Posterior reversible encephalopathy syndrome – A case report

  • Dejan Ž Kostić
  • Biljana Brkić-Georgievski Special Hospital for Cerebrovascular Diseases „Sveti Sava“, Belgrade, Serbia
  • Aleksandar Jovanovski Institute of Radiology Military Medical Academy, Belgrade, Serbia
  • Smiljana Kostić Clinic for Neurology Military Medical Academy, Belgrade, Serbia
  • Dražen Ivetić Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
  • Leposava Sekulović Institute of Radiology, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Keywords: brain diseases, syndrome, diagnosis, treatment outcome,

Abstract


Introduction. Posterior reversible encephalopathy syndrome (PRES) is characterized by the following symptoms: seizures, impaired consciousness and/or vision, vomiting, nausea, and focal neurological signs. Diagnostic imaging includes examination by magnetic resonance (MR) and computed tomography (CT), where brain edema is visualized bilaterally and symmetrically, predominantly posteriorly, parietally, and occipitally. Case report. We presented a 73-year-old patient with the years-long medical history of hipertension and renal insufficiency, who developed PRES with the symptomatology of the rear cranium. CT and MR verified changes in the white matter involving all lobes on both sides of the brain. After a two-week treatment (antihypertensive, hypolipemic and rehydration therapy) clinical improvement with no complications occurred, with complete resolution of changes in the white matter observed on CT and MR. Conclusion. PRES is a reversible syndrome in which the symptoms withdraw after several days to several weeks if early diagnosis is made and appropriate treatment started without delay.

Author Biography

Dejan Ž Kostić

asistent

kontakt telefon 063 69 69 79

 

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(8): 494−500.

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rab-instein AA. Posterior reversible encephalopathy syndrome: as-sociated clinical and radiologic findings. Mayo Clin Proc 2010; 85(5): 427−32.

Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 2008; 29(6): 1036−42.

Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol 2008; 29(6): 1043−9.

Legriel S, Pico F, Azoulay E. Understand ing posterior reversible encephalopathy syndrome. In: Vincent JL, editor. Annual Up-date in Intensive Care and Emergency Medicine. Berlin: Springer: 2011. p. 631−53.

Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol 1992; 159(2): 379−83.

Schwartz RB, Bravo SM, Klufas RA, Hsu L, Barnes PD, Robson CD, et al. Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol 1995; 165(3): 627−31.

Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcorti-cal lesions. AJNR Am J Neuroradiol 2000; 21(7): 1199−206.

Servillo G, Striano P, Striano S, Tortora F, Boccella P, De RE, et al. Posterior reversible encephalopathy syndrome (PRES) in criti-cally ill obstetric patients. Intensive Care Med 2003; 29(12): 2323−6.

Kozak OS, Wijdicks EF, Manno EM, Miley JT, Rabinstein AA. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology 2007; 69(9): 894−7.

Yoon SD, Cho BM, Oh SM, Park SH, Jang IB, Lee JY. Clinical and radiological spectrum of posterior reversible encephalopa-thy syndrome. J Cerebrovasc Endovasc Neurosurg. 2013; 15(3): 206−13.

Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spec-trum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008; 65(2): 205−10.

Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg 2010; 112(10): 886−91.

Legriel S, Schraub O, Azoulay E, Hantson P, Magalhaes E, Coquet I, et al. Determinants of recovery from severe posterior reversi-ble encephalopathy syndrome. PLoS One 2012; 7(9): e44534.

Marrone LC, Marrone BF, de la Puerta RJ, Gadonski G, da Costa JC. Gemcitabine monotherapy associated with posterior reversible encephalopathy syndrome. Case Rep Oncol 2011; 4(1): 82−7.

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(10): 2179−90.

Loh HH, Tan CH. Acute renal failure and posterior reversible encephalopathy syndrome following multiple wasp stings: a case report. Med J Malaysia 2012; 67(1): 133−5.

Luiz C, Porcello M. Posterior Reversible Encephalopathy Syn-drome Following a Scorpion Sting. J Neuroimaging 2013; 23: 535–6.

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(10): 2179−90.

McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, San-taCruz KS, et al. Posterior reversible encephalopathy syn-drome: incidence of atypical regions of involvement and imag-ing findings. AJR Am J Roentgenol 2007; 189(4): 904−12.

Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol 2002; 23(6): 1038−48.

Kastrup O, Schlamann M, Moenninghoff C, Forsting M, Goericke S. Posterior Reversible Encephalopathy Syndrome: The Spec-trum of MR Imaging Patterns. Clin Neuroradiol 2014; (In Press)

Lee S, Kim SH, Lee SH, Baek HJ, Shon HS, Kim SS. Serial MR spectroscopy in relapsing reversible posterior leukoencephalo-pathy syndrome. Neurologist 2009; 15(6): 338−41.

Alexander AL, Lee JE, Lazar M, Field AS. Diffusion tensor im-aging of the brain. Neurotherapeutics 2007; 4(3): 316−29.

Sonneville R, Klein IF, Wolff M. Update on investigation and management of postinfectious encephalitis. Curr Opin Neurol 2010; 23(3): 300−4.

Thurnher MM, Post MJ, Rieger A, Kleibl-Popov C, Loewe C, Schindler E. Initial and follow-up MR imaging findings in AIDS-related progressive multifocal leukoencephalopathy treated with highly active antiretroviral therapy. AJNR Am J Neuroradiol 2001; 22(5): 977−84.

McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syn-drome using susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012; 33(5): 896−903.

O'Sullivan M. Leukoaraiosis. Pract Neurol 2008; 8(1): 26−38.

Hugonnet E, Da Ines D, Boby H, Claise B, Petitcolin V, Lannareix V, Garcier JM. Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagn Interv Imag-ing 2013; 94(1): 45−52.

Culebras A, Kase CS, Masdeu JC, Fox AJ, Bryan RN, Grossman CB, et al. Practice guidelines for the use of imaging in transient ischemic attacks and acute stroke. A report of the Stroke Council, American Heart Association. Stroke 1997; 28(7): 1480−97.

Matthews PM, Tampieri D, Berkovic SF, Andermann F, Silver K, Chityat D, et al. Magnetic resonance imaging shows specific abnormalities in the MELAS syndrome. Neurology 1991; 41(7): 1043−6.

Pomper MG, Miller TJ, Stone JH, Tidmore WC, Hellmann DB. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. AJNR Am J Neuroradiol 1999; 20(1): 75−85.

Kallenberg K, Schulz-Schaeffer WJ, Jastrow U, Poser S, Meissner B, Tschampa HJ, et al. Creutzfeldt-Jakob disease: comparative analysis of MR imaging sequences. AJNR Am J Neuroradiol 2006; 27(7): 1459−62.

Published
2015/11/02
Section
Case report