Clinical spectrum of patients with posterior reversible encephalopathy syndrome

Authors

  • Sriramchandra Rahul Pulavarty Department of Internal Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India
  • Nagabhushana Midathala Department of Internal Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20204067

Keywords:

Posterior reversible encephalopathy syndrome, Eclampsia, Postpartum, Accelerated hypertension, Chronic kidney disease

Abstract

Background: Posterior reversible encephalopathy syndrome is a neurological disorder which can present with sudden onset headache, visual disturbances, seizures and altered sensorium which is potentially reversible with early detection and treatment of the precipitating factor. The range of presentations is being constantly widened and this endeavour is a step towards understanding the wide array of presentation and primary etiology.

Methods: This is a prospective observational study of 25 patients presenting to a tertiary care hospital with symptoms and imaging features suggestive of PRES. Thorough clinical examination and MRI brain were performed in all patients.

Results: Out of the 25 patients, 18 (72%) were females and 7 (28%) were males. Most common symptom was headache (84%) followed by seizures (56%), nausea (40%), visual blurring (36%) and altered sensorium (20%). In patients presenting with seizure, 28.57% had recurrent seizures.

The most common precipitating cause was postpartum state without hypertension (40%) followed by accelerated hypertension (28%), eclampsia (16%), chronic kidney disease (12%) and one patient of chronic severe anaemia had PRES following blood transfusion (4%). Most of the patients improved with no residual neurological deficit.

Conclusions: Good neurological outcomes can be achieved by early diagnosis and appropriate imaging in patients with PRES. In pregnant and postpartum patients, PRES should be always considered even with normal blood pressure. Rapid correction of chronic severe anaemia is a rare but preventable cause of PRES.

References

Hinchey J, Chaves C, Appignani B, Breen J, Pao L,Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494-500.

Ito Y, Niwa H, Iida T, Nagamatsu M, Yasuda T, Yanagi T, et al. Post-transfusion reversible posterior leukoencephalopathy syndrome with cerebral vasoconstriction. Neurology 1997;49:1174-5.

Ito Y, Arahata Y, Goto Y, Hirayama M, Nagamatsu M, Yasuda T, et al. Cisplatin neurotoxicity presenting as reversible posterior leukoence-phalopathy syndrome. Am J Neuroradiol. 1998;19:415-7.

Jarosz JM, Howlett DC, Cox TC, Bingham JB. Cyclosporine-related reversible posterior leukoencephalopathy: MRI. Neuroradiology 1997;39:711-5.

Ay H, Buonanno FS, Schaefer PW, Le DA, Wang B, Gonzalez RG, et al. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology. 1998;51:1369-76.

Mathy I, Gille M, Van Raemdonck F, Delbecq J, Depre A. Neurological complications of intravenous immunoglobulin (IVIg) therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature. Acta Neurol Belg. 1998;98:347-51.

Lanzino G, Cloft H, Hemstreet MK,West K, Alston S, Ishitani M. Reversible posterior leukoencephalopathy following organ transplantation. Description of two cases. Clin Neurol Neurosurg 1997;99:222-6.

Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalo-pathy syndrome. Arch Neurol. 2008;65:205-10.

Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 2006;27:2179-90.

Lin JT, Wang SJ, Fuh JL, Lian-Tsai H, Jiing-Feng L, Po-Min C. Prolonged reversible vasospasm in cyclosporin A-induced encephalopathy. AJNR Am J Neuroradiol. 2003;24(1):102-4.

Schwartz RB. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(26):1743.

Yadav PK, Sen D. Clinicoradiological Profile and Outcome of Patients with Posterior Reversible Encephalopathy Syndrome. J Assoc Physicians Indian. 2019;67(1):13-6.

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85:427-32.

Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol. 2012; 259(1):155-64.

Rodgers GM, Taylor RN, Roberts JM. Preeclampsia is associated with a serum factor cytotoxic to human endothelial cells. Am J Obstet Gynecol. 1988;159:908-14.

Patil VC, Agrwal V, Rajput A, Garg R, Kshirsagar K, Chaudhari V. Clinical profile and outcome of posterior reversible encephalopathy syndrome (PRES). Ann Trop Med Public Health. 2015;8:105-12.

Boughammoura A, Touze E, Oppenheim C, Trystram D, Mas JL. Reversible angiopathy and encephalopathy after blood transfusion. J Neurol. 2003;250:116-8.

Heo K, Park SA, Lee JY, Lee BI, Lee SK. Post-transfusion posterior leukoencephalopathy with cytotoxic and vasogenic edema precipitated by vasospasm. Cerebrovasc Dis. 2003;15:230-3.

Huang YC, Tsai PL, Yeh JH, Chen WH. Reversible posterior leukoencephalopathy syndrome caused by blood transfusion: a case report. Acta Neurologica Taiwan. 2008;17:258-62.

Sato Y, Hirose M, Inoue Y, Komukai D, Takayasu M, Kawashima E, et al. Reversible posterior leukoencephalopathy syndrome after blood transfusion in a patient with end-stage renal disease. Clin Exp Nephrol. 2011;15:942-7.

Downloads

Published

2020-09-22

Issue

Section

Original Research Articles