Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome after Rapid Blood Transfusion

Saito, Kazuyuki; Shimizu, Yu; Higuma, Maya; Kubodera, Takayuki; Wada, Yoshiaki

doi:10.2169/internalmedicine.1768-18

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…These two clinical conditions were reported in same patients (6)(7)(8)(9)(10) and some revisions were reported in about 10% of RCVS patients' symmetrical high-intensity lesions in posterior zones of the brain as observed in PRES patients (56,64). These observations make conceivable a common origin or a common pathophysiological pathway but due to the lack of prospective studies, neither overlapping syndrome nor a temporal phenomenon could be ruled out (13,65).…”

Section: Rcvs Associated With Presmentioning

confidence: 80%

Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations

2020

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Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are relatively uncommon neurological disorders, but their detection has been increasing mainly due to clinical awareness and spreading of magnetic resonance imaging (MRI). Because these syndromes share some common clinical and radiologic features and occasionally occur in the same patient, misdiagnosis may occur. PRES is characterized by varied neurological symptoms including headache, impaired visual acuity or visual field deficit, confusion, disorders of consciousness, seizures, and motor deficits often associated to peculiar neuroradiological pattern even if uncommon localization and ischemic or hemorrhagic lesions were described. RCVS is a group of diseases typically associated with severe headaches and reversible segmental vasoconstriction of cerebral arteries, often complicated by ischemic or hemorrhagic stroke. Pathophysiological basis of PRES and RCVS are still debated but, because they share some risk factors and clinical features, a possible common origin has been supposed. Clinical course is usually self-limiting, but prognosis may fluctuate from complete recovery to death due to complications of ischemic stroke or intracranial hemorrhage. Neuroradiological techniques such as digital angiography and MRI are helpful in the diagnostic pathway and a possible prognostic role of MRI has been suggested. This review will serve to summarize clinical, neuroradiological features and controversies underlying both syndromes that may mislead the diagnostic pathway and their possible relationship with pathophysiology, clinical course, and prognosis.

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Section: Rcvs Associated With Presmentioning

confidence: 80%

Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations

2020

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“…The explanation for the high blood pressure at the time of PRES could be not by increased intravascular volume but by activated sympathetic nervous system and renin-angiotensin-aldosterone system, probably mediated by sustained uremic condition and inflammation by anti-GBM disease. Furthermore, the patient underwent a total of seven courses of plasma exchange using albumin and fresh frozen plasma and four transfusions of red blood cells prior to the development of PRES, and it is possible that these transfusions may have promoted the development of PRES due to hypervolemia and vasospasm [21]. Furthermore, previous reports suggest that patients with advanced kidney disease and uremic condition are prone to develop PRES [7,9].…”

Section: Discussionmentioning

confidence: 99%

Anti-glomerular basement membrane disease complicated with posterior reversible encephalopathy syndrome and subcortical cerebral hemorrhage: a case report and review of the literature

et al. 2020

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A 71-year-old woman was hospitalized for the treatment of fatigue, fever, and cough. On admission, she showed increased serum inflammation markers, severe anemia, pulmonary hemorrhage, and advanced acute kidney injury requiring hemodialysis. Her serum anti-glomerular basement membrane (GBM) antibody titer was found to be extremely high on the 7th hospital day. She was eventually diagnosed with anti-GBM disease. She was treated with a combination of corticosteroid pulse therapy, oral prednisolone and cyclophosphamide, and plasma exchange, but continued to require maintenance hemodialysis for end-stage kidney disease. During her treatment, she suddenly developed headache, blindness, seizure, and consciousness disturbance. She was diagnosed by magnetic resonance imaging with posterior reversible encephalopathy syndrome (PRES) with subcortical cerebral hemorrhage. Both the PRES and cerebral hemorrhage subsided soon after control of her hypertension and reinforcement of immunosuppressive treatment. PRES, particularly when accompanied by cerebral hemorrhage, may cause irreversible and lethal neurological abnormalities, and nephrologists should, therefore, be aware of the potential risk of PRES in patients with anti-GBM disease. We discuss the current case in the light of the previous literature.

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“…PRES reportedly occurs after a rapid blood transfusion for chronic anemia. 6 Rapid blood transfusion may increase the hematocrit level and viscosity and overload cerebral autoregulation, eventually leading to hyper-perfusion.…”

Section: Discussionmentioning

confidence: 99%

Blood transfusion‐induced posterior reversible encephalopathy syndrome with periodic sharp wave complexes, 14‐3‐3 protein elevation, and the pulvinar sign

Shiraishi

Yamaguchi

Fujiki

et al. 2020

Neurology & Clinical Neurosc

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A 52‐year‐old Japanese woman was admitted to our hospital with consciousness disturbance and convulsions at 10 days after transfusion with 10 U of blood due to severe anemia. Electroencephalography showed periodic sharp wave complexes, cerebrospinal fluid 14‐3‐3 protein levels were elevated, and brain magnetic resonance imaging demonstrated bilateral thalamic hyperintensity. These findings suggested Creutzfeldt‐Jakob disease (CJD); however, her symptoms were resolved with antiepileptic and anti‐hypertensive drugs. We herein report a case of posterior reversible encephalopathy syndrome that occurred after a blood transfusion who showed features compatible with CJD.

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Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome after Rapid Blood Transfusion

Cited by 9 publications

References 22 publications

Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations

Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations

Anti-glomerular basement membrane disease complicated with posterior reversible encephalopathy syndrome and subcortical cerebral hemorrhage: a case report and review of the literature

Blood transfusion‐induced posterior reversible encephalopathy syndrome with periodic sharp wave complexes, 14‐3‐3 protein elevation, and the pulvinar sign

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