for caesarean delivery, MRI showed evidence of intracranial hypotension and posterior reversible encephalopathy syndrome. She was treated with Blood patch which lead to complete resolution of symptoms and radiological findings. The possible pathogenetic relationship between intracranial hypotension, secondary to the inadvertent dural puncture, and PRES is discussed. Prompt diagnosis and proper treatment results in complete cure without permanent neurological sequelae.

scholarly journals A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Taha Nisar ◽  
Abdul R. Alchaki ◽  
Erin Feinstein
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Sinus Thrombosis ◽  
Altered Mental Status ◽  
Cerebral Venous Sinus Thrombosis ◽  
Clinical Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Posterior Leukoencephalopathy ◽  
Vessel Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of headache, altered mental status, and seizures with reversible mainly posterior leukoencephalopathy on neuroimaging. Precipitating factors for PRES are multifactorial and include autoregulatory failure due to changes in blood pressure, metabolic derangements, and cytotoxic medications. We report the second case of cyclophosphamide-induced PRES in a patient with anti-glomerular basement membrane (Anti-GBM) positive vasculitis. In the acute setting, PRES can be challenging to distinguish from cerebral venous sinus thrombosis or cerebral vasculitis based on clinical presentation. Neuroimaging with magnetic resonance imaging (MRI) of the brain along with a vessel imaging, can help reach the diagnosis.

scholarly journals Posterior Reversible Encephalopathy Syndrome Secondary to CSF Leak and Intracranial Hypotension: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Tariq Hammad ◽  
Alison DeDent ◽  
Rami Algahtani ◽  
Yaseen Alastal ◽  
Lawrence Elmer ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Intracranial Hypotension ◽  
Mechanistic Model ◽  
Brain Mri ◽  
Pressure Control ◽  
Csf Leak ◽  
Dural Defect ◽  
Posterior Reversible Encephalopathy ◽  
Posterior Leukoencephalopathy ◽  
Reversible Encephalopathy

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical neuroradiological condition characterized by insidious onset of neurological symptoms associated with radiological findings indicating posterior leukoencephalopathy. PRES secondary to cerebrospinal fluid (CSF) leak leading to intracranial hypotension is not well recognized etiology of this condition. Herein, we report a case of PRES that occurred in the setting of CSF leak due to inadvertent dural puncture. Patient underwent suturing of the dural defect. Subsequently, his symptoms resolved and a repeated brain MRI showed resolution of brain lesions. The pathophysiology and mechanistic model for developing PRES in the setting of intracranial hypotension were discussed. We further highlighted the importance of tight blood pressure control in patients with CSF leak and suspected intracranial hypotension because they are more vulnerable to develop PRES with normal or slightly elevated bleed pressure values.

scholarly journals Spectrum of neurological disorders during pregnancy and postpartum period from a tertiary hospital

2019 ◽  
Vol 6 (6) ◽  
pp. 1869
Author(s):  
Karthik Nagaraj ◽  
Chaithra S. P.
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Sinus Thrombosis ◽  
Neurological Complications ◽  
Tertiary Hospital ◽  
Cerebral Venous Sinus Thrombosis ◽  
Cerebrovascular Diseases ◽  
Posterior Reversible Encephalopathy ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Reversible Encephalopathy

Background: Pregnancy and puerperium are states of hypercoagulability. This predisposes women in these phases to increased risk of cerebrovascular diseases. These neurological complications are important causes of maternal and foetal morbidity and mortality. These must be recognized and managed to decrease their burden on maternal and child health.Methods: The aim of this study was to consider the occurrence of neurological complications in pregnancy and puerperium and to analyse the clinical and radiological spectrum of them. This was a prospective study carried out with 1200 patients from January 2014 to August 2015.Results: Of the 1200 women, 87(7.25%) were diagnosed to have neurological complications. Overall mortality was 11.4%. Eclampsia (63.2%), Cerebral Venous sinus Thrombosis (CVT) (18.3%) and Posterior Reversible Encephalopathy Syndrome (PRES) in (8%) accounted for the majority of cases (Table 1). Eclampsia carried a significant mortality rate of 12.7% whereas CVT and PRES had favourable outcomes. Imaging of CVT revealed involvement of deep venous system in 12% and haemorrhagic infarcts in 69%.Conclusions: The commonest neurological complications seen in this cohort were eclampsia, cerebral venous thrombosis and posterior reversible encephalopathy syndrome. Hence a physician needs to bear in mind the common neurological complications that can occur during pregnancy and puerperium to avert poor pregnancy outcomes for both mother and child.

scholarly journals A Case of Posterior Reversible Encephalopathy Syndrome Induced by Cisplatin/Pemetrexed Chemotherapy for Lung Cancer

2017 ◽  
Vol 10 (1) ◽  
pp. 235-238 ◽  
Author(s):  
Masashi Ishihara ◽  
Noriyuki Matsutani ◽  
Shuji Ota ◽  
Nobuhiko Seki
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Stage Iv ◽  
Anticancer Therapy ◽  
Posterior Reversible Encephalopathy ◽  
Subcortical Region ◽  
Adc Map ◽  
Clonic Convulsions ◽  
Reversible Encephalopathy ◽  
Occipital Lobes

This report presents the case of a 60-year-old woman who was diagnosed with stage IV lung adenocarcinoma with asymptomatic brain metastases and commenced chemotherapy with cisplatin/pemetrexed (CDDP/Pem). She experienced tonic-clonic convulsions on day 9 of the first cycle, which were accompanied by increased blood pressure (173/69 mm Hg) and headache. Therefore, brain MRI was performed to check for stroke or progression of brain metastatic foci. T2-weighted, FLAIR, and ADC map images showed high-intensity areas in the subcortical region of the bilateral parieto-occipital lobes, leading to a diagnosis of posterior reversible encephalopathy syndrome (PRES). The symptoms improved after treatment with antihypertensive and antiepileptic drugs. Clinicians should keep it in mind that central nervous system symptoms during anticancer therapy containing Pem may indicate possible PRES.

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