Abstract
IntroductionA 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. At the time of presentation, her blood pressure was 219/100 mmHg, her arterial pH was 7.64 and her potassium level was 2.7 mM/l.MethodsThe combination of sequential computed tomography (CT) and the triad of hypertension, hypokalemia and metabolic alkalosis in this patient suggested the diagnosis. Supplementary anamnesis and long-term follow-up confirmed it.ResultsBrain computed tomography imaging showed minor bleeding in the left Sylvian fissure and bilateral occipital edema, suggestive of posterior reversible encephalopathy syndrome (PRES). Repeated brain CT after 10 days showed a complete resolution of radiological signs. The patient informed us that she had quit smoking 2 weeks ago and had started consuming large amounts of licorice instead of smoking. After she abandoned licorice consumption, her blood pressure normalized. Her latest blood pressure reading was 106/60 mmHg without the use of any antihypertensive drugs.ConclusionsTo the best of our knowledge, this is the first case report describing licorice consumption as a cause of PRES. Glycyrrhizic acid, a component of licorice, inhibits 11β-hydroxysteroid dehydrogenase and subsequently causes mineralocorticoid excess. Mineralocorticoid excess in turn causes high blood pressure and ultimately gives rise to malignant hypertension. Physicians should remember that licorice use is a very easy-to-treat cause of hypertension, hypertensive encephalopathy and PRES.
Highlights
A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision
A patient with Wegener granulomatosis who is taking immunosuppressive medication and presents with a renal crisis provoked by infection has four conditions associated with posterior reversible encephalopathy syndrome (PRES)
Treatment The diagnosis of PRES was made, and the patient was admitted to the intensive care unit (ICU) for monitoring of blood pressure and neurological status as well as treatment of hypertension with labetolol
Summary
A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. The reversible posterior leukoencephalopathy syndrome, or posterior reversible encephalopathy syndrome (PRES), was first described by Hinchey et al in 1996 [1] It is characterized by symptoms of acute neurological (often visual) symptoms combined with brain imaging findings correlating with vasogenic edema and clinical or radiologic proof of reversibility [2,3]. Other frequently occurring symptoms include combinations of Common associated conditions in patients with PRES are hypertension, preeclampsia-eclampsia, acute or chronic renal failure, infection, sepsis or multiple organ dysfunction, autoimmune disease and treatment with chemotherapeutic or immunosuppressant agents (the most reported drugs are tacrolimus and cyclosporine) [2].
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