Posterior reversible encephalopathy syndrome in eclamptic patients: Neuroradiological manifestation, pathogenesis and management

Kutlešić, Marija; Kutlešić, Ranko; Koraćević, Goran

doi:10.2298/mpns1502053k

Cited by 17 publications

(9 citation statements)

References 24 publications

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“…29,30 Prognosis is good in most of the cases of PRES; however, secondary complications, such as status epilepticus, intracranial hemorrhage, and large ischemic stroke can cause significant morbidity and mortality. 28,29,31 Our patient did not have any long-term complications. She had complete recovery of focal deficits at the time of her 6-month follow-up visit.…”

Section: Discussionmentioning

confidence: 55%

Neurology Case Studies

Farooq

Gorelick

2016

Neurologic Clinics

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Section: Discussionmentioning

confidence: 55%

Neurology Case Studies

Farooq

Gorelick

2016

Neurologic Clinics

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“…First, her blood pressure began to rise 2 days prior to initiation of induction chemotherapy, and sudden rises in blood pressure are well documented in PRES, although hypertension can also be a manifestation of PRES as well 1. Preeclampsia/eclampsia is a well-known risk factor for PRES 3. Though she delivered 19 days prior to developing PRES, eclamptic episodes are not limited to the prenatal period and episodes of PRES have been reported as many as 12 days after delivery 4.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in a postpartum woman with acute lymphoblastic leukaemia after intrathecal methotrexate

Mescher¹,

Slungaard

2017

BMJ Case Reports

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Posterior reversible encephalopathy syndrome (PRES) is the most common neurological complication occurring in children undergoing induction chemotherapy for acute lymphoblastic leukaemia (ALL) but is increasingly recognised to occur in adults as well. Here, we report a woman who presented with B-cell ALL (B-ALL) at the time of delivery and developed PRES 1 day after receiving intrathecal (IT) methotrexate (MTX) that rapidly resolved. She subsequently received IT MTX without recurrence of neurological symptoms. This case represents the first case of PRES in a postpartum B-ALL patient receiving IT MTX, demonstrates that re-treatment with MTX in this case could be done safely and highlights the risk of PRES in adults treated for B-ALL.

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“…26 Blood pressure is normal in 20%-30% of patients with PRES. 5,38 The syndrome is often encountered in toxemia of pregnancy (eclampsia), 22,23,34,38 chemotherapy in cancer, 9,24,39 transplantation, 15,20,29 and infection. 33,36 Common biological processes include 1) immune system activation of T cells, 2) endothelial cell activation, 3) endothelial injury, 4) vascular instability (systemic vasoconstriction), and 5) organ hypoperfusion.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome following a thoracic discectomy–induced dural leak: case report

Shields

Johnson

Shields

2016

SPI

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Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headaches, altered mental status, seizures, and visual disturbances. Classic MRI findings include white matter changes of the parieto-occipital regions. This syndrome has been encountered in myriad medical illnesses, including hypertension, preeclampsia/eclampsia, and immunosuppressive conditions. While the pathogenesis of the disorder is unclear, vasoconstriction and hypoperfusion leading to brain ischemia and vasogenic edema have been implicated as potential mechanisms. The authors present, to the best of their knowledge, the first case of PRES following a thoracic spinal surgery–induced dural leak noted on resection of the fifth rib during a thoracotomy for a T4–5 discectomy. Brain MRI revealed large areas of increased FLAIR and T2 hyperintensity in the superior posterior frontal lobes, superior and medial parietal lobes, and bilateral occipital lobes. Following repair of the CSF leak, the patient's symptoms resolved. Spinal surgeons should be alert to the potentially life-threatening condition of PRES, especially in a hypertensive patient who experiences surgery-induced dural leakage. The development of a severe positional headache with neurological signs is a red flag that suggests the presence of PRES. Prompt attention to the diagnosis and treatment of this condition by repairing the dural leak via surgery or expeditious blood patch increases the likelihood of a favorable outcome.

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Posterior reversible encephalopathy syndrome in eclamptic patients: Neuroradiological manifestation, pathogenesis and management

Abstract: Posterior reversible encephalopathy syndrome in eclamptic patients is completely reversible if adequate diagnosis is promptly made and intensive treatment immediately administered.

Cited by 17 publications

References 24 publications

Neurology Case Studies

Neurology Case Studies

Posterior reversible encephalopathy syndrome in a postpartum woman with acute lymphoblastic leukaemia after intrathecal methotrexate

Posterior reversible encephalopathy syndrome following a thoracic discectomy–induced dural leak: case report

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