Posterior reversible encephalopathy syndrome (PRES) in a patient with moyamoya disease

Abstract

Introduction:Moyamoya disease (MMD) and posterior reversible encephalopathy syndrome (PRES) share similar pathophysiological characteristics of endothelial dysfunction and impaired cerebral autoregulation. However, there have never been any published studies to demonstrate the relationship between these 2 rare diseases.Patient concerns:A 26-year-old Asian man presented with a throbbing headache, blurred vision, and extremely high blood pressure. We initially suspected acute cerebral infarction based on the cerebral computed tomography, underlying MMD, and prior ischemic stroke. However, the neurological symptoms deteriorated progressively.Diagnosis:Cerebral magnetic resonance imaging indicated the presence of vasogenic edema rather than cerebral infarction.Interventions and outcomes:An appropriate blood pressure management prevents the patient from disastrous outcomes successfully. Cerebral magnetic resonance imaging at 2 months post treatment disclosed the complete resolution of cerebral edema. The patient's recovery from clinical symptoms and the neuroimaging changes supported the PRES diagnosis.Conclusion:This report suggests that patients with MMD may be susceptible to PRES. It highlights the importance of considering PRES as a differential diagnosis while providing care to MMD patients with concurrent acute neurological symptoms and a prompt intervention contributes to a favorable clinical prognosis.

Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case

“…However, the authors also noted that focal hyperperfusion on SPECT and TNDs after combined surgery was not a significant pathological condition, but it was similar to posterior reversible encephalopathy syndrome and vascular edema. 8 , 33 Rapid changes in focal CBF due to direct bypass and direct stimulation of the brain in combined revascularization and changes in the composition of cerebrospinal fluid due to indirect surgery may be microenvironments that induce an impaired blood–brain barrier and endothelial injuries. 34 This environment may induce hyperpermeability of the vasculature, which results in CBF decreases and intravascular dehydration.…”

Post Infectious Glomerular Nephritis (PIGN) leading to Posterior Reversible Encephalopathy Syndrome (PRES); an uncommon presentation

“…PRES is a neurological condition, primarily characterized by headache, altered consciousness, visual symptoms and convulsions clinically and vasogenic oedema primarily in subcortical white matter areas, predominantly in posterior cerebral hemispheres (parieto-occipital regions), also in cerebellum and brainstem radiologically (1). Hypertensive crisis is the commonest cause but also occurs with cytotoxic immuno suppressive therapy, renal disease and auto immune disorders (2). Children are more vulnerable even in the low blood pressure.…”

“…PRES is characterized by headache, altered consciousness, visual symptoms, convulsions and symmetrical subcortical white matter vasogenic edema predominantly in posterior cerebral hemispheres (1). Hypertensive crisis is the common cause for PRES (2). Developing hypertensive encephalopathy and PRES following PIGN is known but uncommon presentation.…”

Cortical Blindness and Moyamoya Angiopathy in the Context of an Acute COVID-19 Infection

“…Detailed evaluation for secondary causes of MMA was noncontributory. Although posterior reversible encephalopathy syndrome can have a similar clinical and parenchymal imaging features and has rarely been reported to occur concurrently with MMA, an absence of headache, hypertension, use of immunosuppressant, or renal disease fairly negated its possibility in this case (4).…”