MR Imaging in Eclampsia

Background : The aim of this study is to determine the distribution and nature of Cranial MRI findings in eclamptic patients, and to correlate them with clinical and laboratory data. Materials and Methods : This study was conducted in the Department of Obstetrics and Gynecology in Sri Ramachandra Institute of Higher Education and Research. A total number of 35 Eclamptic patients were included in this study and they were analyzed retrospectively. Laboratory parameters, Blood Pressure and Cranial MRI was performed for all and the same were analyzed statistically. Results : Out of 35 Eclamptic patients, MR Imaging was normal in 6 patients. Among the 29 patients with abnormal MRI, Cortical-subcortical Lesion, appeared iso/hypo-intense in T-1 weighted images and hyper intense in T-2 weighted images. In most of the patients, occipital lobe was involved followed by involvement of other lobes such as Parietal, Frontal, Temporal, Basal Ganglia and Cerebellum. When patients with and without positive MRI findings were compared regarding clinical features such as Headache, Blurred Vision, Nausea and Vomiting, Epigastric Pain, Loss of Consciousness, Reduced Urine Output there was no statistically significant difference between the two groups. Similarly, there was no statistical difference in mean arterial pressures between MRI positive and MRI negative patients (p=0.218) however, it was found that those with MR imaging positive features had a higher Blood Pressure than those with MRI negative findings. Among the laboratory parameters, in the patients with abnormal MRI findings Fibrinogen was found to be significantly low than those with normal MRI findings (p=0.0002).

DELAYED PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN POSTPARTUM PERIOD

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological entity which presents with diverse neurological symptoms ranging from headache, seizure, visual symptoms with altered consciousness and focal signs. The hallmark of this condition is its reversibility. The etio- pathogenesis is attributed to vasogenic cerebral oedema seen in occipital and parietal lobes of brain. We hereby present this case of a multiparous lady presenting with altered sensorium postpartum. Characteristic findings on imaging helped us to form the diagnosis of PRES in this patient

Imaging manifestations of central nervous system complications after heart transplantation / 器官移植

Heart transplantation is the main treatment of end-stage heart failure. With the advancement of heart transplantation and rational use of postoperative immunosuppressants, the survival rate of recipients has been gradually enhanced. However, a variety of central nervous system complications may still occur following heart transplantation, including immunosuppressant-associated neurotoxicity, epilepsy, stroke, encephalopathy, central nervous system infection and de novo malignant tumors in the central nervous system. These complications will severely affect the quality of life of heart transplant recipients. Consequently, prompt imaging diagnosis plays a significant role in the prevention and treatment of central nervous system complications. In this article, main imaging manifestations of central nervous system complications after heart transplantation were reviewed, aiming to provide reference for prompt diagnosis and differential diagnosis of complications, guide clinical treatment and management, and improve the long-term prognosis of the recipients.

Síndrome de encefalopatía posterior reversible. Presentación radiológica atípica / Posterior Reversible Encephalopathy Syndrome. Atypical radiological presentation / Síndrome de encefalopatia posterior reversível (PRES), apresentação radiológica atipica

Resumen: Introducción: El síndrome de encefalopatía posterior reversible (PRES por las siglas en inglés Posterior Reversible Encephalopathy Syndrome) es una entidad clínica caracterizada por cefalea, alteraciones visuales y crisis convulsivas. Ésta es una entidad subdiagnosticada, que tiene como fisiopatología la alteración del vaso de regulación cerebral y se puede presentar en féminas gestantes, lo que puede llegar a confundirse con eclampsia. Caso clínico: Paciente de 20 años sin antecedentes patológicos, con embarazo de término normoevolutivo. Presentó ruptura prematura de membranas e ingresó para conducción de trabajo; se preparó a la paciente para analgesia obstétrica; sin embargo, previamente al procedimiento presentó crisis convulsivas de características tonicoclónicas generalizadas. Se realizó un manejo avanzado de la vía aérea y se realizó una cesárea de urgencia; se obtuvo producto único vivo y fue ingresada a la Unidad de Cuidados Intensivos. El perfil toxémico no reportó alteraciones y la tomografía computarizada inicial no mostró alteraciones estructurales. Se le retiró a la paciente la ventilación mecánica 12 horas después. Se realizó una resonancia magnética que mostró en fase T2, hiperintensidad subcortical parieto-occipital derecho. Permaneció en vigilancia y fue egresada a piso sin complicaciones ni secuelas neurológicas. Conclusiones: El tratamiento del PRES va enfocado al control de la presión arterial, y el soporte orgánico y metabólico. No todos los enfermos con PRES se recuperan neurológicamente ad integrum; sin embargo, la proporción de pacientes que cursan sin secuelas es mayor en pacientes obstétricas. La resonancia magnética es el estudio de elección; el hallazgo característico es el edema simétrico de la materia blanca en la región occipital de los hemisferios cerebrales, en particular las regiones parieto-occipitales, no obstante, existen otro tipo de presentaciones radiológicas.

Abstract: Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical entity characterized by headache, visual disturbances and convulsive seizures. It is a sub-diagnosed entity that, due to its trigger being cerebral vasoregulation disorders, may present in pregnant women, which may be confused with eclampsia. Clinical case: Patient of 20 years of age, without pathological antecedents, with term pregnancy, evolutionary norm. Who enters by exit of mucous plug, followed by premature rupture of membranes, so it is admitted for conduction of labor, however presents convulsive crisis, generalized clonic tonic. Advanced airway management is decided, and an emergency caesarean section is performed, obtaining a single live product, and the patient is admitted to the ICU. His toxemic profile was reported without alterations, his initial CT scan without structural alterations, and mechanical ventilation was removed twelve hours later. MRI is performed where subcortical right parieto-occipital hyperintensity is observed, being kept under surveillance and graduated to floor without complications. Conclusions: The treatment of PRES syndrome is focused on organic and metabolic supports and mainly on tension Figures. Not all are reversible, however, the pregnant patient is more frequent than present evolution without sequelae. Magnetic resonance is the study of choice for this clinical entity, and the typical findings are symmetrical edema of white matter in the posterior cerebral hemispheres, particularly the parieto-occipital regions, but there are variations.

Resumo: Introduçao: A síndrome da encefalopatia posterior reversível (PRES) é uma entidade clínica caracterizada por dor de cabeça, distúrbios visuais e convulsões. É uma entidade subdiagnosticada, cuja fisiopatologia é a alteração do vaso de regulação cerebral, pode ocorrer em mulheres grávidas, o que pode ser confundido com eclampsia. Caso clínico: Paciente de 20 anos, sem antecedentes patológicos, com gestação á término e evolução normal. Apresentou ruptura prematura de membranas e ingressou para indução do trabalho de parto, preparou-se para analgesia obstétrica, porém antes do procedimento apresentou convulsões com características tônicas clônicas generalizadas. Foi realizado manejo avançado das vias aéreas e cesariana de emergência, obtendo-se um único produto vivo, e foi admitida na Unidade de Terapia Intensiva. O perfil toxémico não relatou alterações, a tomografia computadorizada inicial não mostrou alterações estruturais e a ventilação mecânica foi removida doze horas depois. Foi realizada ressonância magnética que mostrou na fase T2, hiperintensidade subcortical parieto-occipital direita. A paciente permaneceu sob vigilância e recebeu alta sem complicações ou sequelas neurológicas. Conclusões: O tratamento do PRES, está focado no controle da pressão arterial, suporte orgânico e metabólico. Nem todos os pacientes com PRES se recuperam neurologicamente ad integrum, no entanto, a proporção de pacientes que não apresentam sequelas é maior em pacientes obstétricos. A ressonância magnética é o estudo de eleição; o achado característico é edema simétrico de substância branca na região occipital dos hemisférios cerebrais, particularmente regiões parietooccipitais, porém existem outros tipos de apresentações radiológicas.

A case report: κ light chain multiple myeloma with posterior reversible encephalopathy syndrome / 上海交通大学学报（医学版）

Multiple myeloma (MM) is a common malignant tumor of blood system, often manifested as bone destruction, hypercalcemia, and hyperviscosity syndrome. Electrolyte disturbance and hypertension caused by MM can induce posterior reversible encephalopathy syndrome (PRES). This case report reviews that a patient with osteodynia had several mental abnormalities, and was diagnosed as having κ light chain MM with PRES after thorough examination.

Reversible Cerebral Vasoconstriction Syndrome and Posterior Reversible Encephalopathy Syndrome Presenting with Deep Intracerebral Hemorrhage in Young Women

Reversible cerebral vasoconstriction syndrome (RCVS) is a group of syndromes characterized by reversible segmental constriction of cerebral arteries. Posterior reversible encephalopathy syndrome (PRES) is another clinical-radiologic syndrome characterized by reversible, posterior-predominant brain edema. Although the exact causes of these reversible syndromes are poorly understood, these entities may share some common pathophysiologic elements leading to hemorrhagic strokes and rarely, deep intracerebral hemorrhage (ICH). Recent studies have suggested that endothelial dysfunction is a common pathophysiologic factor associated with these syndromes. We report on two young female patients who presented with deep ICH and were later diagnosed as RCVS and PRES. Both patients suffered from vasoconstriction and delayed ischemic stroke. Early detection of distinguishing clinical-radiologic features associated with these reversible syndromes and removing triggers would facilitate successful treatment with no complications.

Síndrome de encefalopatía reversible posterior (PRES) asociada a eclampsia y síndrome HELLP / Posterior reversible encephalopathy syndrome (PRES) associated with eclampsia and HELLP syndrome

Es un síndrome usualmente reversible consistente en cefalea, alteración del estado mental, convulsiones y pérdida de la visión, asociado a edema cerebral de localización predominantemente posterior en estudios de imagen (1). La falta de su reconocimiento y manejo temprano puede ocasionar daños neurológicos permanentes (2). Se presenta el caso de una paciente de 29 años con 36 semanas de edad gestacional que ingresa al servicio de urgencias en estado epiléptico por eclampsia, síndrome HELLP (Hemólisis, Enzimas hepáticas elevadas, Plaquetas bajas) e imágenes hipodensas en regiones occipital y frontal en Tomografía Axial Computarizada de cráneo.

This syndrome, usually reversible, consists in symptoms like headache, altered mental status, seizures and lost of sight, associated to brain edema predominantly in posterior cerebral regions. The lack of its recognition and early management can lead to permanent neurological damage. It is presented the case of a 29 - year - old patient with 36 weeks of gestational age who arrives to the emergency room in epileptic status. She was diagnosed with eclampsia, HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and occipital hypodense images were determined by cerebral Computarized Tomography.

A Case of Gemcitabine and Cisplatin Associated Posterior Reversible Encephalopathy Syndrome / Journal of the Korean Cancer Association, 대한암학회지

A 58-year-old female receiving gemcitabine and cisplatin chemotherapy for stage IV gallbladder cancer developed the clinicoradiologic syndrome, posterior reversible encephalopathy syndrome (PRES). Just before the 4th gemcitabine chemotherapy cycle, she was admitted to the hospital with complaints of headache, dizziness, and generalized tonic-clonic seizures. A MRI was performed on the day when the seizure developed, and the findings showed patchy cortical and subcortical T2 hyperintensity without enhancement that involved both occipital and parietal lobes. Phenytoin loading and maintenance was started for prevention of recurrent seizures, which was successful. The follow-up brain MRI obtained 10 days after the seizure attack showed completely resolved radiologic findings. After the MRI findings revealed complete resolution, phenytoin maintenance was stopped. Even with discontinuation of phenytoin, she had no seizures or other clinical manifestations.

Hypertension-induced Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome (PRES) involves predominantly posterior subcortical white matter and cortex. PRES is associated with an abrupt and severe increase in blood pressure or administration of various immuno-suppresants. We present a 18-year-old female with PRES. She was admitted to our hospital with seizures. She had been suffering from acute hypertension (170/100 mmHg) associated with acute renal failure. Brain MRI showed reversible biparietal cortical and subcortical edema. We report a case of hypertension-induced PRES associated with acute renal failure. (J Korean Neurol Assoc 19(5):541~543, 2001)