Posterior Reversible Encephalopathy Syndrome Research Articles

Posterior Reversible Encephalopathy Syndrome with Addison’s Disease in a Known Case of Arnold Chiari Malformation

Posterior Reversible Encephalopathy Syndrome (PRES) is a life-threatening neurological disease. The aetiology of Addison’s disease has been modified from infectious to autoimmune pathology. Underlying pathogenesis is insufficient production of glucocorticoids and mineralocorticoids. Case series with PRES syndrome and Cushing’s syndrome have been reported but PRESS with adrenal insufficiency is rarely published. We hereby report an operated case of Arnold Chiari malformation presenting with first episode of generalised tonic clonic seizure and diarrhoea for four days. Postictal confusion was present for two hours. She was previously diagnosed with Addison’s disease. Patient had hypotension and dyselectrolytaemia. Systemic examinations were within normal limits. MRI brain revealed features of PRES. The authors encountered certain challenges in her management which included persistent hypokalaemia, hypocalcaemia and hypotension. Patient is on regular follow-up and she is currently asymptomatic. Prompt diagnosis of PRES and intensive case treatment is a must for the betterment of prognosis.

A RARE CAUSE OF ENCEPHALOPATHY IN CHILDREN: PRES SYNDROME

Background: Major clinical symptoms of posterior reversible encephalopathy syndrome include headache, mental status changes, visual disturbances, seizures, especially in the posterior cerebral region, and radiographic findings of vasogenic edema, especially in the posterior cerebellar region. Case Report: We present our 6-year-old patient with chronic renal failure. admitted to our pediatric emergency department with an acute hypertensive crisis. Generalized tonic-clonic seizures and mental status changes were accompanied in the follow-up of the patient whose GCS was 11; With symptomatic treatment, regression in both clinical complaints and imaging findings of our patient is consistent with Posterior reversible encephalopathy syndrome (PRES). Conclusion: It is imperative to consider PRES syndrome as a differential diagnosis when pediatric patients exhibit symptoms of acute encephalopathy. It is crucial to emphasize the critical nature of early diagnosis and treatment, as well as the potential for complete recovery without sequelae.

Distinguishing Between Preeclampsia and Dural Puncture Headaches in a Postpartum Patient: A Challenging Diagnosis

This case report highlights the diagnostic challenges in distinguishing between postpartum headaches caused by preeclampsia and those caused by a suspected dural puncture in a patient with both conditions. The patient had a history of preeclampsia, was well-controlled with labetalol, and received epidural anesthesia using the Tuohy needle during labor. Six hours after delivery, she reported postural headaches, neck tension, and tinnitus, typical symptoms of dural puncture headaches. However, the patient eventually experienced a generalized tonic-clonic seizure and was diagnosed with posterior reversible encephalopathy syndrome and intracranial hypotension. This case highlights the importance of considering multiple underlying factors when analyzing postpartum headaches and the need for prompt and appropriate management to prevent potentially life-threatening complications.

Cocaine induced PRES – A 25-year-old woman with reversible vision loss

Drug abuse is a frequent cause of stroke in the young adults. The more commonly associated drugs with stroke are cocaine, heroin, and psychotomimetic drugs as cannabis, etc., Cocaine is reported more commonly to be associated with ischemic as well as hemorrhagic stroke, though association with posterior reversible encephalopathy syndrome (PRES) like presentation is very uncommon as seen in our patient. She was a young lady who presented to us with headache, seizure, and vision loss after consuming cocaine.

Posterior Reversible Encephalopathy Syndrome (PRES) and Low Serum Magnesium in Cesarean Delivery: Causative Factor or Coincidence in the Absence of Previous Co-morbidities?

Posterior Reversible Encephalopathy Syndrome (PRES) and Low Serum Magnesium in Cesarean Delivery: Causative Factor or Coincidence in the Absence of Previous Co-morbidities?

Case Report: AMSAN variant of GBS complicating immediate postpartum period with severe dysautonomia leading to Posterior Reversible Encephalopathy Syndrome

Case Report: AMSAN variant of GBS complicating immediate postpartum period with severe dysautonomia leading to Posterior Reversible Encephalopathy Syndrome

Chemotherapy-induced posterior reversible encephalopathy syndrome in an adolescent patient with acute lymphoblastic leukemia – A case report

Chemotherapy-induced posterior reversible encephalopathy syndrome in an adolescent patient with acute lymphoblastic leukemia – A case report

Update on the efficiency and safety of orally administered nasal decongestants

Nasal congestion leading to obstruction is one of the main symptoms in acute rhinosinusitis (common cold), other upper respiratory infections and allergic rhinitis. The EPOS 2020 guidelines place oral decongestants as an efficient therapy for the relief of nasal obstruction. In Romania, there are more than 50 available nasal decongestants, so it is very important for practitioners from all medical domains to be aware of recent data regarding their effectiveness and safety profile. Recent concerns raised by both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) regarding the efficacy and safety of pseudoephedrine (PSE) and phenylephrine (PHE) emphasize the need for informed decision-making in prescribing. Notably, there were concerns raised about the association between PSE, reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES). EMA’s safety committee, Pharmacovigilance Risk Assessment Committee (PRAC), recently recommended measures to minimize risks of serious side effects when using medicines containing PSE. PRAC recommends that medicines containing PSE should not be used in patients with severe or uncontrolled hypertension and severe acute or chronic kidney disease or failure. Additionally, PRAC recommends healthcare professionals to counsel patients to discontinue the use of such medicines promptly and seek medical assistance if they experience symptoms suggesting PRES or RCVS, such as sudden onset of severe headache, confusion, vomiting, visual disturbances or seizures. While effectiveness of oral PSE is confirmed by clinical studies, expert consensus is unfavorable to PHE. Both in vitro and in vivo clinical pharmacology data indicate that neither the recommended doses nor higher doses of oral PHE demonstrate efficacy in alleviating symptoms of nasal congestion.

Posterior Reversible Encephalopathy Syndrome Associated with Late onset Eclampsia: A Case Report

We describe a case of 25 year old women who had full term pregnancy, presented with symptoms of headache, loss of vision and seizure episodes after 7th postpartum day. There were no findings of pre-eclampsia in antenatal stage. The diagnosis of posterior reversible encephalopathy syndrome was made after magnetic resonance imaging. Imaging findings include vasogenic edema of bilateral occipital lobe and parietal lobe. Hypertension and endothelial injury seems to be involved in pathophysiology of the syndrome. After appropriate management, the syndrome resolved. Early diagnosis and proper treatment plays a key role in management of posterior reversible encephalopathy syndrome.

Prosopagnosia: face blindness and its association with neurological disorders.

Loss of facial recognition or prosopagnosia has been well-recognized for over a century. It has been categorized as developmental or acquired depending on whether the onset is in early childhood or beyond, and acquired cases can have degenerative or non-degenerative aetiologies. Prosopagnosia has been linked to involvement of the fusiform gyri, mainly in the right hemisphere. The literature on prosopagnosia comprises case reports and small case series. We aim to assess demographic, clinical and imaging characteristics and neurological and neuropathological disorders associated with a diagnosis of prosopagnosia in a large cohort. Patients were categorized as developmental versus acquired; those with acquired prosopagnosia were further subdivided into degenerative versus non-degenerative, based on neurological aetiology. We assessed regional involvement on [18F] fluorodeoxyglucose-PET and MRI of the right and left frontal, temporal, parietal and occipital lobes. The Intake and Referral Center at the Mayo Clinic identified 487 patients with possible prosopagnosia, of which 336 met study criteria for probable or definite prosopagnosia. Ten patients, 80.0% male, had developmental prosopagnosia including one with Niemann-Pick type C and another with a forkhead box G1 gene mutation. Of the 326 with acquired prosopagnosia, 235 (72.1%) were categorized as degenerative, 91 (27.9%) as non-degenerative. The most common degenerative diagnoses were posterior cortical atrophy, primary prosopagnosia syndrome, Alzheimer's disease dementia and semantic dementia, with each diagnosis accounting for >10% of this group. The most common non-degenerative diagnoses were infarcts (ischaemic and haemorrhagic), epilepsy-related and primary brain tumours, each accounting for >10%. We identified a group of patients with non-degenerative transient prosopagnosia in which facial recognition loss improved or resolved over time. These patients had migraine-related prosopagnosia, posterior reversible encephalopathy syndrome, delirium, hypoxic encephalopathy and ischaemic infarcts. On [18F] fluorodeoxyglucose-PET, the temporal lobes proved to be the most frequently affected regions in 117 patients with degenerative prosopagnosia, while in 82 patients with non-degenerative prosopagnosia, MRI revealed the right temporal and right occipital lobes as most affected by a focal lesion. The most common pathological findings in those with degenerative prosopagnosia were frontotemporal lobar degeneration with hippocampal sclerosis and mixed Alzheimer's and Lewy body disease pathology. In this large case series of patients diagnosed with prosopagnosia, we observed that facial recognition loss occurs across a wide range of acquired degenerative and non-degenerative neurological disorders, most commonly in males with developmental prosopagnosia. The right temporal and occipital lobes, and connecting fusiform gyrus, are key areas. Multiple different pathologies cause degenerative prosopagnosia.

Severe Posterior Reversible Encephalopathy Syndrome Secondary to Hyponatremia in a Patient with Water Intoxication.

Severe Posterior Reversible Encephalopathy Syndrome Secondary to Hyponatremia in a Patient with Water Intoxication.

A rare presentation of unilateral posterior reversible encephalopathy syndrome following a trivial head trauma

AbstractPosterior reversible encephalopathy syndrome is typically a reversible clinico‐radiological entity associated with some specific features on brain imaging. However, there are several atypical radiological presentations. Unilateral presentation of this condition has rarely been reported in past and may mimic other pathologies. Here, we report a very rare case of atypical, unilateral posterior reversible encephalopathy syndrome in a 25‐year‐old female following a trivial head injury. All other relevant secondary causes had been ruled out.

Patterns and Outcomes of Acute Central Nervous System Complications During Treatment of Childhood Acute Lymphoblastic Leukemia: A Single-center Experience.

Central nervous system (CNS) complications are considered adverse events during the treatment of pediatric acute lymphoblastic leukemia (ALL). This study aimed to assess the incidence, types, clinical and radiologic patterns, risk factors, and the fate of different CNS complications during the treatment of pediatric ALL. A retrospective study included 390 patients with pediatric ALL, treated according to St. Jude total XV protocol at the National Cancer Institute, Cairo University, from January 2012 to December 2017. Thirty-nine (10%) patients developed different types of CNS complications. Nineteen (4.9%) patients had cerebrovascular complications, 12 (3.1%) patients had posterior reversible encephalopathy syndrome (PRES), and 6 (1.5%) patients had leukoencephalopathy; both CNS infections and leukemic infiltrates were diagnosed in one patient each. CNS complications were significantly higher in patients older than 10 years old, patients with high-risk disease, and patients who were classified as CNS III status with a statistically significant P value of 0.040, 0.020, and 0.002, respectively. There were 31 (79.5%) cases that achieved complete recovery, 6 (15.4%) patients who died, and 2 (5.1%) patients who developed residual neurological deficits. In conclusion, pediatric patients with ALL, who presented with older age, high-risk disease initially, and had initial CNS III status, were at higher risk of developing acute CNS complications during their treatment period. Patients who developed visual disturbances were associated with unfavorable outcomes. Despite that, around 80% of patients showed complete recovery, but still, 15% of them died from these complications.

Experimental Models of Posterior Reversible Encephalopathy Syndrome: A Review From Pathophysiology to Therapeutic Targets.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized by nonspecific symptomatology (eg, headache, visual disturbances, encephalopathy, and seizures) and classically cortical and subcortical vasogenic edema predominantly affecting the parietooccipital region. PRES etiologies are usually dichotomized into toxic PRES (eg, antineoplastic drugs, illicit drugs) and clinical condition-associated PRES (eg, acute hypertension, dysimmune disorders). Although the pathophysiology of PRES remains elusive, 2 main pathogenic hypotheses have been suggested: cerebral hyperperfusion due to acute hypertension and cerebral hypoperfusion related to endothelial dysfunction. Research into the pathogenesis of PRES has emerged through the development of animal models in the last decade. The motivation for developing a suitable PRES model is 2-fold: to fill in knowledge gaps of the pathophysiological mechanisms involved, and to open new perspectives for clinical assessment of pharmacological targets to improve therapeutic management of PRES. All current models of PRES have a hypertensive background, on which other triggers (acute hypertension, inflammatory, drug toxicity) have been added to address specific facets of PRES (eg, seizures). The initial model consisted in inducing a reduced uterine perfusion pressure that mimics preeclampsia, a leading cause of PRES. More recently, a model of stroke-prone spontaneously hypertensive rats on high-salt diet, originally developed for hypertensive small vessel disease and vascular cognitive impairment, has been studied in PRES. This review aims to discuss, depending on the research objective, the benefits and limitations of current experimental approaches and thus to define the desirable characteristics for studying the pathophysiology of PRES and developing new therapies.

Recurrent exercise-induced acute kidney injury associated with hypouricemia: a case report and literature review

BackgroundHereditary renal hypouricemia (RHUC) is a heterogenous disorder characterized by defective uric acid (UA) reabsorption resulting in hypouricemia and increased fractional excretion of UA. RHUC is an important cause of exercise-induced acute kidney injury (EIAKI), nephrolithiasis and posterior reversible encephalopathy syndrome (PRES). We present here an unusual case of a patient with RHUC who presented with recurrent EIAKI and had two heterozygous mutations in the SLC2A9 gene.Case presentationA 43-year old man was admitted to our clinic because of bilateral loin pain, nausea and sleeplessness for 3 days after strenuous exercise. The laboratory results revealed increased levels of blood urea nitrogen (BUN) (15 mmol/l) and serum creatinine (Scr) (450 μmol/l), while the UA level was extremely low at 0.54 mg/dl, and his fractional excretion of urate (FE-UA) was 108%. The patient had an episode of acute kidney injury after playing soccer approximately 20 years ago, and on routine physical examination, his UA was less than 0.50 mg/dl. In view of the marked hypouricemia and high FE-UA, a diagnosis of RHUC was suspected, which led us to perform mutational screening of the SLC22A12 and SLC2A9 genes. DNA sequencing revealed no mutation in SLC22A12 gene, but two heterozygous mutations in the SLC2A9 gene.ConclusionsThis is a rare report of a patient with RHUC2 due to the mutation of SLC2A9. And this unique symptom of EIAKI and decreased or normal serum concentrations of UA warrant more attention as an early cue of RHUC.

The Association of Hypertension With Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus Patients: A Systematic Review.

Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is a rare disorder that most commonly affects the posterior part of the brain. Two common causes of PRES are hypertension and autoimmune diseases such as systemic lupus erythematosus (SLE). This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations and aimed at finding the association between hypertension and PRES in SLE patients. We searched medical databases such as PubMed, PubMed Central(PMC), Cochrane Library, and Multidisciplinary Digital Publishing Institute (MDPI) for relevant medical literature. The identified papers were screened, subjected to inclusion and exclusion criteria, and ran through quality appraisal tools, after which 16 papers were finalized. The finalized papers explored the roles of hypertension in SLE patients diagnosed with PRES. In this review, we identified a link between hypertension and PRES-SLE patients. We aimed to explain the role of hypertension in the development of PRES in SLE patients. This study also explains the different treatment modalities to be used for treating the patients presenting with PRES and differentiates other neuropsychiatric illnesses commonly present in SLE patients from PRES. It's important to make an accurate clinical diagnosis by understanding the clinical features and neuroimaging results of PRES for future care since it may even be incurable in some circumstances.

Posterior reversible encephalopathy syndrome and stem cell transplantation in sickle cell disease: Case series and literature review

Posterior reversible encephalopathy syndrome and stem cell transplantation in sickle cell disease: Case series and literature review

COVID-19 and Brain complications in adult and pediatric patients: A review on neuroimaging findings

In this review, we will discuss the neuroimaging findings of patients with COVID-19 from the outbreak (late December 2019) to the end of October 2021. PubMed, Scopus, Google Scholar, Science Direct, ProQuest, Web of Science and the World Health Organization database (January 01, 2020, to October 30, 2021) were searched for related published articles. In each of the databases, the appendix search strategies were performed and the below keywords were used: COVID-19”OR“coronavirus disease 2019” AND “brain MRI” OR “brain magnetic resonance imaging” OR “brain CT” OR “neuroimaging”. In total, neuroimaging findings of 1550 patients, with ages from 1-96 years, were analyzed. Most brain neuroimaging findings include hyperintensity, Cerebral venous thrombosis, intraventricular and subarachnoid hemorrhage, infarction, leukoencephalopathy, acute ischemic strokes and posterior reversible encephalopathy syndrome (PRES) in adult patients and severe encephalopathy, stroke, infarction, CNS infection/demyelination, neuritis or polyradiculitis, venous thrombosis, Guillain-Barré syndrome, and longitudinally extensive myelitis, and myositis in pediatric patients. Our findings showed that the most important complication of the coronavirus is not just respiratory complications, because although transiently, COVID-19-related brain complications are seen in pediatrics as well as adults, and families should pay more attention to health care.

Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era

Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era

Evaluation of inpatients neurology consultations in the department of gynecology, obstetrics, and reproductive medicine of a tertiary hospital in Turkey

Background & Objective: It is important to be aware of hormonal changes in neurological disease in neurology training. We aimed to investigate the most common disorders which resulted in the clinicians from the Department of Gynecology, Obstetrics, and Reproductive Medicine (GORM) to ask for neurology consultation from the Department of Neurology. Methods: All the neurology consultations requested from the Department of GORM between 2015 and 2023 at Harran University Hospital, Sanliurfa, Turkey, were retrospectively evaluated with regard to demographic characteristics, the reason for referral, neurologic diagnoses, and treatment, imaging features. SPSS statistical software version 22 (IBM Inc. NC, USA) was used to perform all statistical analyses. Results: There were 333 patients with a mean age of 32.5 years (range 17-68) seeking consultations; 287 had obstetric problems, and 46 had gynecological issues. In the obstetric group, pre-eclampsia and Posterior Reversible Encephalopathy Syndrome (PRES) were the most frequent final neurological diagnoses, while headache and acute cerebrovascular disease were the most common frequent problems in the gynecological group. The number of consultations rose from 23 in 2015 to 66 in 2022. The predicted rate of final diagnosis of GORM residents was 58%. The neurologist’s contribution has substantial influence on the management of 208 (62%) patients. Conclusion: Neurologists have a significant contribution to the management of GORM inpatients. In neurological training, importance should be given to the effect of hormonal changes on neurological diseases in neurology training.