Syndrome d’encéphalopathie postérieure réversible (EPR) : aspects en imagerie TDM et IRM

Hugonnet, E.; Ines, D. Da; Boby, Henri; Claise, Béatrice; Petitcolin, V.; Lannareix, V.; Garcier, Jean-Marc

doi:10.1016/j.jradio.2011.05.022

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Clinically, there were several arguments in favor of a vascular origin because of the sudden onset of symptomatology and the lupus field. But the different descriptions on the scanner with distribution of lesions in the white matter after injection of the iodine contrast agent were at a disadvantage [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…In imaging, whether on MRI or cerebral CT scan, it is a white matter lesion starting in the parieto-occipital region most often symmetrical in 98% of cases [5]. In CT scans, the lesion is marked by hypodensities not enhanced by contrast injection and MRI lesions appear in isosignal or hyposignal T1 and hypersignal T2 and FLAIR [5].…”

Section: Reversible Posterior Leukoencephalopathymentioning

confidence: 99%

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Lupus leukoencephalopathy simulating progressive multifocal leukoencephalopathy

Agbodande¹,

Sbmg²,

Rdtk³

et al. 2019

Intern Med Inside

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Lupus neurological manifestations are various. Authors report a lupus leukoencephalopathy case simulating a progressive multifocal leukoencephalopathy (PML). Female patient of 32 years old, hospitalized in internal medicine for a long-term fever exploration. Clinical examination found a symmetrical inflammatory peripheral joint syndrome, alopecia and facial erythema in verspertilio. Laboratory tests found: severe normotic regenerative anemia (Hb=4, 9 g/dl), Erythrocyte Sedimentation Rate accelerated to 80 mm. Proteinuria was at 1630 mg/24 hours. This clinical situation led to suspect a systemic lupus. A 500 mg/24 h of Methylprednisolone bolus was started because kidney biopsy is not feasible in our context, relayed by 1 mg/kg/day of prednisone and a transfusion. The evolution was complicated from flaccid tetraplegia. Brain scan found diffuse and asymmetric white matter lesions that suspect a PML. HIV status was negative and the immunological assessment revealed antinuclear antibodies at 1/1280 homogeneous and speckled fluorescence; native Anti-DNA and ENA (Anti-Sm, Anti-SSA, Anti-RNP) were positive. This assessment confirms a systemic erythematosus lupus. She received daily 400 mg of Hydroxychloroquine in combination with corticosteroid therapy. Evolution was favorable in two weeks with normalization of motor skills. Control CT scan was normal. The diagnosis of Leucoencephalopathy of lupus origin was therefore retained.

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Section: Discussionmentioning

confidence: 99%

Section: Reversible Posterior Leukoencephalopathymentioning

confidence: 99%

Lupus leukoencephalopathy simulating progressive multifocal leukoencephalopathy

Agbodande¹,

Sbmg²,

Rdtk³

et al. 2019

Intern Med Inside

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“…In imaging, posterior reversible encephalopathy is characterized by abnormalities of the white and the grey matter, which preferentially affect the posterior regions [4,19] . In computed tomography (CT), the lesion is marked by diffuse hypodensity, In this case, cerebral CT showed hypodensity in the occipital and parietal region (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

“…At the MRI, the lesions appear in iso signal or hypo signal T1 and hypersignal T2 and FLAIR. There is usually no enhancement after injection of contrast [4] .…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus Associated Posterior Reversible Encephalopathy Syndrome (PRES): About a case

Hamidi¹,

Bedou²,

Lahlali³

et al. 2018

J. Med. Res.

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The Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome, it may occur due to a number of causes, including the use of immunosuppressive treatments. It is a rare entity. We report here the occurrence of a PRES syndrome in a patient treated with tacrolimus after liver transplantation, revealed by ocular manifestations associated with intermittent headaches of moderate intensity and tremor in the hands later complicated by a condition epilepticus. The brain scan showed an occipital hematoma in resorption and a lumbar puncture with normal pressure measurement. The brain MRI had objectified on the FLAIR sequence an evocative aspect of reversible posterior encephalopathy in the posterior occipital and parietal territory. Antiepileptic treatment was introduced and tacrolimus was replaced by ciclosporin, given the strong presumption of its involvement in the occurrence of this PRES, with good evolution. The prognosis of PRES is generally favorable under treatment, with a risk of serious sequelae in case of delayed diagnosis justifying that this syndrome must be evoked in front of neurological manifestations in a patient on tacrolimus.

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“…La présentation radiologique du SEPR est variée, décrite selon quatre profils types par Bartynski et Boardman [12] : holohémisphérique (23 %) ; sulcus frontal supérieur (27 %) ; pariéto-occipital (22 %) ; partiel ou asymétrique (28 %). Habituellement, l'imagerie de diffusion retrouve une augmentation du coefficient de diffusion apparent en rapport avec l'existence d'un oedème vasogénique [13]. Dans certaines formes sévères, un oedème cytotoxique peut apparaître avec un coefficient de diffusion diminué [14].…”

Section: Discussionunclassified