Presentation Of Posterior Reversible Encephalopathy Syndrome Research Articles

A Unique Case of Posterior Reversible Encephalopathy Syndrome Presenting With a Cranial Nerve 3 Palsy, a Bacillary Layer Retinal Detachment, and Bilateral Serous Retinal Detachments.

A Unique Case of Posterior Reversible Encephalopathy Syndrome Presenting With a Cranial Nerve 3 Palsy, a Bacillary Layer Retinal Detachment, and Bilateral Serous Retinal Detachments.

Posterior Reversible Encephalopathy Syndrome presenting in late postpartum eclampsia challenging differential diagnosis

Posterior Reversible Encephalopathy Syndrome presenting in late postpartum eclampsia challenging differential diagnosis

Posterior Reversible Encephalopathy Syndrome (PRES) Associated With COVID-19 Infection—A Case Report and Review

Coronavirus disease 2019 (COVID-19) has caused a large number of systemic complications including a variety of neurological complications. Some of the neurological complications are not known. Posterior reversible encephalopathy syndrome (PRES) is a known acute neurotoxic syndrome causing a wide range of neurological symptoms. If remains untreated, it can potentially become a life-threatening condition. However, it is not a known neurological complication of COVID-19. We describe a presentation of PRES in a patient with positive COVID-19 and presented with altered mental status. A 78-year-old male with history of idiopathic epilepsy was initially admitted with respiratory illness with negative COVID-19 test. Later during his hospitalization, his respiratory condition got worse and his repeat COVID-19 test came back positive. He had continued encephalopathy and was found to have status epilepticus afterward. Magnetic Resonance Imaging brain showed extensive PRES-related changes. His blood pressure remained overall within control without significant fluctuations. No other apparent etiology was identified for PRES except for possible correlation with COVID-19. Clinicians should consider PRES early in their differential diagnoses in patients with severe COVID-19 with continued encephalopathy.

Posterior Reversible Encephalopathy Syndrome Presenting with Epilepsia Partialis Continua induced by Pseudo-hyperaldosteronism Secondary to Chronic Ingestion of Licorice (4746)

Posterior Reversible Encephalopathy Syndrome Presenting with Epilepsia Partialis Continua induced by Pseudo-hyperaldosteronism Secondary to Chronic Ingestion of Licorice (4746)

Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report

BackgroundTo report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES).Case presentationWe report a case of a 64-year-old male patient on tacrolimus treatment following LDLT. On day 11, during his post-operative routine follow-up. The patient developed sudden onset of left upper limb monoplegia associated with attacks of convulsions and sudden bilateral blindness. MRI revealed multiple, bilateral cortical, and subcortical areas of high T2 and FLAIR signal intensity that did not show restricted diffusion. Findings were suggestive of posterior reversible encephalopathy syndrome (PRES). After the cessation of tacrolimus, vision was completely regained and all other neurologic symptoms were resolved, and follow-up MRI was normal. This case represents an uncommon presentation of tacrolimus toxicity.ConclusionTacrolimus toxicity may present with PRES. Neurological deficits may be fully reversible with discontinuation of the drug; therefore, the early recognition and prompt management of this condition are of utmost importance.

Posterior reversible encephalopathy syndrome presenting as acute blindness

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma (NHL) accounting for approximately 25–30% of NHL cases. The treatment is based upon stage and extent of disease. In most cases, NHL is treated with systemic chemotherapy and sometimes also radiation. As it is well known, there are numerous side effects to chemotherapy that includes rituximab. We are here to present one rare side effect of treatment called posterior reversible encephalopathy syndrome (PRES).

Posterior reversible encephalopathy syndrome presenting as bilateral blindness in a post partum female

Posterior reversible encephalopathy syndrome PRES previously is an europhthalmic disorder characterized by painless loss of vision seizures headache and altered mental status and is associated with white matter vasogenic edema predominantly affecting the occipital and parietal lobes of the brain It has several etiologies but one of the most common includes eclampsia This case report describes a rare scenario where a patient presented with complete bilateral loss of vision due to PRES syndrome She was days postpartum and had undergone caesarian section for pre eclampsia Her condition recovered completely with treatment within a week of presentation

Case of Fatal Posterior Reversible Encephalopathy Syndrome Presenting as Cerebellar Edema and Reverse Herniation (P4.389)

Case of Fatal Posterior Reversible Encephalopathy Syndrome Presenting as Cerebellar Edema and Reverse Herniation (P4.389)

Posterior reversible encephalopathy syndrome presenting as cortical blindness: a case report

Posterior reversible encephalopathy syndrome (PRES) is characterized clinically by the presence of headache, seizures, loss of consciousness, and cortical blindness in a woman with high blood pressure in the third trimester of pregnancy, and radiological findings in such patients are predominantly posterior cerebral edema all of which are reversible within three months. We report a 24 year old patient who presented with headache and visual loss on fourth day post delivery. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment

Life-threatening complications of posterior reversible encephalopathy syndrome in children

BackgroundAlthough the posterior reversible encephalopathy syndrome (PRES) is considered to have a benign clinical outcome, the presentation of PRES can be associated with life-threatening complications such as severe cerebral hemorrhage, cerebellar herniation and refractory status epilepticus (SE). The aim of this paper is to report incidence, clinical features and outcome of life-threatening complications related to PRES in children. MethodsPatients who suffered from life-threatening complications were retrospectively identified from a group composed by 27 consecutive children diagnosed with PRES in our hospital between 2000 and 2012. The clinical, radiological and EEG features and the outcome of these patients were evaluated and compared to the characteristics of patients with no complications. ResultsFive patients (18%) presented life-threatening complications: 2 cerebral hemorrhages with mass effect and midline shift (1 massive intraparenchymal hemorrhage and 1 subdural hemorrhage and intraparenchymal hemorrhage), 2 transforaminal cerebellar herniations and 1 refractory SE. Two children died because of complications and 2 children required urgent neurosurgical intervention. The infratentorial involvement at onset of PRES and the observation of focal neurological deficits other than visual disturbances were significantly more frequent in children with life-threatening complications (p < 0.01). ConclusionsPRES is associated with a non-negligible incidence of life-threatening complications. A careful clinical, neuroradiological and EEG monitoring is necessary in order to improve the outcome especially in the case of focal neurological deficits and infratentorial involvement.

Optic Ataxia: From Balint’s Syndrome to the Parietal Reach Region

Optic ataxia is a high-order deficit in reaching to visual goals that occurs with posterior parietal cortex (PPC) lesions. It is a component of Balint's syndrome that also includes attentional and gaze disorders. Aspects of optic ataxia are misreaching in the contralesional visual field, difficulty preshaping the hand for grasping, and an inability to correct reaches online. Recent research in nonhuman primates (NHPs) suggests that many aspects of Balint's syndrome and optic ataxia are a result of damage to specific functional modules for reaching, saccades, grasp, attention, and state estimation. The deficits from large lesions in humans are probably composite effects from damage to combinations of these functional modules. Interactions between these modules, either within posterior parietal cortex or downstream within frontal cortex, may account for more complex behaviors such as hand-eye coordination and reach-to-grasp.

Antiepileptic Drug Treatment Following Status Epilepticus Secondary to Posterior Reversible Encephalopathy Syndrome in the Pediatric Population (P04.175)

Objective: Studies on antiepileptic drug (AED) treatment following status epilepticus (SE) related to posterior reversible encephalopathy syndrome (PRES) in the pediatric population are lacking. We report two cases of SE in teenage girls with PRES secondary to hypertension from post-infectious glomerulonephritis treated with a course of levetiracetam. Background PRES is a clinical syndrome of headache, altered mental status, seizures, and vision loss associated with brain MRI characteristics of symmetrical white matter edema in the posterior cerebral hemispheres. Design/Methods: Initial presentation, clinical course, diagnostic test results, and AED management from two teenage girls with SE secondary to PRES and post-infectious glomerulonephritis are described. Results: Two teenage girls were treated with antibiotics for pharyngitis as outpatients. Both girls developed headache, vomiting, and presented in SE. The thirteen (13) year old girl also experienced vision loss and hypertensive urgency while the fourteen (14) year old girl had a retropharyngeal abscess and subsequently developed hypertension. Labs revealed hematuria, elevated creatinine, hyperkalemia, and low C3 consistent with poststreptococcal glomerulonephritis. Infection was established by elevated DNase B and ASO in the former case and culture in the latter. CSF studies were benign. Brain MRI studies showed cortical and subcortical T2/FLAIR prolongation in the occipital, parietal, and temporal lobes bilaterally. Acute SE resolved with benzodiazepines and hypertension controlled with amlodipine. In follow up, the 14 year old patient had a recurrent seizure four weeks following the initial SE, but complete imaging resolution at six weeks. Both patients were managed with a 3-6 month course of levetiracetam. Conclusions: Guidelines on continued AED treatment following PRES are unclear. This case of a breakthrough seizure following initial presentation of SE and PRES reflects the potential need for continued AED treatment. SE as the first presentation of PRES may dictate future risk of seizures and larger studies are needed to follow outcomes of these children. Disclosure: Dr. Avallone has nothing to disclose. Dr. Maski has nothing to disclose.

Posterior Reversible Encephalopathy Syndrome Presenting as Balint Syndrome

Balint syndrome is a disorder of inaccurate visually guided saccades, optic ataxia, and simultanagnosia that typically results from bilateral parieto-occipital lesions. Visual perception disturbances in the posterior reversible encephalopathy syndrome (PRES) include hemianopia, visual neglect, and cerebral blindness, but Balint syndrome had not been recognized. We report Balint syndrome associated with PRES in a 37-year-old woman with acute hypertension and systemic lupus erythematosus. Balint syndrome can be an initial presentation of PRES.

Posterior reversible encephalopathy syndrome presenting as papilledema

Posterior reversible encephalopathy syndrome (PRES) is a central nervous system pathology characterized by headaches, altered mental status, seizures, and visual loss. The syndrome is a clincoradiologic diagnosis, which mandates neuroimaging. The aim of this study is to describe a case of asymptomatic PRES in which the only sign was incidental papilledema found on ophthalmologic examination. A thin 19-year-old female G1P1 s/p natural spontaneous vaginal delivery was referred to our emergency department (ED) by the ophthalmology clinic after finding bilateral papilledema on fundoscopic examination. She denied any fevers, chills, nausea, vomiting, as well as headache, lightheadedness, visual changes, or blurriness. Lumbar puncture was performed, and opening pressure was found to be greater than 55 cmH2O. After collecting Cerebrospinal fluid (CSF) for routine analysis, approximately 15 to 20 mL of CSF was drained. After several revisits to the ED, the neurology clinic was consulted. The magnetic resonance imaging ordered by the neurology clinic, as read by the radiologist, showed a focal lesion in splenium of the corpus callosum and diffusion restriction suggestive of acute infarction (although the anatomical location and age would be unusual). This is an atypical manifestation of PRES. The myriad of clinical symptoms and presentations of PRES has become more identifiable as more case reports of the syndrome are published. This case demonstrates that this atypical syndrome may present in an atypical way. The patient may be asymptomatic, and although imaging defines the diagnosis, a complete physical examination must not be ignored because the only sign may be papilledema.

Posterior reversible encephalopathy syndrome presenting after a liver transplantation: a report of three cases

緒言：Posterior reversible encephalopathy syndrome（以下PRESと略す）は主要症状として頭痛・脳症・視野障害・痙攣を呈し，神経症状を残さずに臨床症候や画像所見が改善する可逆的な臨床的・放射線学的症候群である。PRESの発症原因は様々であるが，今回我々は生体肝移植術後に合併した敗血症が発症に関与したと考えられたPRESの3症例を経験したので文献的考察を含めて報告する。症例：症例1は28歳の女性。劇症肝炎に対して生体肝移植術を施行したが，手術後約5週間後に突然の視力障害で発症した。後頭葉・橋に脳浮腫が認められた。PRESと診断し，保存的対症療法を行ったところ，更に6週間後にはMRI上も脳浮腫は消失し神経症状も右同名半盲以外後遺しなかった。症例2は5歳の女児。先天性胆道閉鎖症のため葛西手術が行われていたが，今回生体肝移植術が施行された。術後約4週間後に突然の痙攣発作で発症した。MRIで左右後頭葉を中心に頭頂葉・側頭葉・前頭葉と散在性に脳浮腫像を認めた。第41病日にはMRI所見の改善が認められた。症例3は19歳の男性。生体肝移植術の5日後に強直性間代性痙攣で発症した。第35病日にはMRI所見の改善が認められた。症例2・3は神経症状の後遺を認めなかった。3症例とも免疫抑制薬の血中濃度は正常範囲内であったが，PRES発症に先行する敗血症を認めた。考察：PRESの原因には様々な病態が考えられるが，免疫抑制薬使用時は血中濃度のみならず敗血症にも十分注意しなければならない。結語：生体肝移植術後に敗血症が原因と考えられるPRESの3症例を経験した。救急・集中治療医はPRESの病態・治療法等を熟知しておくべきである。

A Case of Posterior Reversible Encephalopathy Syndrome Presenting with Isolated Diplopia

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical entity characterized by a unique pattern of vasogenic brain edema mainly caused by eclampsia, immune suppressing drugs, or severe hypertension. The disease typically affects parieto-occipital lobe as the nomenclature indicates. Here we report a man with isolated concomitant strabismus, who was initially suspected as having glioma but was finally diagnosed with PRES. Methods: A 43-year-old man complained of horizontal double vision for a week. He had no other neurological symptom, including headache or confusion. He had a history of hypertension but had no medication. On examination, he showed 10 to 12 prism diopter of exotropia in all gaze directions without any restriction of eye movement. The sudden onset of the symptom and the history of hypertension urged us to take head MRI, which showed poorly-demarcated T2-high intensity area in extensive brainstem and bilateral cerebellum. The image suggested a plausible diagnosis of brainstem glioma. Results: He was admitted for planning brain biopsy. Since his systolic blood pressure was over 240 mmHg, he was to undergo blood pressure control before the biopsy. As the pressure decreased to around 180 mmHg, his symptom improved gradually. The lesion diminished in 2 weeks. Finally, he was diagnosed with PRES due to hypertension judged from the clinical course. Conclusions: PRES can affect any locations in central nervous system including brainstem as shown in the present case. And of note, the patients with brainstem variant of PRES may present only minimal symptoms such as diplopia in the present case. Differentiation from tumors or infarction is very important to avoid unnecessary and invasive interventions. One useful characteristic is the clinical radiologic dissociation. Once brainstem variant of PRES is diagnosed, to monitor and control blood pressure is important because it is often caused by severe secondary hypertension.

Lysergic Acid Amide-Induced Posterior Reversible Encephalopathy Syndrome with Status Epilepticus

Posterior reversible encephalopathy syndrome (PRES) is known to occur in association with several substances. However, lysergic acid amide (LSA) is not among the previously reported causes of PRES. We report on a patient with PRES presenting as convulsive status epilepticus associated with hypertensive encephalopathy after LSA ingestion. Magnetic resonance imaging was performed and catecholamine metabolites assayed. The patient achieved a full recovery after aggressive antihypertensive therapy and intravenous anticonvulsivant therapy. The clinical history, blood and urinary catecholamine levels, and response to treatment strongly suggest that PRES was induced by LSA. LSA, a hallucinogenic agent chiefly used for recreational purposes, should be added to the list of causes of PRES.

Posterior reversible encephalopathy and Guillain-Barré syndrome in a single patient: Coincidence or causative relation?

We report 62-year-old female patient with coincident posterior reversible encephalopathy syndrome (PRES) and Guillain-Barré syndrome (GBS). The first presentation of PRES was a generalised tonic–clonic seizure. A risk factor for PRES was acute arterial hypertension. The diagnosis of PRES was established by MRI (magnetic resonance imaging) and hypertension was treated with labetalol 800 mg daily followed by regression of symptoms of PRES. Two days after the seizure the first motor signs of GBS presented with a weakness in both upper arms. The diagnosis of GBS was finally established 6 days after the seizure by clinical evolution, lumbar puncture and electrophysiological findings. After treatment of GBS with intravenous immunoglobulins (IVIg), antihypertensive therapy could be phased out and finally stopped. The patient was discharged after 25 days without any medication. At that time she was completely recovered from PRES and recovering well from GBS. The acute arterial hypertension, the provoking factor of PRES, was probably caused by an autonomic dysfunction in the context of GBS before motor signs of GBS were present but we speculate also that there are other GBS related factors playing a role in PRES. This hypothesis is based on the relatively high coincidence of these two rare syndromes which appears from a review of the literature. One other possible mechanism can be the influence of cytokines, produced in the context of a GBS, on the permeability of blood brain barrier.