Postoperative posterior reversible encephalopathy in Escherichia coli bacteremia

Abstract

Posterior reversible encephalopathy syndrome (PRES) is clinically characterized by headaches, decreased cognition, cortical vision loss, confusion, seizures and it is associated with characteristic radiologic findings. The currently known etiologies of PRES include: hypertension, renal failure, immunomodulating drugs, infective processes, and shock. The relative infrequency combined with the broad differential diagnosis makes PRES a diagnostic challenge. The best imaging for detecting PRES is magnetic resonance imaging. Computerized tomography/magnetic resonance imaging of PRES shows specific damage to bilateral parietal and occipital lobes, specifically the cortical and subcortical regions, depicting vasogenic edema. The extent of brain damage and duration of onset without diagnosis essentially determines the “reversible” effects. Therefore, the absence of the more common etiologies in this case of PRES highlights the diagnostic value of maintaining a broad clinical differential diagnosis when evaluating a patient with new-onset postoperative seizures to correctly guide diagnostic work up and treatment. We describe the first case of PRES in the setting of acute lower gastrointestinal bleeding, Escherichia coli bacteremia and recent general anesthesia.