Posterior reversible encephalopathy syndrome in a adult female

Abstract

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic diagnosis, with rapidly evolving neurologic condition, characterized by headache, confusion, altered mental status, seizures, cortical blindness, lethargy, stupor, and occasionally, focal neurological signs accompanied by a typical computed tomography or magnetic resonance imaging pattern. With early recognition and treatment, complete resolution of symptoms occurs. Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Atypical imaging finding of contrast enhancement of lesion can occur, but is less common. A 20-year-old primiparous lady presented with posterior reversible encephalopathy syndrome. To the best of our knowledge, this is the first documented case in Nigeria. This case-report highlights the importance of recognizing the salient imaging features in this lethal but reversible entity with prompt management.

A Typical Case of Posterior Reversible Encephalopathy Syndrome Associated with Postpartum Eclampsia-HELLP Syndrome

“…It is believed that a rapid rise in blood pressure overcomes cerebral autoregulatory mechanisms with abrupt dilatation of cerebral arterioles. The most characteristic imaging pattern in PRES is the presence of edema involving the white matter of the posterior portion of both cerebral hemispheres, especially the parietooccipital regions, in a relatively symmetric pattern that spares the calcarine and para-median parts of the occipital lobes [1] [6] [9] [15]. Asymmetric appearance had also been noted [8].…”

Challenges of Diagnosing Pediatric Posterior Reversible Encephalopathy Syndrome in Resource Poor Settings: A Narrative Review

“…In Turkey, 5 children reviewed and diagnosed with PRES by Emeksiz et al 18 showed that 2 had acute lymphocytic leukemia, 1 had Henoch-Schönlein purpura, another had systemic lupus erythematous and acute poststreptococcal glomerulonephritis was diagnosed in the fifth child. The only 2 case reports on PRES in Nigeria were in adults (two separate reports of women with eclampsia), 73,74 a worrisome finding since early recognition of PRES and optimal therapy are important to limit morbidity and mortality in children. 75 Renal diseases as a precipitating factor for pediatric PRES, as seen in other reports and infectious diseases in children are still a major challenge in resource poor countries such as Nigeria and thus provide a background for PRES etiology.…”

Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients

“…PRES as a neuroradiological entity is relatively new. The typical features of PRES include signs and symptoms such as hypertension, headache, disturbances of vision, altered mental status as well as generalized seizures accompanied by characteristic MRI findings [1,2,10,28].…”

“…The clinical diagnosis of PRES is established on the presence of certain conditions such as hypertension, headache, visual disturbances, altered consciousness, and generalized seizures with characteristic MRI findings [1,2,10,28]. Imaging findings are of primary importance for PRES diagnostics.…”

“…Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome was first described by Hinchey, in 1996, as a reversible syndrome manifested with an acute headache, consciousness impairment, seizures, and visual deficits, associated with white matter changes predominately affecting the posterior parietal and occipital lobes of the brain but also involving the brainstem, cerebellum, and other cerebral areas [1][2][3].…”