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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
4.
BMJ Case Rep ; 12(7)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300598

RESUMO

A 61-year-old Caucasian woman with a history of hypertension presented with a week's history of confusion falls and back pain was found to have hyponatraemia from secretion of antidiuretic hormone and treated appropriately. Given her persistent symptoms, despite a normal CT head on presentation, an MRI head was obtained, showing vasogenic oedema in line with posterior reversible encephalopathy syndrome (PRES). Despite aggressive antihypertensives and supportive measures, unfortunately, her condition deteriorated, with increased confusion, new left-sided flaccid paresis, paraesthesias and worsening of the back pain. Following further testing including a cerebrospinal fluid analysis, finally diagnosed with an atypical presentation of Guillain-Barre syndrome (GBS), and prompt management with intravenous immunoglobulins was initiated. She recovered clinically and returned to near-normal function on follow-up. We use this case to suggest the importance of dysautonomia in GBS and various clinical manifestations it can present with, including PRES and hyponatraemia.


Assuntos
Síndrome de Guillain-Barré/diagnóstico , Hiponatremia/fisiopatologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Acidentes por Quedas , Confusão/etiologia , Feminino , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Hiponatremia/tratamento farmacológico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-31152638

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is one of the most serious complication after allogeneic stem cell transplantation in paediatric setting. It is most commonly reported as adverse event of immunosuppressive strategies during transplantation. We present a case of a 7 years old girl with myelodysplastic syndrome (MDS) treated with allogeneic stem cell transplantation (ASCT) at our department. Diagnosis of PRES was confirmed by imaging techniques during the first month after transplant and it was very likely connected with cyclosporine neurotoxicity. The aim of this article is to present our first experience in diagnosing and treating PRES in paediatric stem cell transplantation. Our experience showed that PRES is one of the reasons for higher transplant related mortality in children. Early prediction of factors contributing to PRES and closely monitoring of patient's vital signs, especially blood pressure, neurological status and vision are the main contributors for challenging the patient with another immunosuppressive agent that has less neurological toxicity. Still studies have to be initiated to confirm the influence of PRES on transplant outcome.


Assuntos
Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Síndromes Mielodisplásicas/terapia , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Criança , Ciclosporina/uso terapêutico , Evolução Fatal , Feminino , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Síndromes Neurotóxicas/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Transplante de Células-Tronco/métodos , Transplante Homólogo/métodos
6.
BMC Med Imaging ; 19(1): 35, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039748

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a rare clinic-radiological entity characterized by headache, an altered mental status, visual disturbances, and seizures. Reversible splenial lesion syndrome (RESLES) is a new clinic-radiological syndrome characterized by the presence of reversible lesions with transiently restricted diffusion (cytotoxic edema) in the splenium of the corpus callosum (SCC) on magnetic resonance (MR) images. Here we report a rare case involving a 23-year-old pregnant woman with eclampsia who sequentially developed PRES and RESLES. CASE PRESENTATION: The patient, a 23-year-old pregnant woman, presented with sudden-onset headache, dizziness, and severe hypertension (blood pressure, 170/110 mmHg). Brain MR imaging (MRI) revealed T2 hyperintense lesions in the posterior circulation territories. Immediate cesarean section was performed, and the patient received intravenous infusion of mannitol (125 ml, q8h) for 8 days for the treatment of PRES. Ten days later, or 1 day after the discontinuation of mannitol, T2-weighted MRI showed that the hyperintense lesions (vasogenic edema) had disappeared. However, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping revealed an isolated lesion in the splenium of the corpus callosum (SCC) that was accompanied by restricted diffusion (cytotoxic edema); these findings indicated reversible splenial lesion syndrome (RESLES). Five days after the discontinuation of mannitol, she had no abnormal symptoms and was discharged from our hospital. Brain MRI performed 29 days after the clinical onset of symptoms showed no abnormalities. CONCLUSION: The sequential occurrence of the two reversible diseases in our patient prompted us to propose a novel pathogenesis for RESLES. Specifically, we believe that the vasogenic edema in PRES was reduced with mannitol treatment, which increased the hyperosmotic stress and opened the blood-brain barrier; meanwhile, upregulation of aquaporin-4 expression secondary to the increased osmotic pressure resulted in cytotoxic edema in the astrocytes in SCC (RESLES). Further research is necessary to confirm this possible pathogenesis.


Assuntos
Corpo Caloso/efeitos dos fármacos , Eclampsia/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Cesárea , Corpo Caloso/patologia , Imagem de Difusão por Ressonância Magnética , Eclampsia/tratamento farmacológico , Serviços Médicos de Emergência , Feminino , Humanos , Manitol/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Gravidez , Resultado do Tratamento , Adulto Jovem
7.
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
8.
Acta Neurochir (Wien) ; 161(2): 217-224, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30659351

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis. Despite initial conservative therapy including anti-epileptic drugs, magnesium therapy, empiric antibiotics, and Trendelenburg positioning, the patient continued to deteriorate. Follow-up imaging was suggestive of PRES with signs of intracranial hypertension. The patient underwent a decompressive suboccipital craniectomy for refractory and severe PRES and later fully recovered. This case highlights the sometimes difficult diagnosis of PRES, possible association with pregnancy, eclampsia/preeclampsia and/or cerebrospinal fluid drainage, and the rare but life-saving need for decompression in severe cases.


Assuntos
Craniectomia Descompressiva , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Período Pós-Parto , Adulto , Feminino , Humanos , Pressão Intracraniana , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/cirurgia , Gravidez
9.
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.
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
13.
Acta pediatr. esp ; 76(11/12): e170-e173, nov.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177431

RESUMO

El síndrome de encefalopatía posterior reversible es una entidad clinicorradiológica cada vez más conocida en la práctica diaria pediátrica, pero puede presentarse con una sintomatología neurológica muy diversa (cefalea, alteración del nivel de conciencia, pérdida de visión, crisis convulsivas, etc.), generalmente asociada a un cuadro de hipertensión arterial o insuficiencia renal. Para su diagnóstico se utilizan actualmente pruebas de imagen, como la resonancia magnética, con una elevada sensibilidad, la tomografía computarizada y el electroencefalograma. Su manejo radica en el tratamiento de las crisis y el control de la presión arterial, además de la eliminación de los factores predisponentes, y suele tener un buen pronóstico, con una resolución completa del cuadro en días o semanas


Posterior reversible encephalopathy syndrome is a clinical-radiological entity that is increasingly known in pediatric practice but it can be presented with a diverse neurological clinic (headache, altered consciousness level, loss of vision, seizures, etc.), usually associated to an episode of hypertension or renal failure. Imaging tests such as magnetic resonance, with greater sensitivity, and computed tomography or electroencephalogram are currently used for diagnosis. Its management is based in seizures treatment and control of blood pressure in addition to the elimination of predisposing factors and it usually has a good prognosis with a complete resolution of the episode in days or weeks


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Prognóstico , Hipertensão/diagnóstico , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Tomografia Computadorizada de Emissão , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Hipertensão/terapia , Imunossupressores/administração & dosagem , Diagnóstico Diferencial , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Edema/diagnóstico por imagem , Edema/patologia
14.
Ugeskr Laeger ; 180(37)2018 Sep 10.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30259830

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a complex clinical condition with a wide clinical spectrum. In this report two cases illustrate two different onsets. The first patient presented with general seizures, whereas the other presented with symptoms of pre-eclampsia, which developed into sudden blindness. Both patients had uneventful caesarean sections performed, with delivery of healthy children. Due to CT scans of the cerebrum, correct treatment and diagnosis were delayed in both cases, but subsequently, PRES was confirmed by MRI. Both patients were discharged in good health.


Assuntos
Síndrome da Leucoencefalopatia Posterior , Adulto , Cegueira/etiologia , Cesárea , Feminino , Humanos , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Gravidez , Complicações na Gravidez , Convulsões/etiologia , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 120: 532-536, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30261399

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic condition that manifests with heterogeneous clinical findings, including altered mental status, seizure, vision loss, and vomiting. It characteristically leads to diffuse subcortical vasogenic edema, most commonly in the parieto-occipital regions. Although frequently reported with conditions such as hypertension, eclampsia, sepsis, electrolyte imbalances, autoimmune diseases, and immunosuppressive therapy, PRES may rarely occur after surgery for posterior fossa tumors. In the postsurgical setting, clinical features of PRES usually develop intraoperatively or in the immediate postoperative period. Delayed presentation months after the surgery has not been reported earlier. CASE DESCRIPTION: A 23-year-old woman who underwent surgery for vestibular schwannoma 8 months earlier presented with altered sensorium, generalized seizures, and high blood pressure. Common possibilities were ruled out by clinical history, diagnostic imaging, and appropriate blood tests. Radiologic imaging revealed rapid recurrence of tumor with diffuse subcortical edema involving both hemispheres. The patient showed complete neurologic recovery with antihypertensive and antiepileptic drugs. CONCLUSIONS: PRES is a rare but important cause of acute neurologic deterioration following posterior fossa tumor surgery. Prompt diagnosis and aggressive treatment often lead to complete neurologic recovery.


Assuntos
Neuroma Acústico/cirurgia , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Anticonvulsivantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Neuroma Acústico/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
BMJ Case Rep ; 20182018 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-29991547

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by parieto-occipital vasogenic oedema seen on MRI. Infection and sepsis has been reported as a possible cause for this disorder.We present a 19-year-old immunocompetent Caucasian man with known type 1 diabetes mellitus who presented to the emergency department with acute onset of bilateral visual loss, headaches and hypertension; he had been discharged 2 weeks ago for severe diabetic ketoacidosis and Staphylococcus aureus bacteraemia. Initial CT scan of the head was negative, but MRI showed findings suggestive of PRES. He was treated with nicardipine drip for strict blood pressure management and symptoms resolved within 4 days. PRES is a rare disease that has been increasingly reported as MRI becomes more commonplace. Usually associated with immunological disease, pre-eclampsia and cytotoxic therapies but an association with sepsis due to gram-positive bacteria.


Assuntos
Síndrome da Leucoencefalopatia Posterior/etiologia , Sepse/complicações , Anticonvulsivantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Encéfalo/diagnóstico por imagem , Cetoacidose Diabética/complicações , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Levetiracetam , Imagem por Ressonância Magnética , Masculino , Nicardipino/uso terapêutico , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
JAAPA ; 31(7): 31-34, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29957604

RESUMO

Posterior reversible encephalopathy syndrome is a characteristic clinical-radiographic syndrome with diverse and multifactorial causes. Symptoms include headache, altered mental status, seizures, nausea and vomiting, and vision abnormalities. The syndrome is treated by lowering BP, administering anticonvulsant medications, correcting metabolic abnormalities, and removing offending agents. Secondary complications include ischemia, hemorrhage, and cerebral infarction.


Assuntos
Anticonvulsivantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Encéfalo/patologia , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Convulsões/tratamento farmacológico , Convulsões/etiologia
18.
J Pediatr Hematol Oncol ; 40(6): 433-437, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29697577

RESUMO

Posterior reversible encephalopathy syndrome (PRES) has diverse etiologies and is closely linked to hematopoietic stem cell transplant (HSCT). Headache and seizures are the most common clinical presentations. Although near total recovery is seen in the majority of patients with appropriate management, the implications of its occurrence in the setting of an HSCT is much more than the residual neurological deficits. Graft rejection and occurrence of graft versus host disease has been reported. We analyzed retrospectively our data of 35 pediatric HSCT recipients over the last 2 years at our center. In total, 17% (n=6) patients developed PRES. Headache and seizures were the most common clinical presentations. All patients were on calcineurin inhibitors at the onset of symptoms. The median time after HSCT to the onset of PRES was 21 days. In total, 34% (n=2) patients developed residual neurological deficit. One patient died of acute graft versus host disease at a later date, and 50% (n=3) patients had graft rejection and return to transfusion dependence. The implications of PRES on HSCT outcomes are grave, and better immunosuppression transition protocols need to be developed.


Assuntos
Inibidores de Calcineurina/administração & dosagem , Rejeição de Enxerto/tratamento farmacológico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Criança , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/mortalidade , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/mortalidade , Humanos , Masculino , Síndrome da Leucoencefalopatia Posterior/etiologia , Síndrome da Leucoencefalopatia Posterior/mortalidade , Estudos Retrospectivos
19.
Neurologist ; 23(2): 65-66, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29494439

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a potentially reversible failure of cerebral autoregulation managed by correction of hypertension or underlying medical condition. Nonresponding cases progress to irreversible brain damage. There is some evidence of association of hypomagnesemia with PRES. We describe a case of nonresolving PRES where use of magnesium sulfate led to improvement in neurological function and eventual recovery. Our case highlights the need for a randomized controlled trial to test the efficacy of magnesium in PRES.


Assuntos
Fármacos Cardiovasculares/farmacologia , Sulfato de Magnésio/farmacologia , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Adulto , Fármacos Cardiovasculares/administração & dosagem , Humanos , Sulfato de Magnésio/administração & dosagem , Masculino , Resultado do Tratamento
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