An atypical subacute presentation of posterior reversible encephalopathy syndrome

Bazuaye-Ekwuyasi, Eseosa; Chow, Robert Dobbin; Schmalzle, Sarah

doi:10.1080/20009666.2017.1369381

Cited by 5 publications

(15 citation statements)

References 30 publications

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“…This may partially explain the difference in prevalence, especially since the whole brain MRI was not available for neuroradiological analysis. The atypical distribution involving the thalamus (18,19,21,34), basal ganglia (18,19,46), midbrain (18,19), and corpus callosum (39) was less commonly reported, as described in the literature. As with other PRES etiologies, atypical imaging appearances including hemorrhage, contrast enhancement, and restricted diffusion on MRI were reported in similar proportions (58).…”

Section: Radiological Featuresmentioning

confidence: 91%

“…We collected six reports of illicit drug-induced PRES, involving cocaine (18,19), amphetamine (52), mephedrone (50), kratom (20), and lysergic acid amide (21). Acute high blood pressure was reported in all patients (18-21, 50, 52).…”

Section: Illicit Drugmentioning

confidence: 99%

“…Acute high blood pressure was reported in all patients (18-21, 50, 52). Patients had several risk factors for PRES such as chronic hypertension (18,19), chronic kidney disease (18,19), alcohol abuse (21,50), and HIV infection (18).…”

Section: Illicit Drugmentioning

confidence: 99%

“…While parieto-occipital involvement (12-14, 16-18, 20-34, 36-51) was predominant (39/42, 93%), as described in the literature (57), the isolated parieto-occipital was not the main pattern in this review, supplanted by the pattern combining various anatomical regions involved. Frontal (13, 17, 18, 20, 22, 24-26, 28, 31, 33, 38, 44, 46, 48, 49, 51), temporal lobe (18,25,26,30,32,33,47), and cerebellum (14, 15, 18-21, 30, 35, 41, 52) involvement occurred in 41% (17/42), 17% (7/42), and 24% of patients (10/42), respectively. In this review, the prevalence of frontal and temporal involvement is lower than previously described, where it can be seen in up to 75% of cases (3).…”

Section: Radiological Featuresmentioning

confidence: 99%

“…In substance abuse-related PRES, patients had several risk factors for PRES such as chronic hypertension (18,19), chronic kidney disease (18,19), and HIV infection (18). In these cases, the different risk factors should act synergistically on the different pathophysiological pathways leading to PRES.…”

Section: Multiple Risk Factors In Substance Abuse Patientsmentioning

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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Section: Radiological Featuresmentioning

confidence: 91%

Section: Illicit Drugmentioning

confidence: 99%

Section: Illicit Drugmentioning

confidence: 99%

Section: Radiological Featuresmentioning

confidence: 99%

Section: Multiple Risk Factors In Substance Abuse Patientsmentioning

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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Arginine Vasopressin and Posterior Reversible Encephalopathy Syndrome Pathophysiology: the Missing Link?

et al. 2019

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A Case of Synthetic Cannabinoid (K2)-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

et al. 2022

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Patient: Female, 24-year-old Final Diagnosis: K2 induced posterior reversible encephalopathy syndrome Symptoms: Abnormal behavior • headache Medication: — Clinical Procedure: — Specialty: General and Internal Medicine • Toxicology Objective: Unusual clinical course Background: K2 is an artificially synthesized cannabinoid (SCB), manufactured as a non-consumption herbal incense but increasingly misused as a recreational drug. Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by brain edema, often in the setting of acute hypertension. Cases of PRES caused by recreational drug use have been reported in the literature. Case Report: We report an unusual case of PRES after consumption of K2 in a 24-year-old healthy woman who presented with episodic agitation and altered mental status. Magnetic resonance imaging showed nonspecific subtle high T2/FLAIR (fluid-attenuated inversion recovery) signal intensities in the region of the posterior parietal and occipital cortices. Her extensive drug screen report was positive for K2. Her mental status improved over the course of 3 weeks and she had returned to her baseline at 3-month follow-up. Conclusions: Our case highlights the importance of having a high clinical suspicion in patients presenting with altered mental status and a history of recreational drug use. K2 is not detected by routine urine drug testing, so a high level of clinical suspicion is required to request an extensive drug screen. It is important for the physician to counsel active synthetic cannabinoid users regarding these rare complications.

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An atypical subacute presentation of posterior reversible encephalopathy syndrome

Cited by 5 publications

References 30 publications

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

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

Arginine Vasopressin and Posterior Reversible Encephalopathy Syndrome Pathophysiology: the Missing Link?

A Case of Synthetic Cannabinoid (K2)-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

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