Unusual Late Neurological Complication in a Child After an Indian Krait Bite

Kaushik, Jaya Shankar; Chakrabarty, Biswaroop; Gulati, Sheffali; Patel, Harsh; Lodha, Rakesh; Pai, Gautham; Kumar, Atin

doi:10.1016/j.pediatrneurol.2014.02.014

Cited by 7 publications

(13 citation statements)

References 10 publications

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“…What stands out in these cases as well as ours is that there was no hypertension in 4 of the 5 patients except Kaushik et al's [18]. Two of the cases had other clinical conditions that may explain the occurrence of PRES; the patient of Kaushik et al [18] had uncontrolled hypertension and the patient of Varalaxmi et al had renal impairment.…”

Section: Discussionsupporting

confidence: 61%

“…On follow-up, his blood pressure normalized and his antihypertensive medications were stopped. Repeated MRI studies revealed resolution of the findings [18]. …”

Section: Discussionmentioning

confidence: 99%

“…Two of the cases had other clinical conditions that may explain the occurrence of PRES; the patient of Kaushik et al [18] had uncontrolled hypertension and the patient of Varalaxmi et al had renal impairment. Both conditions are known to be associated with PRES [11].…”

Section: Discussionmentioning

confidence: 99%

“…If the initial symptoms of the patient of Kaushik et al [18] were not part of PRES, that would make them 3. Antivenin is known to have possible adverse neurological effects [8].…”

Section: Discussionmentioning

confidence: 99%

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A Horned Viper Bite Victim with PRES

Ibrahim

ElSefi

Ghanem

et al. 2017

Case Reports in Neurological Medicine

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Neurological complications of snake bites have been well documented in the literature as neuromuscular paralysis and cerebrovascular complications; posterior reversible encephalopathy syndrome was rarely described. A 23-year-old lady presented near full term of her pregnancy with a horned snake Cerastes cerastes bite; after successful delivery she started complaining of altered mental status and visual disturbance with ulceration over the site of the snake bite. On admission, the patient had Glasgow Coma Score of 12, blood pressure 130/80 mmHg, temperature 38°C, sinus tachycardia at 120 beats per minute, severe dehydration, and reduction in visual acuity to “hand motion” in both eyes with poor light projection and sluggish pupillary reactions. CT brain was not conclusive; MRI revealed features of PRES. Treatment was mostly supportive within one week; the patient regained consciousness; visual disturbance, however, persisted. This patient as well as the few previously described cases highlights PRES as a possible complication of snake bites.

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Section: Discussionsupporting

confidence: 61%

“…On follow-up, his blood pressure normalized and his antihypertensive medications were stopped. Repeated MRI studies revealed resolution of the findings [18]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…If the initial symptoms of the patient of Kaushik et al [18] were not part of PRES, that would make them 3. Antivenin is known to have possible adverse neurological effects [8].…”

Section: Discussionmentioning

confidence: 99%

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A Horned Viper Bite Victim with PRES

Ibrahim

ElSefi

Ghanem

et al. 2017

Case Reports in Neurological Medicine

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“…Out of 42 patients included, 22 were female (52%); median age was 41 years (IQR 27-55, range 3-73). Four children were included (12)(13)(14)(15). The median time to PRES onset from the start of exposure or intoxication diagnosis was 3 days (IQR 2-10) and ranged from 2 h (13) to 4 months (16,17).…”

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

et al. 2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Methods: Medline/PubMed, Web of Science, and PsycINFO were screened through May 31, 2019, to systematically identify case reports and case series describing PRES associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical substances) in accidental context, intentional overdose, and substance abuse. The methodological quality of eligible case reports/series was assessed. Patients and exposure characteristics were recorded; relevant toxicological, radiological, and clinical data were extracted. Results: Forty-one case reports and one case series reporting 42 unique cases were included. The median time to PRES onset from the start of exposure was 3 days (IQR 2-10). Acute high blood pressure, visual disturbance, and seizure were reported in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. One-third of patients had at least one risk factor for PRES such as chronic hypertension (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the combination of classical parieto-occipital edema with another anatomical region (e.g., frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance Largeau et al. PRES in Clinical Toxicology imaging. The median time required to hospital discharge was 14 days (IQR 7-18). Mortality and neurological recurrence rate were null. Conclusions: Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored.

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