Seizures in posterior reversible encephalopathy syndrome: blood pressure management in normotensive patients

Lu Lu,Yingfeng Xiao,Dong Zhou,Yingying Zhang,Weixi Xiong

doi:10.1186/s42494-021-00064-y

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare clinical disease that refers to the subcortical vasogenic edema involving bilateral parieto-occipital regions, with a usually reversible syndrome when causes are eliminated or controlled. Hypertension or blood pressure fluctuations are most common causes of PRES, but other contributors like chemotherapy and autoimmune disorders have also been reported. PRES has rapid onset of symptoms. Therefore, it is of major importance to determine whether blood pressure management plays an important role in prognosis. We presented two PRES patients who developed non-convulsive seizure but had normal baseline blood pressure at the time of presence of cause. The diagnosis of PRES was made by neurologists. The patients had no history of seizure or hypertension, but during the disease course they presented with temporal elevation of blood pressure with different durations. The second patients without instant blood pressure control developed residual symptoms of seizure at 90- and 120-day follow-up. Although the exact pathophysiology of PRES remains to be fully understood, primary and secondary prolonged blood pressure fluctuations may be associated with the prognosis of this syndrome. Early blood pressure management would be critical to favorable outcome.

Highlights

Posterior reversible encephalopathy syndrome (PRES), known as the reversible posterior leukoencephalopathy syndrome (RPLS), is a condition associated with radiographic features of subcortical vasogenic brain edema involving bilateral parieto-occipital regions
It occurs in circumstances of renal failure, blood pressure fluctuations, use of cytotoxic drugs, autoimmune disorders, or eclampsia
While varied etiologies have been reported, there are two main hypotheses regarding the pathophysiology of PRES

Summary

Background

Posterior reversible encephalopathy syndrome (PRES), known as the reversible posterior leukoencephalopathy syndrome (RPLS), is a condition associated with radiographic features of subcortical vasogenic brain edema involving bilateral parieto-occipital regions. Case 1 The patient was a 52-year-old woman who was admitted to the respiratory ward for acute lung infection with pulmonary arterial hypertension. The diagnosis was considered as chronic pulmonary heart disease, cardiac insufficiency, lung infection, old pulmonary tuberculosis and prerenal renal insufficiency, so anti-infection treatment and diuretics were given She developed type 2 respiratory failure on the day (PaO2 129.7 mmHg, PaCO2 72.8 mmHg), and was occupied with non-invasive ventilator treatment. The ventilation support was weaned on day 9 after admission, when she had normal temperature and respiratory and renal functions, and stable vital signs Three hours later, she experienced sudden dizziness and developed gazing of the eyes, loss of consciousness, and convulsion of the left upper limb for 2 min. The follow-up MRI showed similar impairment as the acute phase (Fig. 3)

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