Acute Bismuth Intoxication: Acute Renal Failure, Tonsillar Ulceration and Posterior Reversible Encephalopathy Syndrome

Akıncı, Emine; Köylü, Ramazan; Yortanlı, Mehmet; Gümüş, Haluk; Köylü, Öznur; Altıntepe, Lütfullah; Cander, Başar

doi:10.1177/102490791502200208

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…The classical PRES pattern, involving only parieto-occipital lobes, was found in 19% (8/42) of patients (12,16,23,27,37,40,42,45). The variant pattern of PRES (6/42, 14%), including isolated anatomical region such as occipital (29,36,43,50) and cerebellum (15,52), occurred in 9 and 5%, respectively. In five reports, angiography (by contrast-enhanced arteriography in CT, or MRI sequences including non-contrast time-of-flight and angio-MRI or digital subtraction angiography) showed narrowing of the cerebral arteries (16,28,36,37,49).…”

Section: Radiological Featuresmentioning

confidence: 99%

“…Out of 42 patients included, 22 were female (52%); median age was 41 years (IQR 27-55, range 3-73). Four children were included (12)(13)(14)(15). The median time to PRES onset from the start of exposure or intoxication diagnosis was 3 days (IQR 2-10) and ranged from 2 h (13) to 4 months (16,17).…”

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

“…The median time to PRES onset from the start of exposure or intoxication diagnosis was 3 days (IQR 2-10) and ranged from 2 h (13) to 4 months (16,17). The initial clinical presentation was alertness disorders in 64% of patients (13)(14)(15). Visual disturbances were reported in 55% of patients ( (19,20,35), visual hallucination (21,23,26,27), and cortical blindness (15,16,24,29,34,37).…”

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

“…Nine patients experienced PRES in a context of drug overdose, involving lithium (33,34), dextroamphetamine (35), acetaminophen (51), ephedrine (49), phenylpropanolamine (36), digitoxin (37), and bismuth (15). The median time to PRES onset from the intoxication was 3 days, and two distinct situations were identified.…”

Section: Drug Overdosementioning

confidence: 99%

“…The median time to PRES onset from the intoxication was 3 days, and two distinct situations were identified. PRES occurred during the acute phase of poisoning (35)(36)(37)49) or at distance from intoxication (i.e., after stopping the causative drug) (15,33,34,51). Three case reports indicated an association between lithium and PRES (33,34).…”

Section: Drug Overdosementioning

confidence: 99%

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Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

et al. 2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Methods: Medline/PubMed, Web of Science, and PsycINFO were screened through May 31, 2019, to systematically identify case reports and case series describing PRES associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical substances) in accidental context, intentional overdose, and substance abuse. The methodological quality of eligible case reports/series was assessed. Patients and exposure characteristics were recorded; relevant toxicological, radiological, and clinical data were extracted. Results: Forty-one case reports and one case series reporting 42 unique cases were included. The median time to PRES onset from the start of exposure was 3 days (IQR 2-10). Acute high blood pressure, visual disturbance, and seizure were reported in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. One-third of patients had at least one risk factor for PRES such as chronic hypertension (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the combination of classical parieto-occipital edema with another anatomical region (e.g., frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance Largeau et al. PRES in Clinical Toxicology imaging. The median time required to hospital discharge was 14 days (IQR 7-18). Mortality and neurological recurrence rate were null. Conclusions: Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored.

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