Tacrolimus-Induced Vision Loss in a Renal Transplant Patient: Posterior Reversible Encephalopathy Syndrome

2019 ◽  
Author(s):  
Fatih Cakmak ◽  
Altug Kanbakan ◽  
Yonca Senem Akdeniz ◽  
Afsin İpekci ◽  
Turkan Ikizceli
Keyword(s):  
Renal Transplant ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Renal Transplant Patient ◽  
Transplant Patient ◽  
Vision Loss ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

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.

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.

Posterior Reversible Encephalopathy Syndrome Causing Vision Loss After Endoscopic Endonasal Resection of Pituitary Adenoma

2017 ◽  
Vol 100 ◽  
pp. 708.e1-708.e10 ◽  
Author(s):  
Nicolas W. Villelli ◽  
Daniel M. Prevedello ◽  
Daniel S. Ikeda ◽  
Alaa S. Montaser ◽  
Bradley A. Otto ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Endoscopic Endonasal ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

scholarly journals Ophthalmic Disorders in Posterior Reversible Encephalopathy Syndrome Associated with Preeclampsia

2021 ◽  
Author(s):  
Katarina Cvitkovic ◽  
Anita Pusic Sesar ◽  
Antonio Sesar ◽  
Ivan Cavar
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Vasogenic Edema ◽  
Serous Retinal Detachment ◽  
Cortical Blindness ◽  
Hypertensive Retinopathy ◽  
Posterior Reversible Encephalopathy ◽  
Cerebral Vasoconstriction ◽  
Purtscher’S Retinopathy ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity presented with different symptoms such as visual disturbances, headaches, seizures, severe hypertension and altered mental status. It has been recognized in a different pathological conditions, although preeclampsia/eclampsia is the most common cause of PRES. The pathogenesis of PRES is still not fully understood, but it seems that failure of cerebrovascular autoregulation causing vasogenic edema, cerebral vasoconstriction, and disruption of the blood brain barrier plays an important role. Cortical blindness, hypertensive retinopathy, serous retinal detachment (SRD), central retinal artery and vein occlusions, retinal or vitreous hemorrhages, anterior ischemic optic neuropathy (AION) and Purtscher’s retinopathy are ophthalmic disorders that may occur in PRES associated with preeclampsia. Among these, cortical blindness is the best documented complication of preeclampsia. Magnet resonance imaging (MRI) is a gold standard to establish the diagnosis of PRES because clinical findings are not sufficiently specific. Typically, there are bilateral cortical occipital lesions with hyperdensity on T2-weighted MRI. Blindness due to occipital lesions is reversible and the vision loss is usually regained within 4 h to 8 days.

scholarly journals Posterior Reversible Encephalopathy Syndrome : A Rare Cause of Sudden Onset Vision Loss in Pregnancy

2012 ◽  
Vol 6 (2) ◽  
pp. 51-52
Author(s):  
R Chaudhary ◽  
S Dadhich ◽  
J Vyas
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Case Reports ◽  
Altered Mental Status ◽  
Sudden Onset ◽  
Cortical Blindness ◽  
Posterior Reversible Encephalopathy ◽  
Visual Deficits ◽  
Reversible Encephalopathy ◽  
In Pregnancy

Posterior Reversible Encephalopathy Syndrome (PRES) is a very rare cause of sudden onset vision loss in pregnancy. There are only few case reports in literature. It is characterized by headache, seizures, altered mental status and visual deficits ranging from visual neglect to cortical blindness. Here a case if PRES has been reported with discussion on its pathophysiology. NJOG 2011 Nov-Dec; 6 (2): 51-52 DOI: http://dx.doi.org/10.3126/njog.v6i2.6759

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