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1.
Medicine (Baltimore) ; 99(4): e18877, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977892

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD). PATIENT CONCERNS: A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria. DIAGNOSIS: PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia. INTERVENTIONS: The patient received levetiracetam and valproate for seizure management. OUTCOMES: Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission. LESSONS: PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.


Assuntos
Morte Fetal/etiologia , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Complicações na Gravidez/diagnóstico , Acidente Vascular Cerebral/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Cesárea , Eletrocorticografia , Feminino , Humanos , Síndrome da Leucoencefalopatia Posterior/complicações , Gravidez , Gravidez de Gêmeos , Convulsões/etiologia
2.
World Neurosurg ; 134: 176-181, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712110

RESUMO

BACKGROUND: Various radiologic patterns of posterior reversible encephalopathy syndrome (PRES) have been reported. Among them, PRES involving brainstem, thalamus, or deep white matter and lacking parieto-occipital edema is rare. Although PRES in general has a benign course, PRES-related intracranial hemorrhage has been associated with a poor prognosis. We report a case of variant type of PRES associated with deep brain hemorrhage and discuss the characteristics of PRES-related intracranial hemorrhage via a literature review. CASE DESCRIPTION: A woman aged 41 years with a history of untreated hypertension presented to our hospital complaining of severe headache and with an elevated blood pressure of 237/142 mmHg. Computed tomography revealed a hemorrhage in the left thalamus and basal ganglia. Magnetic resonance imaging revealed remarkable hyperintensity in the left cerebellum, pons, bilateral temporal lobes, bilateral basal ganglia, and bilateral cerebral white matter on fluid-attenuated inversion recovery imaging, which represented vasogenic edema. The parieto-occipital regions were unremarkable. Given this clinical presentation, PRES associated with deep brain hemorrhage was suspected. The patient received strict blood pressure control treatment, which resulted in gradual symptom improvement. Magnetic resonance images obtained 1 month after admission demonstrated an almost complete resolution of the edema. CONCLUSIONS: Although hemorrhage in the thalamus, basal ganglia, or brainstem is uncommon in patients with PRES, it may occur in patients with variant type of PRES involving these lesions. It is important to recognize the presence of variant patterns of clinical features and radiologic findings of PRES to allow for early identification and appropriate treatment.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Doenças Talâmicas/diagnóstico por imagem , Adulto , Anti-Hipertensivos/uso terapêutico , Hemorragia dos Gânglios da Base/complicações , Hemorragia dos Gânglios da Base/fisiopatologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Doenças Talâmicas/complicações , Doenças Talâmicas/fisiopatologia , Tomografia Computadorizada por Raios X
4.
J Stroke Cerebrovasc Dis ; 28(12): 104473, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677961

RESUMO

BACKGROUND: Nontraumatic convexity subarachnoid hemorrhage (cSAH) is a nonaneurysmal variant that is associated with diverse etiologies. METHODS: With IRB approval, we retrospectively reviewed consecutive nontraumatic cSAH from July 1, 2006 to July 1, 2016. Data were abstracted on demographics, medical history, neuroimaging, etiology, and clinical presentation. RESULTS: We identified 94 cases of cSAH. The cases were classified according to the following etiologies: reversible cerebral vasoconstriction syndrome (RCVS) 17 (18%), cerebral amyloid angiopathy (CAA) 15 (16%), posterior reversible encephalopathy syndrome 16 (17%), cerebral venous thrombosis 10 (11%), large artery occlusion 7 (7%), endocarditis 6 (6%), and cryptogenic 25 (27%). Early rebleeding occurred in 9 (10%) patients. Time from initial imaging to CT rebleeding was 40 hours (range, 5-74). CAA was associated with the highest mean age at 75.8 and RCVS the lowest at 47.6 years (P< .0001). Among patients with RCVS, initial vascular imaging was negative in 6 (35%), and repeat imaging documented vasoconstriction at a mean delay of 5 days (range, 3-16). CONCLUSION: There were significant differences among the subgroups in cSAH, with CAA presenting as older men with transient neurological deficits, and RCVS presenting as younger women with thunderclap headache. Rebleeding was seen in 10% of cSAH patients. One-third of RCVS patients with cSAH required repeat vascular imaging to diagnose vasoconstriction.


Assuntos
Angiopatia Amiloide Cerebral/complicações , Endocardite/complicações , Trombose Intracraniana/complicações , Síndrome da Leucoencefalopatia Posterior/complicações , Hemorragia Subaracnóidea/etiologia , Vasoespasmo Intracraniano/complicações , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Endocardite/diagnóstico , Feminino , Humanos , Trombose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Valor Preditivo dos Testes , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Hemorragia Subaracnóidea/diagnóstico por imagem , Síndrome , Fatores de Tempo , Vasoconstrição , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , Adulto Jovem
6.
Medicine (Baltimore) ; 98(34): e16759, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441849

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease of the posterior subcortical white matter that manifests as headache, seizures, visual impairment, disturbance of consciousness, and changes in mental state. While PRES is associated with specific imaging findings involving the posterior circulation area of the brain. In the present study, we report the first case of PRES associated with essential thrombocythemia (ET). PATIENT CONCERNS: A 49-year-old man suddenly experienced headache, followed by the gradual appearance of consciousness disorders and mental behavior abnormalities. Neurological tests showed that the patient had a Glasgow Coma Scale score of 12, normal muscle strength and tension of the limbs, and was negative for meningeal irritation. DIAGNOSIS: Magnetic resonance imaging of the brain showed extensive vasogenic edema in the deep white matter of the right cerebellum and the left occipital and temporal lobes and a diagnosis of PRES was considered. Routine blood test showed that his platelet count was markedly increased, and the JAK2 V617F mutation analysis with allele-specific real-time polymerase chain reaction was positive. The bone marrow biopsy indicated an increasing number of megakaryocytes. These findings indicated ET. INTERVENTIONS: PRES was treated with a dehydrating agent and supportive and symptomatic treatments. Aspirin tablets were prescribed to address the patient's ET. OUTCOME: After treatment, the abnormal findings on head imaging were completely reversed. His neurological symptoms were completely relieved. LESSONS: PRES may be correlated with ET; specifically, ET may trigger PRES and be a risk factor for the acute onset of neurological deficits.


Assuntos
Síndrome da Leucoencefalopatia Posterior/complicações , Trombocitemia Essencial/complicações , Encéfalo/patologia , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Trombocitemia Essencial/diagnóstico
8.
Curr Atheroscler Rep ; 21(9): 33, 2019 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-31230137

RESUMO

PURPOSE OF THE REVIEW: Maternal morbidity and mortality is rising in the USA, and maternal stroke is a major contributor. Here, we review the epidemiology, risk factors, and current recommendations for diagnosis and acute treatment of ischemic and hemorrhagic stroke during pregnancy and postpartum, focusing on recent evidence. RECENT FINDINGS: The incidence of maternal stroke has risen in recent years, possibly due to increasing rates of hypertensive disorders of pregnancy. The risk of maternal stroke is highest in the peripartum and early postpartum period. Preeclampsia is highly associated with reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome and is also associated with long-term increased risk of stroke and vascular dementia. Hypertensive disorders of pregnancy, migraine, and infections are risk factors for maternal stroke. Limited data suggest that thrombolytics and endovascular reperfusion therapy are safe and effective in pregnant women with ischemic stroke, but few data are available regarding safety of thrombolytics in the postpartum period. New consensus guidelines are now available to assist with management of ischemic and hemorrhagic stroke in pregnancy. Many gaps remain in our understanding of maternal stroke. While risk factors have been identified, there are no prediction tools to help identify which women might be at highest risk for postpartum stroke and require closer monitoring. The risk of recurrent maternal stroke has not been adequately quantified, limiting clinicians' ability to counsel patients. The complex pathophysiology of preeclampsia and its effects on the cerebral vasculature require further targeted study. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reducing maternal morbidity and mortality.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Isquemia Encefálica/complicações , Feminino , Humanos , Incidência , Hemorragias Intracranianas/complicações , Mortalidade Materna , Síndrome da Leucoencefalopatia Posterior/complicações , Período Pós-Parto , Pré-Eclâmpsia , Gravidez , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Adulto Jovem
9.
BMJ Case Rep ; 12(4)2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30996063

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome characterised by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. We describe an unusual case of PRES with isolated pontine involvement with coincidental acute ischaemic stroke in a 60-year-old man who presented with headache, unsteadiness of gait, blurred vision and elevated blood pressure. MRI scan revealed an expanded pons with diffuse T2 and Fluid attenuated Inversion Recovery (FLAIR) hyperintensities and an acute infarct in the right temporal lobe. A diagnosis of PRES was considered most likely after exclusion of other differentials and the patient was started on antihypertensive treatment as for hypertensive encephalopathy. He became asymptomatic after controlling blood pressure and the follow-up MRI scan at 3 weeks showed complete resolution of the pontine high signals which confirmed the diagnosis of PRES.


Assuntos
Anti-Hipertensivos/uso terapêutico , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Imagem por Ressonância Magnética , Ponte/patologia , Síndrome da Leucoencefalopatia Posterior/patologia , Acidente Vascular Cerebral/patologia , Transtornos Neurológicos da Marcha/etiologia , Cefaleia/etiologia , Humanos , Hipertensão/etiologia , Isquemia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Ponte/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento
10.
J Gynecol Obstet Hum Reprod ; 48(6): 431-434, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30905853

RESUMO

Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction (RCVS) are rare neurological disorders with complex physiopathology which is not yet fully understood. We present here the case of a 31-year-old woman with a bi-amniotic bi-chorial pregnancy who developed immediate postpartum eclampsia after vaginal delivery, associated with RCVS and PRES. Although post-partum is a well-known precipitating factors for these diseases, to our knowledge, there are only few similar cases reported with the association of these syndromes. Repeated MRI scans were instrumental in the final diagnosis of RCVS associated with PRES, allowing us to give the patient the appropriate treatment. These two syndromes have similar symptoms but may have different treatments, thus highlighting the importance of a correct diagnosis.


Assuntos
Doenças Arteriais Cerebrais/complicações , Eclampsia/diagnóstico , Síndrome da Leucoencefalopatia Posterior/complicações , Transtornos Puerperais/diagnóstico , Vasoconstrição , Adulto , Doenças Arteriais Cerebrais/diagnóstico , Doenças Arteriais Cerebrais/tratamento farmacológico , Eclampsia/fisiopatologia , Feminino , Cefaleia , Humanos , Nimodipina/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez de Gêmeos , Transtornos Puerperais/tratamento farmacológico , Transtornos Puerperais/fisiopatologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Síndrome , Vasodilatadores
11.
Medicine (Baltimore) ; 98(2): e13649, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30633153

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES) was termed by Hinchey in 1996. Patients have a reversible vasogenic brain edema in imaging and acute neurological symptoms such as headache, seizures, encephalopathy, and visual disturbances when suffering from hypertension, pre-eclampsia/eclampsia, renal failure, immunosuppressive medications, autoimmune disorders, sepsis, thrombocytopaenia, hypocalcaemia, alcohol withdrawal, and many other potential causes. de Havenon A et al have proposed a new syndrome named PRES with spinal cord involvement (PRES-SCI). The patients with PRES-SCI have similar symptoms these of PRES. Patients have neurologic signs with the spinal cord involved and lesions in magnetic resonance imaging (MRI) extending to the cervicomedullary junction, usually with extreme elevation in blood pressure and a history of hypertensive retinopathy. We administrated a young patient whose condition was consistent with PRES-SCI except for the hemisphere lesions. PATIENT CONCERNS: A 20-year-old Asian male patient was admitted for a 1 week history of blurred vision and weakness of the limbs. He has had poorly controlled hypertension for 1 year before admission. In emergency room, his blood pressure could raise to 260/140mmHg. Neurological examinations and cerebral spinal fluid tests were negative. The MRI of the brain and spinal cord showed reversible lesions in the medulla and upper cervical spinal cord that extended to the lower thoracic spine. DIAGNOSIS: Taking into account the characteristic lesions in the MRI as well as the reversible course upon treatment, he was diagnosed PRES-SCI. INTERVENTIONS: He was treated with medicines for the hypertension. OUTCOMES: His symptoms rapidly improved and finally the lesions on the MRI of the brain and spianl cord disappeared. LESSONS: Clinicians should suspect PRES-SCI when patients have mild or no neurologic signs accompanied with extreme elevation in blood pressure and lesions in spinal cord. Spinal lesions alone may be a subtype of PRES-SCI.


Assuntos
Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Anti-Hipertensivos/uso terapêutico , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/tratamento farmacológico , Adulto Jovem
12.
Neurol Sci ; 40(2): 377-384, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30478719

RESUMO

BACKGROUND AND PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity for which eclampsia is one of the most common predisposing conditions. Despite the imaging changes typically reported, the predisposing factors and clinical implications of atypical presentations have yet to be fully clarified. METHODS: A total of 56 patients with PRES were selected for study. Demographic, clinical, and laboratory data were analyzed, focusing on atypical presentations of PRES. Multiple logistic regression was applied to identify factors impacting such atypical presentations, and functional outcomes were assessed upon patient discharge. RESULTS: Overall, 22 of the 56 patients (39.3%) displayed features of atypical PRES. By multiple logistic regression, headache (OR = 5.39; 95% CI, 1.24-23.51; p = 0.025) and frequent convulsions (OR = 4.41; 95% CI, 1.09-17.91; p = 0.038) proved to be independent factors associated with atypical PRES. Ultimately, outcomes of 18 patients were gauged as poor, based on the modified Rankin Scale (mRS). Logistic regression indicated that visual disturbances (OR = 9.02; 95% CI, 1.37-59.35; p = 0.02), frequent convulsions (OR = 9.47; 95% CI, 1.67-53.63; p = 0.01), and restricted diffusion on imaging (OR = 11.96; 95% CI, 1.76-81.11; p = 0.01) were independently associated with poor outcomes in patients with eclampsia-related PRES. CONCLUSION: Headache and frequent convulsions are independently associated with atypical presentations of PRES. If present, restricted diffusion may help in predicting poor outcomes of such patients upon discharge.


Assuntos
Eclampsia/diagnóstico , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Eclampsia/terapia , Feminino , Humanos , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/terapia , Gravidez , Prognóstico , Estudos Retrospectivos
16.
Neurol India ; 66(6): 1629-1633, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30504555

RESUMO

Background: Status epilepticus (SE) related to pregnancy is rare and carries a significant risk to both the mother and the fetus. Objectives: We conducted this study to devise a protocol for the management of SE related to pregnancy in a cohort of female patients admitted with SE during pregnancy. Materials and Methods: All women who developed SE related to pregnancy (gestation, labor, and puerperium) between January 2000 and December 2016 were included. Data was collected using a structured proforma. Results: There were 17 women who had SE related to pregnancy, of whom 10 had refractory SE. The various causes of refractory SE were eclampsia (N = 2), posterior reversible encephalopathy syndrome (PRES) due to various causes other than eclampsia (N = 3), cortical venous thrombosis (CVT) [N = 3], subarachnoid hemorrhage (SAH) [N = 1], and N-methyl-D-aspartate (NMDA) receptor antibody-mediated encephalitis (N = 1). Six out of 10 women with refractory SE (60%) and five out of 10 fetuses (50%) had a good outcome. Conclusion: There is a dearth of literature with regards to SE related to pregnancy and little or no guidelines exist for its management. Awareness about the diverse etiologies other than eclampsia is important. A protocol-based approach to the diagnosis and management of SE is necessary to ensure best outcomes.


Assuntos
Anticonvulsivantes/uso terapêutico , Eclampsia/terapia , Síndrome da Leucoencefalopatia Posterior/complicações , Complicações na Gravidez/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Adulto , Protocolos Clínicos , Feminino , Humanos , Unidades de Terapia Intensiva , Gravidez , Estado Epiléptico/etiologia , Resultado do Tratamento
17.
Tidsskr Nor Laegeforen ; 138(17)2018 10 30.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30378405

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a rare clinicoradiographic disorder characterized by acute neurological symptoms with typical neuroimaging findings of vasogenic edema in posterior regions of the brain. This complication is linked to a number of medical conditions, and is increasingly being documented as a side effect associated with a number of therapeutic agents. We present a case of PRES as a result of treatment with the vascular endothelial growth factor (VEGF) multikinase inhibitor, regorafenib. A man in his 50's with known metastatic colorectal cancer presented with headache, vomiting, altered mental state, reduced hand coordination and dexterity, and a homonymous inferior quadrantanopia. Symptoms developed soon after completion of the 3rd regorafenib therapy cycle. Cerebral MRI demonstrated signs indicative of PRES with bilateral vasogenic edema in the occipitotemporal regions. Regorafenib was subsequently discontinued and the patient's condition improved gradually, with normalization of his neurological symptoms within a month. Albeit rare, PRES has been linked to VEGF treatments, particularly sorafenib, sunitinib and pazopanib, however this is the second reported case linking regorafenib with PRES. PRES is usually associated with good prognosis. However, delayed diagnosis and treatment may lead to permanent neurological symptoms, higher morbidity and in rare cases mortality. Therefore increased awareness of this condition is vital.


Assuntos
Antineoplásicos/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Síndrome da Leucoencefalopatia Posterior , Piridinas/efeitos adversos , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Evolução Fatal , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos de Fenilureia/administração & dosagem , Compostos de Fenilureia/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Neoplasias Retais/patologia , Tomografia Computadorizada por Raios X
18.
BMC Neurol ; 18(1): 180, 2018 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-30382822

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a reversible clinical and neurological entity. There are varieties of comorbid conditions which are associated with PRES. Chronic obstructive pulmonary disease (COPD) is a rare predisposing factor for the development of PRES. CASE PRESENTATION: A 55 year old female who was being treated for acute exacerbation of COPD developed altered sensorium and multiple episodes of seizure. Characteristic imaging findings and associated clinical symptoms led us to a diagnosis of PRES in our patient. CONCLUSION: Association of PRES and COPD is a rare entity. The diagnosis of PRES should be brought to mind if there is encephalopathy or seizure in COPD exacerbation.


Assuntos
Síndrome da Leucoencefalopatia Posterior/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Feminino , Humanos , Pessoa de Meia-Idade
19.
BMC Neurol ; 18(1): 182, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390663

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition which comprises various neurological symptoms. This syndrome could be complicated by intracranial hemorrhage including subarachnoid hemorrhage (SAH). However, SAH is rarely seen in eclamptic patients with PRES. CASE PRESENTATION: A 34-weeks-pregnant woman at the age of 33 was admitted to the obstetrics department because of an episode of generalized tonic-clonic seizure. Before the seizure, the patient had a headache and was found to have an abnormal systolic blood pressure of 160 mmHg. On admission, systolic and diastolic blood pressures were up to 182 and 99 mmHg, respectively. Emergent cesarean section was then performed. On hospital day (HD) 2, cranial non-contrast computed tomography (CT) revealed the existence of SAH. Multiple areas of high signals on T2-weighted and fluid attenuated inversion recovery (FLAIR) sequences were shown by cranial magnetic resonance imaging (MRI) performed 2 days later. CT-angiography studies didn't reveal intracranial aneurysm. After anti-hypertensive treatment, arterial blood pressure of the patient was gradually tapered to normal values. Eventually, the patient was discharged without any residual symptoms. CONCLUSIONS: SAH is a rare complication of PRES in eclamptic patients. In patients with PRES, occurrence of SAH is related to increased morbidity and mortality especially when the hemorrhage is diffuse or massive. Our patient had a minor hemorrhage. The good prognosis might also be due to immediate elimination of the risk factor of PRES by emergent delivery.


Assuntos
Eclampsia , Síndrome da Leucoencefalopatia Posterior/complicações , Complicações na Gravidez , Hemorragia Subaracnóidea/complicações , Adulto , Feminino , Humanos , Gravidez
20.
Medicine (Baltimore) ; 97(36): e11665, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200061

RESUMO

INTRODUCTION: Acute intermittent porphyria (AIP) is a rare and challenging hereditary neurovisceral disease with no specific symptoms. Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome with bilateral reversible posterior gyriform lesions that can be associated with many different conditions, including AIP. Usually, peripheral neuropathy is considered the most common neurological manifestation of AIP. However, AIP should also be considered when seizures and PRES are associated with unexplained abdominal pain. CASE PRESENTATION: Both the patients were presented with seizures and PRES on brain magnetic resonance imaging (MRI). Unexplained abdominal pain occurred before the onset of seizures. The AIP diagnosis was made after repeated Watson-Schwartz tests. Hematin was not available for these 2 patients. However, supportive treatment including adequate nutrition and fluid therapy as well as specific antiepileptic drugs aided the patient's recovery and no acute attacks had occurred by the 3-year follow-up. CONCLUSION: In contrast to other causes of PRES patients, seizure is the most common symptom in AIP patients with PRES. This is a strong diagnostic clue for AIP when ambiguous abdominal pain patients presented with seizures and PRES on brain MRI. A positive prognosis can be achieved with the combination of early recognition, supportive and intravenous hematin therapy, and withdrawal of precipitating factors, including some antiepileptic drugs.


Assuntos
Porfiria Aguda Intermitente/complicações , Porfiria Aguda Intermitente/diagnóstico , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Convulsões/complicações , Convulsões/diagnóstico , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Porfiria Aguda Intermitente/fisiopatologia , Porfiria Aguda Intermitente/terapia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia , Convulsões/fisiopatologia , Convulsões/terapia
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