scholarly journals Posterior Reversible Encephalopathy Syndrome Following Blood Transfusion: A Rare Case Report with Literature Review

2021 ◽  
Vol 15 (1) ◽  
pp. 31-36
Author(s):  
Jayanti K Gurumukhani ◽  
Harsh D. Patel ◽  
Dhruvkumar M. Patel ◽  
Mukundkumar V. Patel ◽  
Maitri M. Patel ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vasogenic Edema ◽  
Red Cell ◽  
Chronic Anemia ◽  
Posterior Reversible Encephalopathy ◽  
Altered Sensorium ◽  
Mri Brain ◽  
Mri Features ◽  
Reversible Encephalopathy

Background: Posterior reversible encephalopathy syndrome (PRES) is clinicoradiological disease entity characterized by headache, seizures, altered sensorium and corticalvisual loss with characteristic MRI features of subcortical white matter hyperintensities on T2W imaging. Though hypertension is a traditional hallmark of PRES, uncommon causes without hypertension have been described. We report an unusual such case without hypertension, precipitated by red cell transfusion. Case Presentation: A 40 years female received six units of packed cell transfusion for severe anemia (Hemoglobin 3.0 Gm %) transfused over 8 hours. She was having menorrhagia and was operated on for a hysterectomy. She developed a headache on the second postoperative day for five days and no cause was revealed in spite of extensive workup, including MRI brain and CSF study. On the sixth day, she had recurrent seizures followed by altered sensorium in the absence of hypertension. Her repeat MRI brain findings were consistent with PRES. Conclusion: We reviewed 25 cases, including the present one as PRES after the blood transfusion. 24 were females, and 16 of 19 developed PRES in the course of chronic anemia lasting over 1 month. Anemia was severe in 18 of 25 cases, with haemoglobin (Hb) levels < 4.0 Gm%. In 16 of 20 cases, Hb levels increased to 5 g/dl by red cell blood transfusion until the onset of PRES. On MRI brain, 23 of 25 cases showed vasogenic edema and 3 of 25 cases showed an irreversible neurological deficit. When treating severe chronic anemia rapid correction of Hb with blood transfusion, one should consider a possibility of PRES in post-transfusion neurological symptoms in spite of normal diagnostic workup.

Posterior Reversible Encepalopathy Syndrome in A Child With Post Streptococcal Glomerulonephritis- A Rare Case Report

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 50-52
Author(s):  
Sunita Ghimire ◽  
Shree Krishna Shrestha ◽  
Ram Chandra Bastola ◽  
Anita Dahal ◽  
Pragya Shakya
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Vasogenic Edema ◽  
Female Child ◽  
Hypertensive Encephalopathy ◽  
Posterior Reversible Encephalopathy ◽  
Radiological Features ◽  
Rare Case Report ◽  
Post Streptococcal Glomerulonephritis ◽  
Reversible Encephalopathy ◽  
Timely Treatment

Posterior reversible encephalopathy syndrome is a condition occurring  in majority of case of  hypertensive encephalopathy mainly due to vasogenic  edema in parieto occipital region in neuroimaging. It is reversible if timely treatment is done .Here we are reporting a 11 year old female child with acute post streptococal glomerulonephrtitis leading to typical clinical and radiological features of posterior reversible encephalopathy syndrome

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.

scholarly journals Transient increase of fractional anisotropy in reversible vasogenic edema

2016 ◽  
Vol 36 (10) ◽  
pp. 1731-1743 ◽  
Author(s):  
Shihoko Kimura-Ohba ◽  
Yi Yang ◽  
Jeffrey Thompson ◽  
Tomonori Kimura ◽  
Victor M Salayandia ◽  
...  
Keyword(s):  
Fractional Anisotropy ◽  
Acute Phase ◽  
Cyclosporine A ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Pathological Condition ◽  
Neurological Diseases ◽  
Vasogenic Edema ◽  
High Dose ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

Brain vasogenic edema, involving disruption of the blood-brain barrier, is a common pathological condition in several neurological diseases, with a heterogeneous prognosis. It is sometimes reversible, as in posterior reversible encephalopathy syndrome, but often irreversible and our current clinical tools are insufficient to reveal its reversibility. Here, we show that increased fractional anisotropy in magnetic resonance imaging is associated with the reversibility of vasogenic edema. Spontaneously, hypertensive rats-stroke prone demonstrated posterior reversible encephalopathy syndrome-like acute encephalopathy in response to high-dose cyclosporine A treatment; the deteriorating neurological symptoms and worsening scores in behavioral tests, which were seen in acute phase, dissappered after recovery by cessation of cyclosporine A. In the acute phase of encephalopathy, the fractional anisotropy and apparent diffusion coefficient increased in areas with IgG leakage. This increase of fractional anisotropy occurred in the absence of demyelination: fluid leakage into the myelinated space increased the axial, but not the radial, diffusivity, resulting in the increased fractional anisotropy. This increased fractional anisotropy returned to pre-encephalopathy values in the recovery phase. Our results highlight the importance of the fractional anisotropy increase as a marker for the reversibility of brain edema, which can delineate the brain areas for which recovery is possible.

Posterior reversible encephalopathy syndrome (PRES) presenting as Status Epilepticus in a case of Autoimmune Hemolytic Anemia (AIHA): A Case report

2021 ◽  
Vol 12 (6) ◽  
pp. 102-106
Author(s):  
Sameera Dronamraju ◽  
Shilpa Gaidhane ◽  
Aayush Somani ◽  
Sourya Acharya
Keyword(s):  
Status Epilepticus ◽  
Hemolytic Anemia ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Autoimmune Hemolytic Anemia ◽  
Vasogenic Edema ◽  
Complete Recovery ◽  
Young Female ◽  
Posterior Reversible Encephalopathy ◽  
Oral Steroids ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, caused by imbalance in autoregulation of posterior cerebral circulation. We report a case of young female, presented at emergency department with complains of nausea, vomiting and generalized tonic clonic seizures prior to admission. During the course of hospital stay patient landed in status epilepticus which was treated appropriately. Patient’s magnetic resonance imaging (MRI) was done which had classical features of vasogenic edema in occipital and parietal region, suggestive of PRES. She was a known case of autoimmune hemolytic anemia thatwas treated with multiple blood transfusions and low dose oral steroids. She was discharged after complete resolution of symptoms with the advice to follow up in medicine outpatient department. Our case describes about autoimmune hemolytic anemia in which occurrence of PRES is uncommon. Early diagnosis and robust treatment can prevent permanent damage to the brain, and is often associated with complete recovery.

scholarly journals Posterior reversible encephalopathy syndrome following post-streptococcal glomerulonephritis

2013 ◽  
Vol 12 (3) ◽  
pp. 341-343
Author(s):  
Giordano Rafael Tronco Alves ◽  
Isadora Cristina Olesiak Cordenonsi ◽  
Régis Vinícius de Andrade Silva ◽  
Carlos Jesus Pereira Haygert
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Chronic Renal Disease ◽  
Vasogenic Edema ◽  
Medical Science ◽  
Clonic Seizure ◽  
Imaging Features ◽  
Posterior Reversible Encephalopathy ◽  
Inflammatory Conditions ◽  
Post Streptococcal Glomerulonephritis ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) comprises a unique pattern of brain vasogenic edema that is seen in the setting of a neurotoxic status. Besides many etiologies have been already associated with PRES development, such as chronic renal disease, use of chemotherapy agents and inflammatory conditions, the imaging features are very suggestive and helpful for an appropriate diagnosis. We report here a case of PRES secondary to post-streptococcal glomerulonephritis (PSGN), which evolved successfully after clinical management. An 11-year-old boy was admitted with a typical history and findings of PSGN, associated with sensory alterations, headache and recent tonic-clonic seizure. Computed tomography (CT) scan of the head has revealed bilateral and symmetric hypodense areas, remarkably located at posterior cerebral regions, indicating PRES. Patient received support therapy with diuretics, and antibiotics prescription after discharge. At ambulatory follow-ups, the patient remains asymptomatic, with complete clinical and radiological improvement.Bangladesh Journal of Medical Science Vol. 12 No. 03 July ’13 Page 341-343 DOI: http://dx.doi.org/10.3329/bjms.v12i3.13323

Hypertension and Confusion

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
White Matter ◽  
Brain Imaging ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Course ◽  
Severe Hypertension ◽  
Vasogenic Edema ◽  
Blurred Vision ◽  
Posterior Reversible Encephalopathy ◽  
Immunosuppressive Medications ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome is a clinical–radiographic syndrome of progressive headaches, blurred vision, confusion, and seizures in the setting of vasogenic edema on brain imaging, which is often localized to the posterior white matter. The symptoms are classically triggered by severe hypertension, pregnancy and the puerperium, or exposure to immunosuppressive medications. The symptoms can be reversible if the offending etiology is quickly removed, but permanent deficits can remain if strokes or hemorrhage complicate the clinical course.

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.

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