Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

Abstract

The posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visualdisturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the caseof a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergencydepartment for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headachefor two hours. His physical examination was remarkable for a blood pressure of 190/100 mmHg and tenderness in epigastrium. Hisanalytical results revealed emphasis on amylase 193 U/L and lipase 934 U/L. During the observation in the emergency department,he presented a generalized tonic-clonic seizure. Abdominal ultrasonography was performed and suggestive of pancreatitis withoutgallstones signals. Head computed tomography showed subarachnoid haemorrhage and a small right frontal cortical haemorrhage.The brain magnetic resonance imaging done one week after admission showed areas of a bilateral and symmetrical T2 / FLAIRhyperintensities in the subcortical white matter of the parietal and superior frontal regions, suggesting a diagnosis of posterior reversibleencephalopathy syndrome. Abdominal computed tomography (10 days after admission) demonstrated a thickened pancreas inconnection with inflammation and two small hypodense foci in the anterior part of the pancreas body, translating small foci of necrosis.The investigation of a thrombophilic defect revealed a heterozygous G20210A prothrombin gene mutation. The patient was dischargedwithout neurological sequelae and asymptomatic. The follow-up brain magnetic resonance imaging confirmed the reversal of thelesions, confirming the diagnosis.