A case of post-transfusion posterior reversible encephalopathy syndrome with cerebral hemorrhage that may be associated with fat-soluble vitamin deficiency

Abstract

54：518Posterior reversible encephalopathy syndrome（PRES）は， A 36-year-old woman with a 4 year history of lower legs edema, hypermenorrhea and melena without medical treatment was admitted to our hospital. At 18 days before admission, anasarca and general fatigue appeared and she was admitted to another hospital. Her hemoglobin concentration was 1.4 g/dl and chest X-ray showed cardiomegaly. Heart failure with severe chronic anemia was diagnosed, and blood transfusion was performed. Her hemoglobin concentration increased to 10 g/dl and the anasarca disappeared. The day after discharge, she was referred to our hospital with generalized convulsion. We diagnosed posterior reversible encephalopathy syndrome (PRES) from the typical MRI imaging. We started treatment and her consciousness recovered steadily. At a week after admission, left hemiparesis appeared. Her brain imaging revealed multiple intracranial hemorrhages. In addition, her visual disturbance revealed vitamin A and vitamin K deficiency. PRES sometimes occur secondary to blood transfusion, but secondary brain hemorrhage is rare. Her fat-soluble vitamin deficiency, which resulted from a peculiar eating habit, may have contributed to the brain hemorrhage. (Clin Neurol 2014;54:518-521)

Neurological PRESentations in Sickle Cell Patients Are Not Always Stroke: A Review of Posterior Reversible Encephalopathy Syndrome in Sickle Cell Disease

“…A standard institutional transfusion protocol was followed in all transfusions during this admission, so a major difference could not be determined in the administration of the past transfusions and the three that were given prior to the presentation of PRES. Since 2008, there has been significant growth in reported cases of blood transfusion associated PRES, and most were in adult females with chronic anemia due to menorrhagia and some were in iron deficiency, aplastic anemia, and thalassemia patients . Raj et al.…”

“…Since 2008, there has been significant growth in reported cases of blood transfusion associated PRES, and most were in adult females with chronic anemia due to menorrhagia and some were in iron deficiency, aplastic anemia, and thalassemia patients. [7,8,25,[37][38][39][40][41] Raj et al described 10 pediatric patients with PRES: there was 100% prevalence of anemia from different etiologies (one SCD patient), 80% prevalence of hypertension for at least 6 hr preceding the onset of PRES, and only 10% (one patient) received a blood transfusion. Although PRES is likely multifactorial in etiology, it is conceivable that anemia played the most major role in PRES development, and that transfusion alone or hypertension alone is not plausible explanation.…”

Posterior reversible encephalopathy syndrome with extensive cytotoxic edema after blood transfusion: a case report and literature review

“…Second, the period of anemia in the present patient was shorter those that reported in previous cases. Most cases (88% of all reported cases of PRES after blood transfusion) had had chronic anemia lasting over 1 month [ 6 – 8 , 10 , 12 – 16 , 18 – 20 ]. In these typical cases, it assumed that a rapid improvement of oxygenation by blood transfusion induces PRES by disturbing the balance of vessels, which is maintained by chronic hypoxic vasodilation [ 6 ].…”

Blood transfusion‐induced posterior reversible encephalopathy syndrome presenting severe brain atrophy: A report of two cases

“…In addition, she had a fat‐soluble vitamin deficiency and developed night blindness due to vitamin A deficiency. Previously, we reported the patient's acute medical course 4 . Her hemiplegia, blindness, and psychiatric symptoms have continued.…”