Posterior Reversible Encephalopathy Research Articles

Obstructive Hydrocephalus Requiring Emergent EVD in Patient with Posterior Reversible Encephalopathy; A Case Report and Review of Literature (P2-2.006)

Obstructive Hydrocephalus Requiring Emergent EVD in Patient with Posterior Reversible Encephalopathy; A Case Report and Review of Literature (P2-2.006)

Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH-UP Criteria.

Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy-associated ICH (P-ICH), compared with ICH in similar aged nonpregnant adults of both sexes. We performed a retrospective analysis of 134 adults aged 18 to 44 years admitted to our center with nontraumatic ICH from January 1, 2012, to December 31, 2021. We compared ICH characteristics among 3 groups: those with P-ICH (pregnant or within 12 months of end of pregnancy); nonpregnant women; and men. We categorized ICH pathogenesis according to a modified scheme, SMASH-UP (structural, medications, amyloid angiopathy, systemic, hypertension, undetermined, posterior reversible encephalopathy syndrome/reversible cerebral vasoconstriction syndrome), and calculated odds ratios and 95% CIs for primary (spontaneous small-vessel) ICH versus secondary ICH (structural lesions or coagulopathy related), using nonpregnant women as the reference. We also compared specific ICH pathogenesis by SMASH-UP criteria and functional outcomes between groups. Of 134 young adults with nontraumatic ICH, 25 (19%) had P-ICH, of which 60% occurred postpartum. Those with P-ICH had higher odds of primary ICH compared with nonpregnant women (adjusted odds ratio, 4.5 [95% CI, 1.4-14.7]). The odds of primary ICH did not differ between men and nonpregnant women. SMASH-UP pathogenesis for ICH differed significantly between groups (P<0.001). While the in-hospital mortality rate was lowest in the P-ICH group (4%) compared with nonpregnant women (13%) and men (24%), 1 in 4 patients with P-ICH were bedbound and dependent at the time of discharge. In our cohort of young adults with ICH, 1 in 5 was pregnancy related. P-ICH differed in pathogenesis compared with non-pregnancy-related ICH in young adults, suggesting unique pathophysiology.

Newly identified adverse events for gemcitabine using the Food and Drug Administration Adverse Event Reporting System

ABSTRACT Background Our research aimed to identify previously undocumented adverse events (AEs) in the gemcitabine drug insert with the goal of informing clinical practice. Methods We extracted adverse events associated with gemcitabine use through 2023 using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Four algorithms (Reporting Odds Ratio, Proportional Reporting Ratio, Bayesian Confidence Propagation Neural Network, and Empirical Bayesian Geometric Mean) were employed to detect new AE signals. AEs were considered positive signals only if they were detected by all four algorithms. Results From 2014 to 2023, a total of 42,360 AEs were reported in 14,905 individuals following gemcitabine use. These AEs totaled 437 preferred terms (PTs) across 20 system organ classes (SOCs). We identified unexpected AEs related to the ocular disorders, the nervous system, and the ear and the labyrinth. The ocular organ system will present with retinopathy, purtscher retinopathy, choroidal effusion, amaurosis, necrotizing scleritis, etc. The nervous system may experience reversible posterior encephalopathy syndrome, cerebellar syndrome, cauda equina syndrome, athetosis, transverse myelitis, etc. The ears and labyrinth may exhibit ototoxicity. Conclusion Our study identified previously undetected signals following gemcitabine treatment, thereby providing new insights for future medication guidance.

NCMP-22. FLUDARABINE NEUROTOXICITY IN PATIENTS UNDERGOING CAR T-CELL THERAPY - A REPORT OF 2 CASES

Abstract Fludarabine is a purine analog used in the treatment of chronic lymphocytic leukemia (CLL) and as part of immunosuppressive/lymphodepleting regimens in allogeneic stem cell transplant and chimeric antigen receptor (CAR) T-cell therapy. It induces cellular cytotoxicity through multiple mechanisms, ultimately leading to the inhibition of DNA synthesis. Although myelosuppression is the primary dose-limiting side effect of fludarabine, there have been reported cases of delayed-onset neurological symptoms, such as progressive visual impairments, dementia, ataxia, hemiparesis, quadriparesis, and blindness. These symptoms have been observed in patients receiving fludarabine alone or as part of preconditioning treatments for CAR T-cell therapy. The neurological abnormalities are characterized by leukoencephalopathies and can manifest as posterior reversible encephalopathy (PRES), acute toxic leukoencephalopathy (ATL), or other leukoencephalopathy (OLE). We present two cases of patients who underwent fludarabine conditioning before CAR T-cell therapy, exhibiting late-onset and progressive changes in vision and encephalopathy. These symptoms differ in timing and pattern from the neurotoxicities commonly associated with CAR T-cell therapy. Nonetheless, given the overlapping neurological toxicities seen with both CAR-T cell therapy and fludarabine, it is important to consider implementing thorough screening measures to modify preconditioning fludarabine dose intensity, particularly for patients with advanced disease, renal insufficiency, or other risk factors to limit fludarabine-associated adverse effects.

Secondary headaches in pregnancy and the puerperium.

Headache during pregnancy can be due to primary causes such as migraine but can also be a presenting symptom of secondary causes including life threatening conditions. This is a minireview of secondary causes of headache during pregnancy and the puerperium. Unique alterations in physiological and vascular functions as well as in the coagulation pathway which occur during pregnancy increase the risk of most of these secondary conditions which include preeclampsia, eclampsia, hemorrhagic stroke, cerebral venous, sinus thrombosis, reversible cerebral vascular syndrome, and posterior reversible encephalopathy. Marked increase in progesterone level in pregnancy is also associated with the growth of tumors such as meningiomas, as 70% of these tumors are positive for progesterone receptors and increase in size can lead to headache along with other neurological symptoms. Hemodynamic changes can lead to the growth of meningiomas as well. Although hormone producing pituitary tumors are usually not conducing to pregnancy, women with known pituitary tumors who do get pregnant may become symptomatic during pregnancy and develop secondary headache. Another rare cause of secondary headache during pregnancy is pituitary apoplexy. Although its occurrence is uncommon, it needs to be properly recognized and treated to avoid endocrine and visual complications. Other rare entities with increased incidence during the puerperium such postdural puncture headache will be also discussed. In summary, new onset headache during pregnancy deserves special attention because in the absence of proper recognition and treatment, secondary headache disorders can endanger the life of the mother and the fetus.

Guillain-Barré Syndrome Complicated by Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome.

Guillain-Barré syndrome is an immune-mediated inflammatory polyneuritis characterised by rapidly progressive flaccid paralysis. Guillain-Barré syndrome may present with posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome in rare cases. A woman in her 60s with a history of follicular lymphoma presented with a one-week history of difficulty walking and thunderclap headaches. The patient was diagnosed with Guillain-Barré syndrome based on neurological examination, cerebrospinal fluid analysis and nerve conduction findings. Further diagnosis of posterior reversible encephalopathy and reversible cerebral vasoconstriction syndromes was based on imaging findings and headache history. The patient was treated with intravenous immunoglobulin and amlodipine, and symptoms improved. We reviewed the literature on Guillain-Barré syndrome associated with posterior reversible encephalopathy and/or reversible cerebral vasoconstriction syndrome. The underlying pathophysiology may involve dysautonomia resulting in unstable blood pressure, and hyponatraemia causing endothelial dysfunction. The SNOOP mnemonic highlights the 'red flags'. This SNOOP mnemonic suggests the possibility of secondary headaches that require imaging studies. In this case, the patient exhibited three SNOOP symptoms: S (history of malignancy: follicular lymphoma), O (sudden-onset headache) and O (over 50 years old). This case highlights the importance of considering coexisting central neurological disorders in patients with Guillain-Barré syndrome. Guillain-Barré syndrome (GBS) alone rarely causes headaches; therefore, when GBS patients complain of severe headaches, especially when the headache is associated with 'red flags', other complications and differential diagnosis should be considered.Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) can be triggered by GBS.Hyponatraemia, age over 50 years and female gender may be risk factors for developing PRES and RCVS in GBS patients.

Cerebrovascular Pathologies in Women during Pregnancy and Postpartum In the Neurology Departments of the Yalgado Ouédraogo and Bogodogo University Hospitals

Introduction: Pregnancy and post-partum are periods of risk for cerebrovascular complications in women. These pathologies can affect the vital prognosis of the woman. Objectives: To describe the determinants of cerebrovascular pathologies during pregnancy and postpartum in the neurology departments of the CHU-YO and CHU-B. Method: This was a descriptive cross-sectional study collected retrospectively over a period from January 1, 2019 to December 31, 2021. Results: We included 113 patients, mean age 23.35 years with extremes of 15 and 45 years. Eclampsia predominated in 64.60% of cases. Other etiologies were stroke (18.58%), cerebral venous thrombosis (11.51%), reversible posterior encephalopathy syndrome (3.54%) and reversible cerebral vasoconstriction syndrome (1.77%). Factors associated with the occurrence of cerebrovascular pathology were young age [15-19 years] (p=0.001), high blood pressure (p=0.001). The mortality rate was 8.85%. Conclusion: Cerebrovascular pathologies during pregnancy and postpartum with regard to their morbidity and mortality constitute a reproductive health problem and therefore require a multidisciplinary approach.

Reversible Posterior Encephalopathy Syndrome Secondary to Post-Streptococcal Acute Glomerulonephritis in a Child: About an Unusual Case Report and Review of Literature Oumou Maïga, Marwa El Massi, Moussa Coulibaly, Soumia Mghar, Karima El Fakiri, Nouredine Rada, Ghizlane Draiss, Dounia Basraoui, Mohamed Bouskraoui Published: May 6, 2023 | 7 5 DOI: 10.36347/sasjm.2023.v09i05.007 Pages: 434-426 Downloads Abstract Reversible posterior encephalopathy (PRES) is a

Reversible posterior encephalopathy (PRES) is a clinico-radiological syndrome, which manifests as headaches, confusion, visual disturbances, convulsive seizures and radiological abnormalities of the white substance suggesting oedema of the posterior parieto occipital brain regions. It is a poorly known and very rare disease in children. In a 10-year-old boy with an untreated 15-day history of angina, he presents for headaches, associated with vomiting, or even photophobia-type visual disorders and earache-type otalgia and phonophobia, a disorder of conscience of more than 24 hours without the notion of convulsions and a hematuria in broth dirty. All associated with functional impotent of the lower limbs and meningeal syndrome. Cerebral MRI showed a signal abnormality in cortical subcortical range visible in bilateral parieto-occipital, T2 hypersignal and flair with discrete under cortical restriction of diffusion and not raised after injection. We are bringing a case of reversible posterior encephalopathy secondary to acute glomerulonephritis post-streptococcal associated with a meningeal syndrome that could likely be related to germless bacterial meningitis or meningeal hemorrhage. Early detection and prompt treatment are important measures to reduce morbidity and mortality.

Posterior Reversible Encephalopathy after Scorpion Envenomation, Two Cases with Review of the Literature

Posterior reversible encephalopathy (PRES) is a clinico radiological syndrome, which manifests itself by headaches, confusion, consciousness disorders or during a sudden rise in blood pressure but can be seen in other circumstances, such as during an immune reaction or a systemic infection. Its mechanism is explained by a lesion of the blood-brain barrier leading to a reversible vasogenic edema. The scarcity of sympathetic innervation of the posterior cerebral territories explains its usual localization. We report two cases of a 5 and 18 years old girl who presented with tonic-clonic seizures following a scorpion bite. An emergency brain MRI was performed, showing bilateral signal abnormalities of the posterior cortico-subcortical territories and basal ganglia, compatible with an atypical PRES syndrome. The diagnosis of PRES syndrome complicating a scorpion bite was retained.

Porphyria-induced Postpartum Reversible Posterior Encephalopathy Syndrome

Acute intermittent porphyria (AIP) is a rare condition that needs to be kept in mind where its early recognition, conservative management, and removal of the precipitating factor are the key factors in its management. This “little imitator” presented with varied symptoms is often misdiagnosed. The diagnosis requires a strong index of suspicion as choosing an antiepileptic medication in the management of seizure requires a judicial choice to avoid precipitation of the underlying illness.How to cite this article: Sharma SR, Sharma N, Synmon B, Hynniewtaya Y. Porphyria-induced Postpartum Reversible Posterior Encephalopathy Syndrome. Indian J Crit Care Med 2022;26(6):728–730.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: DIVERSE ETIOLOGIES

Objective: Posterior Reversible Encephalopathy, called PRES, is a clinico-radiological entity individualized for the first time in 1996 as a special form of hypertensive encephalopathy. Design and method: We collected retrospectively 8 cases of PRES Syndrome either on-specific or followed in Internal Medicine service. All patients had a confirmed diagnosis by brain MRI. Results: There were 5 women and 3 men, mean age was 30 years (range 16–66 years). Three patients had a past history of arterial hypertension. Two patients had moderate chronic renal failure, three had a chronic renal failure on hemodialysis, one had normal renal function and the two others were transplanted. Hypertension with diastolic blood pressure greater than 120 mmHg was noted in two patients. For the others, it was an acute and sudden increase of blood pressure usually well balanced. Neurological manifestations are on-specific, such as confusion, a prolonged critical post coma or seizure initially focal (Braved-Jacksonian) limited to brain lobe affected by the PRES which become generalized secondarily. All patients had seizures, one presented a status epilepticus. They all underwent magnetic resonance imaging (MRI). Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Involvement of the white matter is constant. To equilibrate the systemic blood pressure, we used calcium channel blockers in all cases (nicardipine in the electric syringe pump in one case). The therapeutic goal was to maintain a mean arterial pressure between 105 and 125 mmHg. Conclusions: PRES is highly diverse in terms of etiologies. Our series is particular by the large number of cases of PRES compared to the literature but especially by the diversity of the etiologies of PRES. All our patients had chronic renal failure and / or underlying nephropathy.

Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures.

ObjectiveIn order to analyze the clinical characteristics of epileptic seizures in children with acute lymphoblastic leukemia (ALL) during treatment.MethodsThe clinical and imaging data of children diagnosed as ALL with epilepsy seizures from January 2013 to December 2020 were retrospectively analyzed.ResultsA total of 2217 children with ALL were admitted during the study, of whom 229 (10.33%) had epileptic seizures after ALL treatment. Among them, 45 (19.65%) were in the high-risk group and 184 (80.35%) were in the low-risk group. Epileptic seizures mainly occurred in the induction remission period (24.02%), maintenance treatment period (25.33%) and after bone marrow transplantation (21.40%). The common causes were MTX-related demyelinating encephalopathy (34.06%) and reversible posterior encephalopathy syndrome (PRES) (25.3%). The first symptom was mainly convulsion (34.50%). The first attack had a comprehensive attack and partial attack. Most patients stop themselves. 30 cases (13.10%) had acute recurrence of epilepsy (recurrence within 3 months after the first attack), and 49 cases (25.76%) had neurological dysfunction after follow-up. 36 cases developed symptomatic epilepsy. Among the 130 children who completed the follow-up, 78 (60.00%) had no obvious neurological sequelae, and 52 (40.0%) had neurological sequelae. Among the 52 cases, there were 34 cases of mild sequelae and 18 cases of severe sequelae, including 8 cases of epilepsy combined with cognitive impairment.ConclusionEpileptic seizure is a common neurological complication during ALL treatment. The etiology and associated manifestations of the first epileptic seizure are diverse. Early neuroimaging and EEG examination are helpful for early diagnosis and treatment.

Risks and renal outcomes of severe acute kidney injury in children with steroid-resistant nephrotic syndrome.

Risks and renal outcomes of severe acute kidney injury (AKI) in children with steroid-resistant nephrotic syndrome (SRNS), particularly those who require dialysis, have not been fully explored. This retrospective cohort study enrolled children who had been diagnosed with idiopathic nephrotic syndrome at the National Center for Child Health and Development between March 2002 and December 2018. Children with steroid-sensitive nephrotic syndrome or SRNS-related gene mutations were excluded. Sixty-two children with SRNS (37 boys; median age, 3.6years [interquartile range (IQR) 2.0-10.3]) were enrolled. Sixteen patients (25.8%) had severe AKI, including nine patients (14.5%) who received dialysis. The period from nephrotic syndrome (NS) onset to partial remission (median [IQR]) was not significantly influenced by dialysis status, but tended to be longer in the dialysis group (125days [74-225] vs. 40days [28-113]; p = 0.09); notably, no patient developed chronic kidney disease during the follow-up period. Infection and posterior reversible encephalopathy (PRES) were significantly associated with AKI. Patients with AKI tended to require dialysis in the presence of infection, undergo treatment with cyclosporine A, and have PRES. The period from onset of NS to AKI was significantly longer in the dialysis group (26days [15.5-46.0] vs. 4days [0.0-14.0]; p = 0.01). Dialysis was commonly required among children with SRNS who exhibited severe AKI. The period from onset of NS to partial remission tended to be longer in patients receiving dialysis, whereas renal prognosis was satisfactory during subsequent follow-up.

Adult-onset Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Induced by MRSA Endocarditis.

BackgroundMild encephalitis/encephalopathy and a reversible splenial lesion (MERS) is a clinicoradiological syndrome with an unknown pathogenic mechanism, which usually involves children. Thus, adult-onset MERS is quite rare.Case presentationA 71-year-old man, undergoing haemodialysis due to diabetes-induced chronic kidney disease, manifested a persistent fever and disorientation. Blood culture detected methicillin-resistant Staphylococcus aureus (MRSA), while echocardiography revealed vegetation in the aortic and mitral valves. Magnetic resonance imaging of the head revealed a fluid-attenuated inversion recovery-high, diffusion-weighted image-high lesion in the splenium of the corpus callosum, with a number of emboli. Accordingly, the patient was diagnosed with MERS induced by MRSA endocarditis.DiscussionNeurological impairment by MERS can be reversible. However, the differential diagnosis of the disease includes ischaemic lesions, multiple sclerosis, malignant lymphoma, acute disseminated encephalomyelitis, and posterior reversible encephalopathy. Clinicians should consider these diseases when MERS is suspected.LEARNING POINTSAdult-onset mild encephalitis/encephalopathy and a reversible splenial lesion (MERS) is quite rare, and physicians should be aware of it as a differential diagnosis of a diffusion-weighted image-high lesion in the splenium of the corpus callosum.Methicillin-resistant Staphylococcus aureus (MRSA) has rarely been reported as a triggering factor for MERS.

Cerebral Diseases in Liver Transplant Recipients: Systematic Review of Clinical Evidence.

This systematic review presents clinical evidence on early and long-term cerebral diseases in liver transplant recipients. The literature search led to the retrieval of 12 relevant studies. Early postoperative cerebral complications include intracranial hemorrhage associated with a coexisting coagulopathy, perioperative hypertension, and higher MELD scores and is more frequent in critically ill recipients; central pontine and extrapontine myelinolysis are associated with notable perioperative changes in the plasma Na+ concentration and massive transfusion. Long-term follow-up cerebral complications include focal brain lesions, cerebrovascular diseases, and posterior reversible encephalopathy; there is no proven relationship between the toxicity immunosuppressive drugs and cerebral complications. This SR confirms a very low incidence of opportunistic cerebral infections.

Neurological Manifestations and Mortality in Hospitalized Coronavirus Disease 2019 Patients

Purpose: The purpose of the study is to analyze the neurological manifestations and to determine the association between these symptoms and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods: Five hundred and forty-seven hospitalized patients with positive reverse transcriptase-polymerase chain reaction tests for severe acute respiratory syndrome coronavirus in a nasopharyngeal swab were included in this study. The demographic features, laboratory data, and radiologic imaging, neurological symptoms of hospitalized patients with COVID-19 were collected. Results: Of 547 hospitalized COVID-19 patients, the median age was 61 (range 18–93), 61.4% were male. Three hundred and forty-seven (63.4%) patients had a severe infection and 200 (36.6%) patients had a mild infection. Eighty-eight patients (16.1%) died during hospitalization. One hundred and fifty-four (28.2%) patients had at least one neurological symptom. Thirty-five (6.4%) patients manifested with only neurological symptoms at hospital admission. The most frequent neurological symptoms were headache (15.2%), taste and smell disorders (9.1%), and myalgia (6.6%). The other initial neurological manifestations were acute cerebral ischemic stroke, impaired consciousness, epileptic seizure, and posterior reversible encephalopathy. The late-onset neurological complications were autoimmune encephalitis and Guillain-Barre syndrome. The neurological manifestation was linked to the severity of disease (P = 0.005) but not correlated with mortality (P = 0.137). Conclusion: Neurological symptoms were frequent in COVID-19 patients. The neurological symptoms can be the initial symptoms or can be late-onset complications of COVID-19.

Posterior Reversible Encephalopathy in Opiate Toxicity

Posterior Reversible Encephalopathy in Opiate Toxicity

Posterior reversible encephalopathy syndrome in spotted fever group of rickettsial infection with brugada syndrome

Rickettsioses are one of the common causes of undifferentiated febrile illness. Patients present commonly with fever, rash, and eschar. Posterior Reversible Encephalopathy Syndrome (PRES) also known as reversible posterior encephalopathy syndrome is a rare condition, in which parts of the brain are affected by swelling as a result of an underlying cause such as infection. However, PRES caused by spotted fever group of rickettsiosis is rarely reported. We are here with reporting such a case. A 55-year-old male was admitted to MVJ Medical College and Research Hospital, Bengaluru, with complaints of fever for 3 days and one episode of Generalized Tonic Clonic Seizures (GTCS) following which he was in altered sensorium. On examination, there was hepatosplenomegaly. Weil-Felix OX19 and OX2 were 1:320. Lumbar puncture was done which showed 15 cells 98% lymphocytes and 2% neutrophils, proteins-119 mg/dl, and sugar- 153 mg/dl. Magnetic resonance imaging of the brain showed bilateral symmetric hyperintensities on T2-weighted imaging in the parietal and occipital lobes. The calcarine and occipital lobes were spared suggestive of posterior reversible encephalopathy syndrome. Electrocardiogram showed ST elevation in V1 and V2 along with T-wave inversion (Brugada sign). Posterior reversible encephalopathy syndrome is usually commonly seen in hypertensive encephalopathy and in infections such as dengue and few cases of scrub typhus. This is one of the rare cases where spotted fever group of rickettsia has caused posterior reversible encephalopathy syndrome and Brugada syndrome.

Reversible posterior encephalopathy syndrome on malignant hypertension secondary to congenital nephrotic syndrome (case report)

Posterior reversible encephalopathy syndrome (PRES) is a fairly rare complication, and even more so in children. Cerebral magnetic resonance imaging (MRI) is considered the reference examination to evoke this diagnosis. We report the case of a 7-year-old boy presenting with a reversible posterior encephalopathy syndrome secondary to malignant arterial hypertension complicating CKD on congenital nephropathy, which presented with a tonic-clonic seizure and loss of consciousness, with a BP of 190/130mmHg in an apyretic context . Imaging revealed characteristic edema of the white and gray matter in the form of multiple areas of T2 hyper signal and cortico-subcortical cortical temporo-occipital and frontal, of the caudate nucleus and bilateral lenticulars, of the brain stem and cerebellum in relation to the PRES given the clinico radiological context. The course of action was hospitalization in intensive care with stabilization and conditioning, and was put on antihypertensive and anticonvulsant drugs A rigorous monitoring was required in our patient and the evolution was very favorable.

Reversible posterior encephalopathy syndrome in three cases

Reversible posterior encephalopathy is a rare entity whose diagnosis is radio clinical, often it’s associating with headaches, confusion, nausea, convulsions and visual abnormalities; occurring in an acute or subacute manner and often reversible.