Atypical imaging findings in a renal transplant patient with reversible posterior leukoencephalopathy syndrome: a case report

Riera, Cristina Soler; Haddad, Leila; Scocco, Darío; Fischer, Gabriela; Saubidet, Christian Lopez; Álvarez, Paulino

doi:10.1186/1757-1626-2-145

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…Evidence of PRES with hemorrhagic features in transplant patients is scarce. Limited case reports or series, including transplant patients, observed this complication [6,7,[13][14][15]. Numerous variables, including organ transplantation, immunosuppression therapy, hemodynamic parameters, coagulation profile, blood pressure, and other comorbidities, are likely to play a role in the occurrence of hemorrhage in this setting.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Leukoencephalopathy With Hemorrhagic Features: A Case Series

Appiani,

Claverie,

Klein

2023

Cureus

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Introduction Posterior reversible leukoencephalopathy syndrome (PRES) is a clinical-radiological condition characterized by reversible subcortical vasogenic cerebral edema of acute or subacute onset in circumstances that disrupt capillary permeability, unfrequently accompanied by cytotoxic and/or hemorrhagic lesions. We describe a case series of PRES with hemorrhagic features. Subjects and methods Electronic medical records of hospitalized patients diagnosed with PRES from January 2009 to December 2021 were collected. Demographic data, medical history, clinical presentation, and outcome were recorded. Variables were compared between patients with and without hemorrhagic features using the Wilcoxon-Mann-Whitney test with a statistical significance level of p<0.05. Results Over a 12-year period, 33 patients were diagnosed with PRES, of whom 10 had hemorrhagic features: seven cortical microbleeds, two intraparenchymal hematomas, and one subarachnoid hemorrhage. Half of the patients were women, with a median age of 45.8 years (interquartile range (IQR) 21.8), and were admitted for non-neurological reasons. The sample included nine transplant recipients (six solid organa, three bone marrowa), with four patients in the immediate post-transplant period. PRES occurred in the context of infections and blood pressure fluctuations under cytotoxic drugs, such as immunosuppressants. Seventy percent showed improvement/resolution on neuroimaging at a median of 70 days (IQR 62.9). The three major hemorrhages occurred in the context of thrombocytopenia. The recorded in-hospital mortality was 10%. When compared to PRES without hemorrhagic features, patients with hemorrhagic features had a lower use of corticosteroids (50% vs. 78.8%; p=0.02) and a higher presence of restrictive lesions on neuroimaging (60% vs. 17%; p=0.04), with no differences in the other analyzed variables. Conclusion Patients with PRES and hemorrhagic features had a lower use of corticosteroids and a higher presence of restrictive lesions on neuroimaging. Further studies are needed to better understand the clinical implications and management of PRES with hemorrhagic manifestations.

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Leukoencephalopathy With Hemorrhagic Features: A Case Series

Appiani,

Claverie,

Klein

2023

Cureus

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Posterior reversible encephalopathy syndrome after postpartum hemorrhage and uterine artery embolization

Shi

Shen²,

Shi³

et al. 2017

Medicine

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Rationale:Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical and radiological features, including headache, disturbed consciousness, seizures, and cortical blindness associated with findings indicating posterior leukoencephalopathy on imaging studies. Ours is the first case of PRES developing after postpartum hemorrhage and uterine artery embolization.Patient concerns:An 18-year-old patient had postpartum hemorrhage after a normal delivery. She required uterine artery embolization to stop the bleeding; however, she developed PRES 2 hours after the surgery.Diagnoses:Brain computed tomography suggested subarachnoid hemorrhage or cerebral venous sinus thrombosis. However, findings on magnetic resonance imaging were highly indicative of PRES.Interventions:The patient received diazepam and midazolam to prevent seizures.Outcomes:Seizures were controlled on the first day. The patient's visual acuity returned to normal on the fourth day of admission. Thirteen days after admission, her neurological signs and symptoms were completely managed.Lessons:PRES may be related to postpartum hemorrhage, blood pressure fluctuation, inflammation, and contrast agents. Collectively, they cause a breakage in the blood–brain barrier and endothelial cell damage, eventually leading to PRES. We also found PRES had many features similar with contrast-induced encephalopathy.

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Atypical imaging findings in a renal transplant patient with reversible posterior leukoencephalopathy syndrome: a case report

Cited by 2 publications

References 9 publications

Posterior Reversible Leukoencephalopathy With Hemorrhagic Features: A Case Series

Posterior Reversible Leukoencephalopathy With Hemorrhagic Features: A Case Series

Posterior reversible encephalopathy syndrome after postpartum hemorrhage and uterine artery embolization

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