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1.
Medicine (Baltimore) ; 99(5): e18987, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000433

RESUMO

RATIONALE: Pituitary apoplexy (PA) and posterior reversible encephalopathy syndrome (PRES) are rare neurologic diseases that show acute neuro-ophthalmologic symptoms such as headache, decreased visual acuity, and altered consciousness. These diseases are rarely found in patients with end-stage renal disease (ESRD) on hemodialysis, and simultaneous occurrence of these 2 diseases has not been reported. PATIENT CONCERNS: The patient was a 75-year-old man with a history of hypertension, diabetes mellitus, and non-functioning pituitary macroadenoma. He had been receiving hemodialysis for ESRD for 3 months before his presentation to the emergency room. The patient complained of headache, vomiting, and dizziness that started after the previous day's hemodialysis. The patient had voluntarily discontinued his antihypertensive medication 2 weeks before presentation and had high blood pressure with marked fluctuation during hemodialysis. Complete ptosis and ophthalmoplegia on the right side suggested 3rd, 4th, and 6th cranial nerve palsies. DIAGNOSES: Magnetic resonance imaging of the brain revealed a pituitary tumor, intratumoral hemorrhage within the sella, and symmetric vasogenic edema in the subcortical white matter in the parieto-occipital lobes. Based on these findings, the patient was diagnosed with PA and PRES. INTERVENTIONS: Intravenous administration of hydrocortisone (50 mg every 6 hours after a bolus administration of 100 mg) was initiated. Although surgical decompression was recommended based on the PA score (5/10), the patient declined surgery. OUTCOMES: Headache and ocular palsy gradually improved after supportive management. The patient was discharged on the 14th day of hospitalization with no recurrence 5 months post-presentation. Current therapy includes antihypertensive agents, oral prednisolone (7.5 mg/day), and maintenance hemodialysis. LESSONS: Neurologic abnormalities developed in a patient with ESRD on hemodialysis, suggesting the importance of prompt diagnosis and treatment in similar instances.


Assuntos
Falência Renal Crônica/terapia , Apoplexia Hipofisária/etiologia , Síndrome da Leucoencefalopatia Posterior/etiologia , Diálise Renal/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico
3.
BMC Neurol ; 19(1): 214, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470816

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder usually associated with specific medical conditions that cause a disturbance of the CNS homeostasis. It has seldom been reported to be a consequence of an iatrogenic intervention causing intracranial hypotension. CASE PRESENTATION: We report the case of an individual 69-year-old male presenting with headache and blurred vision following cerebrospinal fluid (CSF) leak from resection of a sellar mass. The patient developed the condition following removal of the lumbar drain post-operatively. Magnetic Resonance Imaging showed bilateral occipital, parieto-occipital, and cerebellar T2 FLAIR hyper-intensities, suggesting a radiological diagnosis of posterior reversible encephalopathy syndrome (PRES). The patient's symptoms started to improve shortly afterwards and had completely resolved at 3 months follow-up. CONCLUSIONS: The absence of severe hypertension and presence of an intraoperative CSF leak requiring placement of the lumbar drain suggests that decreased CSF volume and associated reactive hyperemia could have a role in the pathophysiology of the disease.


Assuntos
Drenagem/métodos , Cefaleia/etiologia , Síndrome da Leucoencefalopatia Posterior/etiologia , Idoso , Cerebelo , Drenagem/efeitos adversos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino
4.
J Clin Neurosci ; 70: 249-250, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31447365

RESUMO

Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by headache, seizures, confusion, and visual disturbance. Usual culprits include hypertension, eclampsia, renal failure, or immunosuppressants. PRES has been described in sickle cell patients on a case report basis. More often than not, the patients are children or a recent blood transfusion was culprit. Few case reports describe adults with PRES. We present a series of four adult sickle-cell patients who developed PRES. The association of hypertension, renal failure, and immunosuppressants in sickle cell patients may play a role in the development of PRES in this patient population. It is unclear if SC patients have a higher frequency of PRES predisposing factors than the general population or if SC is an independent risk factor for PRES. Despite this limitation, the presence of acute neurological status changes in adult SC patients should trigger suspicion for PRES as management and outcome may be altered.


Assuntos
Anemia Falciforme/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino
5.
Transplant Proc ; 51(7): 2495-2497, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351771

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiologic syndrome. The etiology of PRES is still unclear. Some factors were described. We present a case of a pediatric patient with liver transplant who developed PRES following blood transfusion while receiving tacrolimus therapy. A 5½-year-old boy who underwent living donor liver transplantation, and PRES developed on the sixth day post transplant under tacrolimus treatment after 6 hours of red blood transfusion. PRES is a rare condition; it should be kept in mind about patients who have received organ transplants and develop sudden neurologic symptoms.


Assuntos
Transplante de Fígado/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/etiologia , Transfusão de Sangue , Pré-Escolar , Humanos , Imunossupressores/uso terapêutico , Doadores Vivos , Masculino , Tacrolimo/uso terapêutico
6.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315841

RESUMO

We present the case of a 30-year-old woman with posterior reversible encephalopathy syndrome (PRES) as a complication of pre-eclampsia in the early postpartum period. PRES is a rare neurological disorder which causes non-specific neurological symptoms such as headache, seizures and visual disturbances. It generally has a good prognosis, but severe complications can arise. Therefore, early recognition and treatment are paramount. Pre-eclampsia is a multiorgan disease and is associated with both maternal and foetal morbidity and mortality. Neurological symptoms occurring in the postpartum period indicate pre-eclampsia until proven otherwise. This case report was written to stress the attention on this rare complication of pre-eclampsia. When a patient in the postpartum period presents with a combination of seizures, disturbed vision and headache, PRES should always be kept in mind.


Assuntos
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/etiologia , Pré-Eclâmpsia/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/terapia , Período Pós-Parto , Gravidez , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Convulsões/etiologia , Resultado do Tratamento , Transtornos da Visão/etiologia
7.
Lupus ; 28(8): 961-969, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31208267

RESUMO

OBJECTIVE: The objective of this paper is to investigate the clinical features, outcomes, and risk factors for posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE). METHODS: From 2011 to October 2017, SLE patients with PRES were identified from the First Affiliated Hospital of Zhengzhou University, China. Patients presenting with neuropsychiatric lupus hospitalized in the same period were included as controls. Additionally, survival status was acquired via telephone follow-up in March 2018. RESULTS: Thirty episodes of PRES were identified in 29 SLE patients from a total of 7059 SLE patients (prevalence 0.43%). Patients with PRES had a younger age at onset than controls, with seizures more commonly the initial clinical manifestation (80.00% vs 42.37%, p = 0.001). Multiple logistic regression yet again confirmed several known risk factors, including younger age (odds ratio (OR) 1.15 (95% confidence interval (CI) 1.13-1.16)), nephritis (OR 20.74 (18.10-23.75)), history of hypertension (OR 1.17 (1.05-1.31)), SLE Disease Activity Index without neurologic symptoms (SLEDAI-N) score >12 (OR 1.14 (1.11-1.18)) and eclampsia (OR 9.38 (7.84-11.23)). Furthermore, we identified two novel independent risk factors for PRES in SLE: white blood cells >9 × 109/l (OR 2.33 (2.05-2.64)) and heart failure (OR 2.10 (1.18-2.42)). At follow-up, SLE patients with PRES had higher mortality than controls (30.77% vs 8.33%, respectively, p = 0.012). CONCLUSIONS: PRES may be a reversible neurological deficit in patients with SLE other than neuropsychiatric lupus. Our results indicate two new risk factors for PRES and that PRES is associated with a higher mortality rate.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Convulsões/etiologia , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Lúpus Eritematoso Sistêmico/mortalidade , Masculino , Análise Multivariada , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Avaliação de Sintomas , Adulto Jovem
8.
Medicine (Baltimore) ; 98(19): e15691, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083272

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES) has been associated with the use of several medications, including chemotherapeutic agents. PATIENT CONCERNS: A 65-year-old woman was diagnosed with adenocarcinoma of the ovary, after sixth-line treatment with topotecan, at the beginning of the fourth cycle, she was admitted to the emergency room for presenting tonic-clonic seizures, visual disturbance, and hypertension. A 66-year-old woman was diagnosed with bilateral breast cancer; due to disease progression, treatment with paclitaxel and gemcitabine was started, 1 month after the last dose of chemotherapy, she was admitted to the emergency room for suffering severe headache, altered mental status, tonic-clonic seizures, and hypertension. A 60-year-old patient diagnosed with breast cancer on the left side, underwent second-line chemotherapy with gemcitabine, carboplatin, and bevacizumab, and 1 month after the last dose of chemotherapy, she was also admitted to the emergency room due to altered mental status, vomiting, tonic-clonic seizures, and hypertension. DIAGNOSIS: They were diagnosed as PRES based on physical examination, laboratory findings, and imaging techniques that revealed diffuse lesions and edema within the parieto-occipital regions. INTERVENTIONS: They received support treatment with blood pressure (BP) control, seizures were controlled with a single anti-epileptic agent, and chemotherapeutic agents from the onset of PRES to its resolution were discontinued. OUTCOMES: All these patients improved after medical treatment was started. LESSONS: Medical personnel and therapeutic establishments need to be made aware about this chemotherapy-induced neurologic complication.


Assuntos
Antineoplásicos/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/etiologia , Idoso , Antineoplásicos/uso terapêutico , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/terapia
9.
Intern Med ; 58(15): 2225-2230, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996159

RESUMO

We herein report a case of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) that occurred immediately after blood transfusion. A 64-year-old Japanese woman was diagnosed with liver cirrhosis due to hepatitis B 2 years ago. She was admitted to our hospital with hemorrhagic shock due to esophageal variceal rupture. She was hospitalized with rapid blood pumping transfusion, after which consciousness disorder appeared, and her blood pressure suddenly increased. Magnetic resonance imaging revealed PRES and RCVS. We speculated that hypoalbuminemia and blood transfusion might have been involved in the development of PRES and RCVS.


Assuntos
Transtornos Cerebrovasculares/etiologia , Síndrome da Leucoencefalopatia Posterior/etiologia , Reação Transfusional , Pressão Sanguínea , Varizes Esofágicas e Gástricas/complicações , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Vasoconstrição/fisiologia
10.
Medicine (Baltimore) ; 98(16): e15187, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008940

RESUMO

RATIONALE: Eclampsia, an obstetric emergency frequently seen in pregnant or puerperal women, is a risk factor for posterior reversible encephalopathy syndrome (PRES). Most cases of eclampsia occur postpartum. We report a woman with PRES associated with eclampsia 10 weeks post-delivery, the latest onset ever reported. PATIENT CONCERNS: A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES. DIAGNOSIS: The patient was diagnosed as PRES associated with eclampsia. INTERVENTIONS: The patient received levetiracetam and edaravone. OUTCOMES: Her clinical course was uneventful and she fully recovered without neurological complications LESSONS:: The possible diagnosis of late onset postpartum eclampsia, even weeks post-delivery, should be considered, since initiation of early treatment averts severe complications and decreases mortality. Sharing our experience may increase awareness of PRES induced by late-onset postpartum eclampsia.


Assuntos
Eclampsia , Síndrome da Leucoencefalopatia Posterior/etiologia , Transtornos Puerperais/etiologia , Feminino , Humanos , Gravidez , Adulto Jovem
11.
Indian Pediatr ; 56(3): 244-246, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30955000

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a benign disorder of reversible subcortical vasogenic cerebral edema. CASE CHARACTERISTICS: A 13-yr-old girl presented 4 days after complete recovery from diabetic ketoacidosis with symptoms of headache, altered sensorium, seizures, and visual loss. There was no hypertension or biochemical abnormalities identified. MRI brain showed hyperintense areas in subcortical and periventricular white matter of bilateral fronto-parieto-occipetal lobes, with possible diagnosis of normotensive PRES. OUTCOME: Full recovery without sequelae, following neuro-protection and expectant treatment. MESSAGE: Identifying PRES in diabetic ketoacidosis assists appropriate treatment and prognostication.


Assuntos
Cetoacidose Diabética/complicações , Síndrome da Leucoencefalopatia Posterior , Adolescente , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Hipertensão/complicações , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/etiologia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia
13.
Eur J Paediatr Neurol ; 23(3): 384-391, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30837193

RESUMO

BACKGROUND AND OBJECTIVE: Nephrotic syndrome (NS) in childhood can be accompanied by serious neurological complications increasing the morbidity of disease. The study aimed to assess the spectrum of neurological complications in children with in terms of clinical presentation, contributory risk factors, and outcome. METHODS: In this systematic review, we searched for articles in PubMed, providing individual patient-level data for any neurological complication in children and adolescents with primary NS, between January 1, 1990 and April 30, 2018. FINDINGS: The search yielded 63 articles, involving 103 patients. Events occurred more frequently during nephrotic state relapses; 71.6% of cerebral thromboembolic (TE) events and 81.2% of posterior reversible encephalopathy (PRES) cases. Median duration of disease before a cerebral TE event was 3 months (IQR 0-27), and 18 months (IQR 1-37.5) for PRES. Among cases with TE, 73.1% presented with cerebral sinovenous thrombosis (CSVT), and 16.9% parenchymal lesions. 70% of patients had a risk factor for neurological complication including NS-associated thrombophilia, hypertension, and treatment with immunosuppressive agents. Outcome was favorable in 93.8% of the patients with PRES. In patients with cerebral TE outcome was favorable in 95.8% of the cases with CSVT only, and in 64.7% of the cases with parenchymal lesions. CONCLUSIONS: Neurological complications may occur in children with primary NS and risk factors during nephrotic state relapses. The outcome for PRES has been reported favorable. Outcome in cerebral TE events may differ by the presence of venous or artery infarct. Recognition of additional protrombotic state risk factors may help to lower the incidence of neurological complications.


Assuntos
Trombose Intracraniana/etiologia , Síndrome Nefrótica/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Trombose Intracraniana/epidemiologia , Masculino , Síndrome da Leucoencefalopatia Posterior/epidemiologia , Fatores de Risco
16.
Pediatr Blood Cancer ; 66(5): e27594, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30592147

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a distinct entity with incompletely known predisposing factors. The aim of this study is to describe the incidence, risk factors, clinical course, and outcome of PRES in childhood acute lymphoblastic leukemia (ALL). PROCEDURE: Patients aged 1.0 to 17.9 years diagnosed with ALL from July 2008 to December 2015 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol were included. Patients with PRES were identified in the prospective NOPHO leukemia toxicity registry, and clinical data were collected from the medical records. RESULTS: The study group included 1378 patients, of whom 52 met the criteria for PRES. The cumulative incidence of PRES at one month was 1.7% (95% CI, 1.1-2.5) and at one year 3.7% (95% CI, 2.9-4.9). Older age (hazard ratios [HR] for each one-year increase in age 1.1; 95% CI, 1.0-1.2, P = 0.001) and T-cell immunophenotype (HR, 2.9; 95% CI, 1.6-5.3, P = 0.0005) were associated with PRES. Central nervous system (CNS) involvement (odds ratios [OR] = 2.8; 95% CI, 1.2-6.5, P = 0.015) was associated with early PRES and high-risk block treatment (HR = 2.63; 95% CI, 1.1-6.4, P = 0.033) with late PRES. At follow-up of the PRES patients, seven patients had epilepsy and seven had neurocognitive difficulties. CONCLUSION: PRES is a neurotoxicity in the treatment of childhood ALL with both acute and long-term morbidity. Older age, T-cell leukemia, CNS involvement and high-risk block treatment are risk factors for PRES.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Recidiva Local de Neoplasia/terapia , Síndrome da Leucoencefalopatia Posterior/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Transplante de Células-Tronco/efeitos adversos , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Epilepsia/etiologia , Epilepsia/patologia , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Hipertensão/patologia , Lactente , Masculino , Recidiva Local de Neoplasia/patologia , Síndrome da Leucoencefalopatia Posterior/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prognóstico , Estudos Prospectivos , Fatores de Risco , Convulsões/etiologia , Convulsões/patologia
17.
Int J Neurosci ; 129(8): 808-813, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30590967

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome, reversible vasogenic edema predominantly within parieto-occipital regions. However, isolated brainstem involvement in PRES has been rarely reported, little is known about its clinical manifestations, radiological features and outcomes. We reported a case with PRES with only brainstem involvement and performed a systematic review of published cases. Twenty-four cases, together with our case, were included in the analysis. Mean age was 43 years and 63% were males. Hypertension (50%), nephropathy (25%) and chemotherapy (21%) were the major risk factors. All patients except two had acute hypertension and 50% of patients had renal dysfunction at onset. The most common symptoms were altered consciousness (46%) and headache (46%), Seizure was only presented in 21% of patients. All patients except two were treated with antihypertension. Most patients recovered to their neurological baseline. Clinicians should recognize this unique variant finding in PRES. which always affects males with severe hypertension, especially combined with renal dysfunction. Antihypertensive treatment is the most widely used therapy. Outcome is usually well.


Assuntos
Anti-Hipertensivos/uso terapêutico , Tronco Encefálico/patologia , Hipertensão/complicações , Nefropatias/complicações , Síndrome da Leucoencefalopatia Posterior , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/etiologia , Síndrome da Leucoencefalopatia Posterior/patologia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Adulto Jovem
18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 50(6): 1102-1107, 2018 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-30562790

RESUMO

This case report concerns a 22-year-old woman who had been diagnosed with systemic lupus erythematosus (SLE). She had intermittent fever, butterfly erythema, photosensitivity, oral ulcers, and multiple arthralgia in the past seven years, but she did not adhere to regular treatments. The edema of the lower extremities and face aggravated in the recent two weeks, so she was admitted to our Department of Rheumatology and Clinical Immunology. Meanwhile, we found she had severe hypertension, the maximal blood pressure was 170/120 mmHg. The patient had high SLE disease activity (the disease activity index score was as high as 23) with blood involvement, acute renal insufficiency, multiple serous effusion and rash. After one week treatments of intravenous methylprednisolone 80 mg daily and other drugs, her conditions made some extent improvement. However, she suffered sudden epileptic attacks. No positive neuropathological signs were found, and the blood pressure was up to 190/130 mmHg before the onset of the seizures. Her cerebrospinal fluid (CSF) pressure was 330 mmH2O, the CSF protein level was normal value, and the white blood cell count was 0 cell/mm3, with no signs of infection. Cranial MRI showed vasogenic edema at bilateral parietal, occipito-parietal regions, and centrum ovale. We prescribed drugs of decreasing intracranial pressure, intravenous drugs of decreasing blood pressure and midazolam for sedation, without corticosteroid impulse therapy. She recovered consciousness in the next day, without epilepsy recurrence. We eventually diagnosed it as posterior reversible encephalopathy syndrome (PRES), according to the history, laboratory results, imaging featuresand clinical outcome. PRES is a disorder of reversible subcortical vasogenic brain edema in patients with acute neurological symptoms (eg, seizures, encephalopathy, headache, and visual disturbances). PRES is mainly caused by blood pressure changes or endothelial injury, which lead to breakdown of the blood-brain barrier and subsequent brain edema. Most patients have a favourable prognosis. SLE complicated with PRES is not rare, especially in patients with disease activity, hypertension, lupus nephritis and/or renal insufficiency, and use of cytotoxic drugs, early recognition and appropriate treatment remain important. Brainstem involvement, intracranial hemorrhage, renal insufficiency and high disease activity of lupus are risk factors for poor prognosis.


Assuntos
Lúpus Eritematoso Sistêmico , Síndrome da Leucoencefalopatia Posterior , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Nefrite Lúpica , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/etiologia , Convulsões , Adulto Jovem
20.
BMC Neurol ; 18(1): 190, 2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30419835

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is described as a clinical-radiological disease entity with good prognosis. In brain MRI, PRES generally presents with vasogenic edema. Although PRES is induced by various causes, a small number of PRES cases have occurred after red cell blood transfusion. It is unclear whether there are characteristic features in PRES after blood transfusion. CASE PRESENTATION: Here, we report a case of 75-year-old Japanese woman who had acute exacerbation of subacute anemia by bleeding from gastric ulcer. After receiving a red cell blood transfusion, she showed disturbance of consciousness with extensive cytotoxic and small vasogenic edema in the occipitoparietal area on brain MRI. She was diagnosed as PRES and suffered irreversible impairments of visual acuity and fields in both eyes. We summarized and discussed clinical features of cases with PRES after blood transfusion. CONCLUSIONS: A total of 21 cases including the present one have been reported as PRES after blood transfusion. Of the cases, 20 of 21 were female, and 15 of 17 developed PRES in the course of chronic anemia lasting over 1 month. Anemia was severe in 15 of 20 cases, with hemoglobin levels < 3.5 g/dl. In 14 of 17 cases, hemoglobin levels increased to 5 g/dl by red cell blood transfusion until the onset of PRES. On brain MRI, 2 of 21 cases showed cytotoxic edema and 3 of 21 cases showed irreversible neurological disturbance. In this patient, the occurrence of PRES in subacute anemia and the presence of extensive cytotoxic brain edema with irreversible neurological deficits were characteristic points. When treating severe anemia, even with a subacute progression, we should consider a possibility that PRES occurs after blood transfusion with extensive cytotoxic brain edema and irreversible neurological changes.


Assuntos
Síndrome da Leucoencefalopatia Posterior/etiologia , Reação Transfusional/complicações , Idoso , Anemia/terapia , Edema Encefálico/etiologia , Transfusão de Eritrócitos/efeitos adversos , Feminino , Humanos , Imagem por Ressonância Magnética
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