MR Imaging in Eclampsia

Background : The aim of this study is to determine the distribution and nature of Cranial MRI findings in eclamptic patients, and to correlate them with clinical and laboratory data. Materials and Methods : This study was conducted in the Department of Obstetrics and Gynecology in Sri Ramachandra Institute of Higher Education and Research. A total number of 35 Eclamptic patients were included in this study and they were analyzed retrospectively. Laboratory parameters, Blood Pressure and Cranial MRI was performed for all and the same were analyzed statistically. Results : Out of 35 Eclamptic patients, MR Imaging was normal in 6 patients. Among the 29 patients with abnormal MRI, Cortical-subcortical Lesion, appeared iso/hypo-intense in T-1 weighted images and hyper intense in T-2 weighted images. In most of the patients, occipital lobe was involved followed by involvement of other lobes such as Parietal, Frontal, Temporal, Basal Ganglia and Cerebellum. When patients with and without positive MRI findings were compared regarding clinical features such as Headache, Blurred Vision, Nausea and Vomiting, Epigastric Pain, Loss of Consciousness, Reduced Urine Output there was no statistically significant difference between the two groups. Similarly, there was no statistical difference in mean arterial pressures between MRI positive and MRI negative patients (p=0.218) however, it was found that those with MR imaging positive features had a higher Blood Pressure than those with MRI negative findings. Among the laboratory parameters, in the patients with abnormal MRI findings Fibrinogen was found to be significantly low than those with normal MRI findings (p=0.0002).

Posterior reversible encephalopathy syndrome in solid organ transplant recipients: a report of 3 cases with a literature review / 中华器官移植杂志

This review summarizes the clinical data of one pediatric liver transplant recipient and two adult kidney transplant recipients with posterior reversible encephalopathy syndrome(PRES)at Tongji Hospital of Huazhong University of Science & Technology.The relevant clinical characteristics of recipients are discussed for providing reference for clinical diagnoses and treatments.

DELAYED PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN POSTPARTUM PERIOD

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological entity which presents with diverse neurological symptoms ranging from headache, seizure, visual symptoms with altered consciousness and focal signs. The hallmark of this condition is its reversibility. The etio- pathogenesis is attributed to vasogenic cerebral oedema seen in occipital and parietal lobes of brain. We hereby present this case of a multiparous lady presenting with altered sensorium postpartum. Characteristic findings on imaging helped us to form the diagnosis of PRES in this patient

Super refractory status epilepticus in a parturient with preeclampsia undergoing cesarean delivery under spinal anesthesia

Super refractory status epilepticus (SRSE) is a rare but serious neurological emergency. This case report aims to highlight the challenges faced during the diagnosis and management of SRSE in a 36-year-old preeclamptic patient taken for cesarean delivery under spinal anesthesia. The patient developed a seizure episode minutes after administration of intrathecal bupivacaine, necessitating administration of general anesthesia. Postoperatively, SRSE developed which did not respond to multiple anti-epileptics and thiopentone sodium infusion. Although the clinical picture and magnetic resonance imaging findings supported the diagnosis of posterior reversible encephalopathy syndrome, the role of intrathecal bupivacaine in causing SRSE could not be ruled out due to the temporal association of events. The patient had a prolonged and complicated hospital stay and despite a multimodal approach to the treatment, suffered neurological sequelae.

Posterior reversible encephalopathy syndrome in pregnancy: A case series of 5 cases

Posterior reversible encephalopathy syndrome (PRES) is a rare clinic-radiological syndrome associated with acute changes in blood pressure during pregnancy. It is characterized symptomatically by headache, seizures, altered mental status, and visual blurring. Radiological changes are white matter vasogenic edema affecting the occipital and parietal lobes of the brain. It is being increasingly recognized due to increased institutional deliveries and advances in imaging particularly magnetic resonance imaging (MRI). Despite the increasing detection, the prediction of PRES and patient factors affecting susceptibility is still not clear. Hence, we conducted a retrospective study to analyze the factors associated with PRES at our tertiary care center.

Spontaneous intracranial hypotension associated with posterior reversible encephalopathy syndrome

Spontaneous intracranial hypotension (SIH) is usually due to cerebrospinal fluid (CSF) leak, resulting in loss of CSF volume. Posterior reversible encephalopathy syndrome (PRES) is the inability of the posterior circulation of the brain to autoregulate in response to significant variation in blood pressure.Altered perfusion with associated blood-brain barrier disruption may lead to vasogenic edema, usually without infarction, commonly in the parieto-occipital regions. Magnetic resonance (MR) imaging of the brain and spine and cerebral MR venography are essential tools for diagnosing clinically suspected SIH and PRES. We present 18-year-young gentleman with clinical and radiological signs of SIH, which later evolved toward PRES.

Cardiac Tamponade an Unusual Presentation of SLE — A Case Report

Systemic Lupus Erythematous (SLE) is an immune mediated disease, having variety of clinical manifestations but Cardiac Tamponade is rare as initial presentation. We are presenting an unusual case of cardiac tamponade as initial manifestation of SLE, which was also associated with Mitral Valve Vegetation, Posterior Reversible Encephalopathy Syndrome (PRESS); successfully responded to Pericardiocentesis, Steroids and Antimalarials

Imaging manifestations of central nervous system complications after heart transplantation / 器官移植

Heart transplantation is the main treatment of end-stage heart failure. With the advancement of heart transplantation and rational use of postoperative immunosuppressants, the survival rate of recipients has been gradually enhanced. However, a variety of central nervous system complications may still occur following heart transplantation, including immunosuppressant-associated neurotoxicity, epilepsy, stroke, encephalopathy, central nervous system infection and de novo malignant tumors in the central nervous system. These complications will severely affect the quality of life of heart transplant recipients. Consequently, prompt imaging diagnosis plays a significant role in the prevention and treatment of central nervous system complications. In this article, main imaging manifestations of central nervous system complications after heart transplantation were reviewed, aiming to provide reference for prompt diagnosis and differential diagnosis of complications, guide clinical treatment and management, and improve the long-term prognosis of the recipients.

Emergencias hipertensivas neurológicas Aproximación diagnóstica y terapéutica con base en imágenes por resonancia magnética / Hypertensive neurological emergencies Diagnostic approach and treatment based on magnetic resonance imaging

RESUMEN El diagnóstico y el tratamiento de las complicaciones cerebrales de la emergencia hipertensiva constituyen un reto para los médicos de urgencias y terapia intensiva. Mediante una aproximación diagnóstica basada en las diferentes secuencias de las imágenes por resonancia magnética se llega al diagnóstico de encefalopatía hipertensiva, isquemia cerebral, hemorragia intracraneal, hemorragia subaracnoidea aneurismática, síndrome de encefalopatía posterior reversible y a su inmediato tratamiento ajustado a nuestro medio según las últimas guías de práctica clínica de la AHA/ASA (Asociación Americana del Corazón y Asociación Americana de Ataque Cerebrovascular).

SUMMARY The diagnosis and treatment of brain injury in patients with hypertensive emergencies is a challenge for the emergency department and intensive care doctors. The diagnosis of hypertensive encephalopathy, ischemic stroke, intracranial hemorrhage, aneurysmal subarachnoid hemorrhage and posterior reversible encephalopathy syndrome is achieved with different MRI sequences as well as their appropriate treatment according to the last AHA/ASA clinical practice guidelines.

A study of posterior reversible encephalopathy syndrome in patients with eclampsia

Background: The association of posterior reversible encephalopathy syndrome with eclampsia has recently received a lot of attention recently. Advances in Imaging has led to better understanding of the pathophysiology of eclampsia. Present study was undertaken to study the clinical characteristics of patients with eclampsia with PRES.Methods: This is a prospective observational study of 50 cases of Eclampsia with PRES in a period of 1 year. Patients admitted with Eclampsia were subjected to neuroimaging with CT or MRI and those with diagnosis of Posterior Reversible Encephalopathy Syndrome were included in the study and clinical profile analyzed.Results: Total of 50 patients were studied in the period of 1 year. The average age of patients was 21.8 years, majority of them residing in rural areas (74%) and 72% were referred cases.Conclusions: PRES is now identified as core component of Eclampsia. More studies are required to compare the outcome of Eclampsia associated with PRES and without PRES.

Síndrome de encefalopatía posterior reversible. Presentación radiológica atípica / Posterior Reversible Encephalopathy Syndrome. Atypical radiological presentation / Síndrome de encefalopatia posterior reversível (PRES), apresentação radiológica atipica

Resumen: Introducción: El síndrome de encefalopatía posterior reversible (PRES por las siglas en inglés Posterior Reversible Encephalopathy Syndrome) es una entidad clínica caracterizada por cefalea, alteraciones visuales y crisis convulsivas. Ésta es una entidad subdiagnosticada, que tiene como fisiopatología la alteración del vaso de regulación cerebral y se puede presentar en féminas gestantes, lo que puede llegar a confundirse con eclampsia. Caso clínico: Paciente de 20 años sin antecedentes patológicos, con embarazo de término normoevolutivo. Presentó ruptura prematura de membranas e ingresó para conducción de trabajo; se preparó a la paciente para analgesia obstétrica; sin embargo, previamente al procedimiento presentó crisis convulsivas de características tonicoclónicas generalizadas. Se realizó un manejo avanzado de la vía aérea y se realizó una cesárea de urgencia; se obtuvo producto único vivo y fue ingresada a la Unidad de Cuidados Intensivos. El perfil toxémico no reportó alteraciones y la tomografía computarizada inicial no mostró alteraciones estructurales. Se le retiró a la paciente la ventilación mecánica 12 horas después. Se realizó una resonancia magnética que mostró en fase T2, hiperintensidad subcortical parieto-occipital derecho. Permaneció en vigilancia y fue egresada a piso sin complicaciones ni secuelas neurológicas. Conclusiones: El tratamiento del PRES va enfocado al control de la presión arterial, y el soporte orgánico y metabólico. No todos los enfermos con PRES se recuperan neurológicamente ad integrum; sin embargo, la proporción de pacientes que cursan sin secuelas es mayor en pacientes obstétricas. La resonancia magnética es el estudio de elección; el hallazgo característico es el edema simétrico de la materia blanca en la región occipital de los hemisferios cerebrales, en particular las regiones parieto-occipitales, no obstante, existen otro tipo de presentaciones radiológicas.

Abstract: Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical entity characterized by headache, visual disturbances and convulsive seizures. It is a sub-diagnosed entity that, due to its trigger being cerebral vasoregulation disorders, may present in pregnant women, which may be confused with eclampsia. Clinical case: Patient of 20 years of age, without pathological antecedents, with term pregnancy, evolutionary norm. Who enters by exit of mucous plug, followed by premature rupture of membranes, so it is admitted for conduction of labor, however presents convulsive crisis, generalized clonic tonic. Advanced airway management is decided, and an emergency caesarean section is performed, obtaining a single live product, and the patient is admitted to the ICU. His toxemic profile was reported without alterations, his initial CT scan without structural alterations, and mechanical ventilation was removed twelve hours later. MRI is performed where subcortical right parieto-occipital hyperintensity is observed, being kept under surveillance and graduated to floor without complications. Conclusions: The treatment of PRES syndrome is focused on organic and metabolic supports and mainly on tension Figures. Not all are reversible, however, the pregnant patient is more frequent than present evolution without sequelae. Magnetic resonance is the study of choice for this clinical entity, and the typical findings are symmetrical edema of white matter in the posterior cerebral hemispheres, particularly the parieto-occipital regions, but there are variations.

Resumo: Introduçao: A síndrome da encefalopatia posterior reversível (PRES) é uma entidade clínica caracterizada por dor de cabeça, distúrbios visuais e convulsões. É uma entidade subdiagnosticada, cuja fisiopatologia é a alteração do vaso de regulação cerebral, pode ocorrer em mulheres grávidas, o que pode ser confundido com eclampsia. Caso clínico: Paciente de 20 anos, sem antecedentes patológicos, com gestação á término e evolução normal. Apresentou ruptura prematura de membranas e ingressou para indução do trabalho de parto, preparou-se para analgesia obstétrica, porém antes do procedimento apresentou convulsões com características tônicas clônicas generalizadas. Foi realizado manejo avançado das vias aéreas e cesariana de emergência, obtendo-se um único produto vivo, e foi admitida na Unidade de Terapia Intensiva. O perfil toxémico não relatou alterações, a tomografia computadorizada inicial não mostrou alterações estruturais e a ventilação mecânica foi removida doze horas depois. Foi realizada ressonância magnética que mostrou na fase T2, hiperintensidade subcortical parieto-occipital direita. A paciente permaneceu sob vigilância e recebeu alta sem complicações ou sequelas neurológicas. Conclusões: O tratamento do PRES, está focado no controle da pressão arterial, suporte orgânico e metabólico. Nem todos os pacientes com PRES se recuperam neurologicamente ad integrum, no entanto, a proporção de pacientes que não apresentam sequelas é maior em pacientes obstétricos. A ressonância magnética é o estudo de eleição; o achado característico é edema simétrico de substância branca na região occipital dos hemisférios cerebrais, particularmente regiões parietooccipitais, porém existem outros tipos de apresentações radiológicas.

Posterior reversible encephalopathy syndrome in preeclampsia

Background: Posterior reversible encephalopathy is a clinico-radiological syndrome marked by headache, altered mental status, seizures, visual disturbances, and extensive white-matter changes, also known as hyper perfusion encephalopathy, brain capillary leak syndrome, and hypertensive encephalopathy. This syndrome was a possible consequence of several medical conditions but especially in pregnancy it is associated with pre-eclampsia and eclampsia. Objective of this study was to know the incidence and analyze the clinical features, biochemical, and radiological abnormalities in posterior reversible encephalopathy syndrome (PRES) as a complication of preeclampsia.Methods: This was a one-year cross-sectional analytical study conducted at NRI general hospital, Chinakakani, Guntur of patients with the diagnosis of PRES. Data was obtained from medical records and analyzed them in terms of mean for continuous variables and percentages for categorical data.Results: Total no of patients diagnosed as PRES were 16 out of 127 patients of preeclampsia. Among them, 14 presented with eclampsia, and two presented with severe preeclampsia and imminent symptoms of eclampsia. Headache was the most common symptom (100%). PRES occurred at a peak SBP of ≥160 mmHg in 75% cases and peak DBP of ≥110 mmHg in 50% cases. Serum lactate dehydrogenase (LDH) level was ≥600 in 56.25% and serum uric acid level ≥6 in 50% of patients of PRES. The drug of choice was magnesium sulfate.Conclusions: Neuroimaging abnormality is a definitive component in the diagnosis of PRES. These cerebral abnormalities are vital components in the pathogenesis of eclampsia. Considerable number of patients of preeclampsia might develop PRES even without eclampsia, with mild elevation in BP, serum LDH, and serum uric acid levels.

Simultanagnosia as a cause of visual disturbance following Posterior Reversible Encephalopathy Syndrome (PRES): A case report

Simultanagnosia resulting from dorsal stream dysfunction is an under recognized condition. In this case report we describe the case of a young woman who developed posterior reversible encephalopathy syndrome (PRES), and who recovered visual acuities of 20/20 in each eye, along with normal visual fields and contrast sensitivities, yet experienced persistent symptoms of perceptual dysfunction. Detailed and systematic history taking revealed consistent visual difficulties typical of dorsal stream dysfunction. After a detailed explanation of her symptomatology and training in a range of strategies to cope, the patient experienced a great improvement in her day-to-day functioning.

Reversible cerebral vasoconstriction syndrome presenting as convexity subarachnoid hemorrhage and posterior reversible encephalopathy syndrome during postpartum: A case report and literature review

@#Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache and reversible cerebral vasoconstriction, with other neurologic signs and symptoms. To the best of our knowledge, there were only a few cases of RCVS presenting both as both convexity subarachnoid hemorrhage (cSAH) and posterior reversible encephalopathy syndrome (PRES). Herein, we report a case of a 32-year-old woman with RCVS who presented with recurrent thunderclap headaches that occurred 50 days after delivery, with cSAH and PRES on magnetic resonance imaging (MRI). She had significant clinical and radiological recovery on 3 months’ follow-up. The clinical coexistence of cSAH and PRES in our case with RCVS is quite rare. This case illustrates the importance of awareness of the diagnosis of RCVS among clinicians even when initial brain and vascular imaging are normal. Early diagnosis and treatment are crucial for better prognosis.

Exercise-induced acute renal failure with posterior reversible encephalopathy syndrome

@#Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, mental changes, epileptic seizures, visual disturbances, and transient changes in the posterior circulation system of the brain. Rhabdomyolysis is a clinical condition characterized by muscle pain, weakness, dark-colored urine, and elevated creatine kinase levels. The common causes of rhabdomyolysis are trauma, excessive fatigue and intense exercise. A 23-year-old male soldier developed rhabdomyolysis-induced acute kidney injury after intense exercise and secondary PRES. The patient also had generalized convulsive seizures. There is no similar case of PRES from acute renal failure induced by muscle injury previously reported in the literature.

Posterior reversible encephalopathy syndrome in cancer patients: experience from a tertiary cancer center, South India

Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by seizures, headaches, altered mental status, cortical blindness and typical transient lesions on MRI. PRES may be associated with chemotherapy, molecular targeted drugs and immunosuppressive agents used in patients with cancer. PRES is a very rare condition in cancer patients. PRES is usually reversible with appropriate supportive care and most patients can be restarted with treatment.

Síndrome De Encefalopatía Posterior Reversible De Etiología Atípica / Posterior Reversible Encephalopathy Síndrome Of Atypical Etiology

Resumen El síndrome de encefalopatía posterior reversible, es un síndrome clínico-radiológico, caracterizado por imágenes compatibles con edema vasogénico, cuya fisiopatología no está esclarecida por completo. Existen múltiples causas descritas de este síndrome, principalmente hipertensión arterial severa, insuficiencia renal, sepsis, preeclampsia o eclampsia, terapia inmunosupresora, entre otras. Presentamos a continuación el caso de un paciente de 38 años, postrasplante renal en tratamiento con micofenolato y prednisona, con falla renal del trasplante y anemia crónica, hospitalizado por sepsis de foco urinario más tuberculosis ganglionar, quien tras recibir un concentrado de glóbulos rojos presenta convulsiones tónico clónicas, elevación de Hb de 3.1 g/dl e imágenes compatibles con edema vasogénico y resolución casi completa de las mismas a los 16 días.

Abstract Posterior reversible encephalopathy syndrome is a clinical-radiological syndrome, characterized by images compatible with vasogenic edema, whose pathophysiology is not fully clarified. There are multiple described causes of this syndrome, mainly severe arterial hypertension, renal insufficiency, sepsis, preeclampsia or eclampsia, immunosuppressive therapy and others. We report a case of a 38-year-old man, renal post-transplant in treatment with mycophenolate and prednisone, with renal failure of the transplant and chronic anemia, hospitalized by urinary focus sepsis plus lymph node tuberculosis, who after receiving 1 concentrate of red blood cells presents seizures, Hb elevation of 3.1 g/dl and images compatible with vasogenic edema and almost complete resolution of them at 16 days.

Successful management of a patient with sudden loss of vision and eclampsia complicated by posterior reversible encephalopathy syndrome

Reversible visual disturbances in patients with eclampsia may be due to either retinal detachment or retinal arteriolar vasospasm or thrombosis of the central retinal arteries or PRES (posterior reversible encephalopathy syndrome). Although retinal arteriolar vasospasm is the most common mechanism of visual disturbance, cortical blindness may occur in 1% to 15% of patients with eclampsia. Reporting herewith a case of reversible cortical blindness in the setting of severe preeclampsia complicated with eclampsia.

Spectrum of neurological disorders during pregnancy and postpartum period from a tertiary hospital

Background: Pregnancy and puerperium are states of hypercoagulability. This predisposes women in these phases to increased risk of cerebrovascular diseases. These neurological complications are important causes of maternal and foetal morbidity and mortality. These must be recognized and managed to decrease their burden on maternal and child health.Methods: The aim of this study was to consider the occurrence of neurological complications in pregnancy and puerperium and to analyse the clinical and radiological spectrum of them. This was a prospective study carried out with 1200 patients from January 2014 to August 2015.Results: Of the 1200 women, 87(7.25%) were diagnosed to have neurological complications. Overall mortality was 11.4%. Eclampsia (63.2%), Cerebral Venous sinus Thrombosis (CVT) (18.3%) and Posterior Reversible Encephalopathy Syndrome (PRES) in (8%) accounted for the majority of cases (Table 1). Eclampsia carried a significant mortality rate of 12.7% whereas CVT and PRES had favourable outcomes. Imaging of CVT revealed involvement of deep venous system in 12% and haemorrhagic infarcts in 69%.Conclusions: The commonest neurological complications seen in this cohort were eclampsia, cerebral venous thrombosis and posterior reversible encephalopathy syndrome. Hence a physician needs to bear in mind the common neurological complications that can occur during pregnancy and puerperium to avert poor pregnancy outcomes for both mother and child.

Posterior reversible encephalopathy syndrome presenting with atypical findings: case study

PRES (posterior reversible encephalopathy syndrome) is a syndrome characterized by headache, confusion, seizures and altered mental status. A 26 years old woman came to emergency department with a history of hypertension, blurred vision and seizures. She was diagnosed as a G3P2L1 at 29 weeks + 1 day with IUGR with preeclampsia associated with deranged kidney functions later complicated by development of PRES. Patient underwent emergency LSCS and was kept on mechanical ventilator as condition worsened during immediate post-operative period. Dialysis was also done to regulate urea and creatinine levels. Patient was treated with anti-hypertensive, anti-epileptics, antibiotics, intravenous fluids and continuous monitoring of blood pressure. Patient’s condition improved gradually, and her discharge was planned. PRES is a condition, if managed in initial phase can lead to early recovery and reduce mortality.