Posterior Reversible Encephalopathy Syndrome Following Diabetic Ketoacidosis: A Case Report

Brain Mri ◽

First Case ◽

Aged Woman ◽

Adequate Hydration ◽

Abstract Background Posterior reversible encephalopathy syndrome (PRES) following the development of diabetic ketoacidosis (DKA) is rare and usually occurs in children. This is the first case of DKA following PRES that we know of that occurred in an adult.Case report We encountered a middle-aged woman with a one-day history of nausea and vomiting who presented with DKA and seizure, along with hallucinations. On presentation, we performed physical examinations and blood biochemistry tests to ascertain the cause of these symptoms. We also performed magnetic resonance imaging (MRI) of her brain, which showed typical brain edema in the bilateral occipital and parietal regions, which indicated PRES. We treated the patient’s symptoms by administering adequate hydration and administering an infusion of insulin of 30 U after breakfast and 15 U after dinner to bring her blood sugar levels under control.The brain MRI we performed showed hyperintensity of the bilateral occipital and parietal cortexes on a fluid-attenuated inversion recovery T2 weighted image, after which the patient was diagnosed with PRES. The patient was discharged thirteen days after admission with stable blood sugar and blood pressure levels. Conclusions Physicians should keep this condition in mind as a possible complication of DKA and treat it quickly and efficiently in order to attain a good patient outcome.This is the first report of DKA-induced PRES in an adult, and physicians should keep this condition in mind as a possible complication of DKA, which is treatable and may have a good prognosis.

Association of Posterior Reversible Encephalopathy Syndrome and Transient Apical Ballooning Syndrome (Takotsubo): First Case Report of a Man and Review of the Literature

Case Reports in Neurology ◽

10.1159/000474933 ◽

2017 ◽

Vol 9 (2) ◽

pp. 173-178 ◽

Cited By ~ 2

Author(s):

Stephan Grimaldi ◽

Emilie Doche ◽

Caroline Rey ◽

Nadia Laksiri ◽

Salah Boussen ◽

...

Keyword(s):

Case Report ◽

Brain Mri ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Apical Ballooning Syndrome ◽

Ventricular Ejection Fraction ◽

First Case ◽

Introduction: An association of posterior reversible encephalopathy syndrome (PRES) and takotsubo is rare. We present the first case of a male patient. Case Report: A 69-year-old man presented to the hospital in a persistent comatose state following a generalized tonic-clonic seizure with high blood pressure. The electrocardiogram revealed transient left bundle branch block. Troponin and BNP were elevated. Cardiac ultrasound showed large apical akinesia with altered left ventricular ejection fraction, and the left ventriculogram showed characteristic regional wall motion abnormalities involving the mid and apical segments. Brain MRI showed bilateral, cortical, and subcortical vasogenic edema predominant in the posterior right hemisphere. The lumbar puncture and cerebral angiography were normal. Paraclinical abnormalities were reversible within 2 weeks with a clinical recovery in 3 months, confirming the takotsubo and the PRES diagnoses. Discussion: Several theories hypothesize the underlying pathophysiology of takotsubo or PRES. Circulating catecholamines are up to 3 times higher in patients with takotsubo causing impaired microcirculation and apical hypokinesia. An association of both takotsubo and asthma crisis and PRES and asthma crisis underlines the role of catecholamines in the occurrence of these disorders. Conclusion: Early recognition of this rare association, in which heart and neurological damage may require rapid intensive care support, is needed.

Posterior Reversible Encephalopathy Syndrome During Induction Treatment of Philadelphia Positive Acute Lymphoblastic Leukemia in an Adult Patient: First Case Report and Literature Review

Journal of Blood & Lymph ◽

10.4172/2165-7831.1000141 ◽

2015 ◽

Vol 05 (03) ◽

Author(s):

Juliette Reure Frederic Peyrade ◽

Christine Lebrun-Frenay

Keyword(s):

Case Report ◽

Acute Lymphoblastic Leukemia ◽

Literature Review ◽

Adult Patient ◽

Lymphoblastic Leukemia ◽

Induction Treatment ◽

First Case ◽

Posterior reversible encephalopathy syndrome following a thoracic discectomy–induced dural leak: case report

Journal of Neurosurgery Spine ◽

10.3171/2016.4.spine1623 ◽

2016 ◽

Vol 25 (5) ◽

pp. 586-590 ◽

Cited By ~ 9

Author(s):

Lisa B. E. Shields ◽

John R. Johnson ◽

Christopher B. Shields

Keyword(s):

Vasogenic Edema ◽

Brain Mri ◽

Csf Leak ◽

First Case ◽

Thoracic Spinal ◽

Blood Patch ◽

Dural Leak ◽

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headaches, altered mental status, seizures, and visual disturbances. Classic MRI findings include white matter changes of the parieto-occipital regions. This syndrome has been encountered in myriad medical illnesses, including hypertension, preeclampsia/eclampsia, and immunosuppressive conditions. While the pathogenesis of the disorder is unclear, vasoconstriction and hypoperfusion leading to brain ischemia and vasogenic edema have been implicated as potential mechanisms. The authors present, to the best of their knowledge, the first case of PRES following a thoracic spinal surgery–induced dural leak noted on resection of the fifth rib during a thoracotomy for a T4–5 discectomy. Brain MRI revealed large areas of increased FLAIR and T2 hyperintensity in the superior posterior frontal lobes, superior and medial parietal lobes, and bilateral occipital lobes. Following repair of the CSF leak, the patient's symptoms resolved. Spinal surgeons should be alert to the potentially life-threatening condition of PRES, especially in a hypertensive patient who experiences surgery-induced dural leakage. The development of a severe positional headache with neurological signs is a red flag that suggests the presence of PRES. Prompt attention to the diagnosis and treatment of this condition by repairing the dural leak via surgery or expeditious blood patch increases the likelihood of a favorable outcome.