Síndrome da Encefalopatia Posterior Reversível (PRES) no ciclo gravídico puerperal: revisão bibliográfica

Objetivo: Elencar as principais características fisiopatológicas, clínicas, diagnósticas e manejo terapêutico da Síndrome da Encefalopatia Posterior Reversível (PRES) em gestantes e puérperas. Métodos: Esta revisão da literatura usou a base de dados de pesquisa CAPES, com os descritores: “PRES”, “Posterior Reversible Encephalopathy Syndrome”, “Posterior Leukoencephalopathy Syndrome” e “Pregnancy”, entre os anos de 2003 a 2019, resultando em 50 artigos que preencheram os critérios de inclusão. Resultados: Verificou-se que, os mecanismos fisiopatológicos que buscam explicar a ocorrência geral dessa síndrome, ainda não são claros. Os principais sinais clínicos identificados foram convulsões associadas a cefaleia e alterações visuais. O exame padrão-ouro é a ressonância magnética, preferencialmente em T1, T2, ADC e DWI, estando a restrição de difusão relacionada a um pior prognóstico. Feito o diagnóstico, é necessário o manejo terapêutico com estabilização da paciente, controles pressórico, controle de convulsões e afastar a causa base que desencadeou o processo da PRES. Considerações finais: A PRES é uma síndrome de início agudo, sendo importante o reconhecimento das suas características clínicas e diagnósticas. Por isso quando pensar em PRES? Sugerimos um recurso mnemônico para lembrar como diagnóstico diferencial. P: Pré-eclâmpsia e eclâmpsia; R: Restrição de difusão na Ressonância Magnética; E: Edema cerebral; S: Sintomas visuais.

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Atypical Posterior Reversible Encephalopathy Syndrome in a Postpartum Woman With Moyamoya Disease: A Case Report and Literature Review

Frontiers in Neurology ◽

10.3389/fneur.2021.696056 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ning Zou ◽

Guixiang Guo ◽

Fangchao Wan ◽

Xin Li

Keyword(s):

Glasgow Coma Scale ◽

Moyamoya Disease ◽

Posterior Reversible Encephalopathy Syndrome ◽

Reversible Posterior Leukoencephalopathy Syndrome ◽

Postpartum Woman ◽

Posterior Reversible Encephalopathy ◽

Coma Scale ◽

Posterior Leukoencephalopathy ◽

Collateral Vessels ◽

Reversible Encephalopathy

Background: Moyamoya disease is a rare cerebrovascular occlusive disease, which is characterized by stenosis and gradual occlusion of the internal carotid arteries, causing the progression of characteristic collateral vessels. To date, most studies investigating moyamoya disease have focused on medical implications, and the potential implications for neurocognitive and/or neuropsychiatric functioning were inconclusive.Case Presentation: we present a case of a 26-year-old Chinese postpartum woman who presented to the emergency department with a 19-h history of cognitive decline, vomiting, and convulsions. Blood pressure, heart rate, and respiration rate were 200/120 mmHg, 115 beats/minute, and 30 breaths/minute, respectively, on arrival. The Glasgow Coma Scale, modified RANKIN scale (mRS), and National Institute of Health stroke scale (NIHSS) scores were 3, 5, and 18, respectively. Moyamoya disease was diagnosed using cerebral angiography and digital subtraction angiography. The cognitive functions of orientation, use of language, ability to calculate, and memory significantly improved after 11 days of treatment (Glasgow Coma Scale: 15; mRS: 0; NIHSS: 0).Conclusions:This patient was diagnosed with reversible posterior leukoencephalopathy syndrome related to moyamoya disease. This case highlights that atypical posterior reversible encephalopathy syndrome can occur in patients with moyamoya disease, and should be considered for the differential diagnosis of cerebral infarcts and hemorrhage in a postpartum female.

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

Case Reports in Neurological Medicine ◽

10.1155/2015/538523 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

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.

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

Case Reports in Neurological Medicine ◽

10.1155/2019/2418597 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

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.

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