Posterior Reversible Encephalopathy Syndrome Due to Hyponatremia

Abstract

Posterior reversible encephalopathy syndrome (PRES) is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea/vomiting, and focal neurological signs. The PRES may occur in diverse situations. The findings on neuroimaging in PRES are often symmetric and predominate edema in the white matter of the brain areas perfused by the posterior brain circulation, which is reversible when the underlying cause is treated. We report the case of PRES in normotensive patient with hyponatremia. (2014;4:31-33)

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

“…Several other chemotherapeutic agents used in the treatment of ALL have also been associated with PRES, most likely through cytotoxic mechanisms . Increasing data indicate that hyponatremia might contribute to the pathogenesis of PRES . The underlying mechanism could be disturbance in the regulation of osmolality in the brain and altered water circulation via the water‐channel protein aquaporin‐4, even in a mildly hyponatremic environment…”

“…9,25,30,31,[34][35][36][37][38][39][40][41][42][43] Increasing data indicate that hyponatremia might contribute to the pathogenesis of PRES. 4,44,45 The underlying mechanism could be disturbance in the regulation of osmolality in the brain 46 and altered water circulation via the water-channel protein aquaporin-4, 4,47 even in a mildly hyponatremic environment. 46 Seizures are the most frequent symptom at PRES presentation, often with distinct EEG findings.…”

Reversible posterior encephalopathy syndrome in children with nephrotic syndrome

“…The abovementioned risk factors may indeed exist in patients with acute NS, placing them at higher risk of RPES compared with patients in the remission stage. Reports about dialysis disequilibrium syndrome, hyponatraemia, and hypercalcaemia leading to RPES by various mechanisms in the absence of hypertension are rare. However, there is no clear evidence to prove that serum electrolyte disturbances and dialysis disequilibrium syndrome induce RPES from the results of our study.…”

Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

“…158 Electrolyte disturbances could putatively contribute to vascular dysautoregulation and give rise to the PRES. [159][160][161][162][163] Calcium and magnesium dyshomeostasis may also contribute to the pathogenesis of PRES in some patients. 52,164,165 Some authors have identified varying degrees of hypomagnesemia in approximately one-third of pediatric patients developing PRES, 32 though serum levels of these divalent cations remain within normal levels in the majority of individuals.…”