An unusual presentation of a rare disease: posterior reversible encephalopathy syndrome following abdominal sepsis

Richards, Carly R.; McMurray, Robert; Criman, Erik T.; Clark, Margaret E.; Gillern, Suzanne

doi:10.1093/jscr/rjw184

Cited by 5 publications

(5 citation statements)

References 9 publications

(11 reference statements)

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“…The breakdown of autoregulation results in hyperperfusion and the subsequent extravasation of fluid into the interstitium of the brain tissue at the periphery of the arterial territories. [ 7 15 16 ] This theory was confirmed by Zeeman et al . who showed that patients with PET/eclampsia develop a significant increase in the cerebral blood flow, which causes vasogenic edema.…”

Section: Discussionsupporting

confidence: 53%

“…and has since then been recognized in a growing number of pathological conditions such as preeclampsia toxemia (PET), eclampsia, hypertensive encephalopathy, autoimmune diseases, infection/sepsis, and the use of cytotoxic or immunosuppressive drugs. [ 1 4 5 6 7 ] Among these, PET or eclampsia has been cited in the literature as the most common cause of PRES. [ 3 ] PET is defined as a new onset of hypertension and proteinuria that appears after the 20 th week of gestation in a previously normotensive woman, and it occurs in 2%–3% of all pregnancies.…”

Section: Introductionmentioning

confidence: 99%

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Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia

Ćavar

Sesar

2018

Taiwan J Ophthalmol

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Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that can cause different ophthalmological and neurological symptoms. Preeclampsia toxemia or eclampsia is one of the leading causes of PRES. Herein, we present a study of a 35-year old woman who gave birth to healthy twins at 35 weeks of gestation by cesarean section because of threatened preterm delivery. On the 1st postoperative day, the woman developed a severe headache, arterial hypertension, tachycardia, generalized tonic–clonic seizures, and loss of consciousness that persisted for about 2 min. A provisional diagnosis of eclampsia was made, and the woman was then quickly transferred to the intensive care unit where she was treated with antihypertensive therapy, magnesium sulphate, and diazepam. Following stabilization of the general condition, the patient noticed sudden bilateral blindness. An ophthalmological examination revealed significant bilateral loss of vision at the level of insecured light perception, normal pupillary responses to a light stimulus, and normal fundus findings. On this basis, an ophthalmologist made the diagnosis to cortical blindness. Radiographic analysis showed an edematous change in the occipital and parietal brain regions, thus suggesting a diagnosis of PRES. In conclusion, cortical blindness is a clinically striking ophthalmic disorder that may occur in PRES associated with postpartum eclampsia.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia

Ćavar

Sesar

2018

Taiwan J Ophthalmol

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“…Other sequelae of intracranial hypertension may be present as well, contributing to the high variability in clinical presentation [4]. The PRES is often found with characteristic findings on neuroimaging studies including edema in the posterior cortical white matter.…”

Section: Discussionmentioning

confidence: 99%

Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus

Mehta¹

2018

Int J Case Rep Images

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We present a case of a 25-year-old African-American woman with a history of chronic pelvic pain secondary to recurrent endometriosis presenting with chief complaints of fever and pelvic pain. She was treated with laparoscopic ablation three months prior. Workup revealed bilateral tuboovarian abscesses and the patient underwent total abdominal hysterectomy and bilateral salpingooophorectomy. Postoperatively, the patient had new onset hypertension which eventually lead to a seizure episode. The patient was transferred to the ICU, started on nicardipine and Keppra and her hypertension improved within several hours. Neuroimaging findings on MRI scan revealed lesions in the occipital and parietal lobes consistent with PRES. Outpatient workup conducted several months afterwards uncovered a diagnosis of systemic lupus erythematosus, leading us to conclude that the postoperative hypertensive emergency and PRES were secondary to undiagnosed SLE. IJCRI publishes Conclusion:The rare complication of PRES has been described in a variety of settings including SLE in which endothelial dysfunction of the intracerebral vasculature leads to characteristic PRES symptoms. Patients, especially those in the postoperative setting covered by multiple specialty providers, with new onset hypertension and neurological symptoms should warrant further workup as they may indicate underlying etiologies such as SLE or other described risk factors for PRES.

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“…Previously, it has been known by various names such as reversible posterior leukoencephalopathy syndrome, reversible posterior cerebral edema syndrome, and reversible occipital parietal encephalopathy [2,3]. PRES was first described in 1996 by Hinchey et al in patients with acute neurological symptoms and since then it has been recognized in different pathological conditions such as preeclampsia, eclampsia, hypertensive encephalopathy, autoimmune diseases, renal failure, infection, and the use of cytotoxic or immunosuppressive drugs [1,[3][4][5][6][7][8][9]. Among these, preeclampsia and eclampsia are the most common causes of PRES.…”

Section: Introductionmentioning

confidence: 99%

Ophthalmic Disorders in Posterior Reversible Encephalopathy Syndrome Associated with Preeclampsia

Cvitkovic¹,

Sesar²,

Ćavar³

2022

Preeclampsia

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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.

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An unusual presentation of a rare disease: posterior reversible encephalopathy syndrome following abdominal sepsis

Cited by 5 publications

References 9 publications

Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia

Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia

Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus

Ophthalmic Disorders in Posterior Reversible Encephalopathy Syndrome Associated with Preeclampsia

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