Reversible posterior leukoencephalopathy syndrome: a possible manifestation of Wegener’s granulomatosis-mediated endothelial injury

Nishio, Minako; Yoshioka, Katsunobu; Yamagami, Keiko; Morikawa, Takashi; Konishi, Yoshio; Hayashi, Noriko; Himuro, Kimihide; Imanishi, Masahito

doi:10.1007/s10165-008-0052-1

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…Corticosteroids with mineral corticoid effects, in particular, may cause hypertension and induce RPLS. On the other hand, some RPLS patients were treated with high-dose methylprednisolone, cyclophosphamide, and/or plasmapheresis as final resolution [9,14,16,18,20,[25][26][27][28]32], as shown in Table 1. There is controversy regarding the relationship of these agents to RPLS.…”

Section: Discussionmentioning

confidence: 99%

Reversible posterior leukoencephalopathy syndrome in a patient with Takayasu arteritis

et al. 2008

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Reversible posterior leukoencephalopathy syndrome (RPLS) has been identified in several connective tissue diseases. However, there are no reports of RPLS associated with Takayasu arteritis (TA). We report the first case of TA associated with RPLS. A 23-year-old woman presented with sudden headache and vomiting, followed by generalized tonic-clonic seizures and mental changes two weeks after administration of oral prednisolone. MRI showed hyperintense signals on T2 and FLAIR images in the bilateral temporal-parietal-occipital lobes, left frontal lobe, and left cerebellar hemisphere. Three weeks after starting control of convulsions and blood pressure with plasmapheresis, high-dose methylprednisolone, and cyclophosphamide, the clinical manifestations and abnormal signals on MRI completely resolved. These reversible clinical and radiological changes are consistent with vasogenic edema in the central nervous system, indicating RPLS. Although high-dose methylprednisolone and cyclophosphamide are thought to cause RPLS, we think that it is justified to use these agents, at least in difficult cases, for making a clear-cut differentiation from CNS vasculitis, as long as blood pressure and fluid volume are well controlled. Moreover, we suggest that RPLS should be included in differential diagnosis of acute neurological changes in connective tissue diseases, including TA.

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Section: Discussionmentioning

confidence: 99%

Reversible posterior leukoencephalopathy syndrome in a patient with Takayasu arteritis

et al. 2008

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“…However, steroids are also used in the treatment of vasogenic edema, such as in patients with intracranial mass lesions [9]. Case reports have implicated steroids as both the precipitant [5, 8, 12, 19, 20, 23, 24, 30, 31, 34, 38, 47, 48] and treatment [1, 6, 8, 12, 13, 18, 25, 28, 30, 33, 36, 37] of PRES. Thus, the role of steroids in PRES remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome

Parikh

Schweitzer

Young

et al. 2017

Journal of the Neurological Sciences

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Background Posterior reversible encephalopathy syndrome (PRES) is a variable cerebrovascular syndrome associated with hypertension and autoregulatory failure. Steroids have been reported to both precipitate and treat PRES. We sought to determine the prevalence of steroid therapy at the time of PRES and to assess the relationship between steroid therapy and extent of vasogenic edema. Methods We performed a retrospective review of radiology reports between 2008 and 2014 from two academic medical centers to identify cases of PRES. Clinical and radiographic data were collected. Descriptive statistics were used to determine the prevalence of corticosteroid therapy at the time of PRES onset and the latency from steroid initiation to PRES onset. The association between steroid therapy and extent of vasogenic edema was assessed in multiple regression models. Results We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30–65) and 74% were women. Steroid therapy at time of PRES onset was identified in 44 of 99 cases. Excluding patients on chronic therapy, the median duration of steroid exposure before PRES onset was 6 (IQR, 3–10) days. Steroid therapy was not associated with extent of vasogenic edema in unadjusted or linear and logistic regression models adjusted for age, sex, and maximum systolic blood pressure on day of onset. Conclusion Corticosteroid therapy, often of brief duration, frequently preceded the onset of PRES and was not associated with severity of vasogenic edema.

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“…To our knowledge, only four cases of PRES associated with ANCA-associated vasculitis have been reported in the literature [4][5][6]. There have been as well other reports of PRES in patients with diagnosed vasculitis including Wegener's, Takayasu's, and Polyarteritis Nodosa, in which similar mechanisms can be theorized as pathogenic in development of PRES.…”

Section: Discussionmentioning

confidence: 81%

Posterior reversible encephalopathy syndrome in a patient with ANCA-associated vasculitis

2010

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Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome that manifests with the onset of headache, confusion or decreased level of consciousness, visual changes, and seizures in conjunction with the typical neuroimaging features of posterior cerebral white matter changes, which are usually reversible. This syndrome has been associated with hypertension, eclampsia, renal insufficiency, immunosuppressive drugs, and connective-tissue diseases. To our knowledge, only four cases of PRES associated with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis have been reported in the literature. Here, we present a patient with ANCA-associated vasculitis complicated by PRES.

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Reversible posterior leukoencephalopathy syndrome: a possible manifestation of Wegener’s granulomatosis-mediated endothelial injury

Cited by 14 publications

References 26 publications

Reversible posterior leukoencephalopathy syndrome in a patient with Takayasu arteritis

Reversible posterior leukoencephalopathy syndrome in a patient with Takayasu arteritis

Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome in a patient with ANCA-associated vasculitis

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