Limits...
Recurrent posterior reversible encephalopathy syndrome potentially related to AIDS and end-stage renal disease: a case report and review of the literature.

Chang OH, Stanculescu A, Dola C, Rothwell WB - Case Rep Med (2012)

Bottom Line: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome that is characterized by clinical features including headache, altered mental status, cortical blindness, seizures, and other focal neurological signs as well as subcortical edema without infarction on neuroimaging.The pathophysiology of PRES is thought to result from abnormalities in the transmembrane flow of intravascular fluid and proteins caused by two phenomena: one, cerebral autoregulatory failure and two, loss of integrity of the blood-brain barrier.Both the HIV and end-stage renal disease appear to further compromise the blood brain barrier.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Tulane University School of Medicine, SL-12, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA.

ABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome that is characterized by clinical features including headache, altered mental status, cortical blindness, seizures, and other focal neurological signs as well as subcortical edema without infarction on neuroimaging. Under the umbrella of hypertensive encephalopathy, PRES is defined by reversible cerebral edema due to dysfunction of the cerebrovascular blood-brain barrier unit. The pathophysiology of PRES is thought to result from abnormalities in the transmembrane flow of intravascular fluid and proteins caused by two phenomena: one, cerebral autoregulatory failure and two, loss of integrity of the blood-brain barrier. PRES is not a common disease in patients with human immunodeficiency virus (HIV) and AIDS with only three previously reported cases. Both the HIV and end-stage renal disease appear to further compromise the blood brain barrier. Although uncommon, PRES recurrence has been described. To the best of our knowledge, this is the first report demonstrating recurrent PRES in a HIV patient on hemodialysis for end-stage renal disease.

No MeSH data available.


Related in: MedlinePlus

(a) At presentation: axial T2-weighted fluid-attenuated inversion recovery MRI showed multiple large areas of edema in the occipitoparietal regions. (b) At presentation: axial T2-weighted FLAIR MRI showed multiple large areas of edema in the occipitoparietal lobe, with the right greater than the left with no mass effect. (c) At 2-week followup: axial T2-weighted FLAIR MRI showed resolving edema. (d) At 5-month followup: axial T2-weighted FLAIR MRI showed no further edema.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3475013&req=5

fig1: (a) At presentation: axial T2-weighted fluid-attenuated inversion recovery MRI showed multiple large areas of edema in the occipitoparietal regions. (b) At presentation: axial T2-weighted FLAIR MRI showed multiple large areas of edema in the occipitoparietal lobe, with the right greater than the left with no mass effect. (c) At 2-week followup: axial T2-weighted FLAIR MRI showed resolving edema. (d) At 5-month followup: axial T2-weighted FLAIR MRI showed no further edema.

Mentions: On hospital day 2 the patient was afebrile, nontachycardic, but noted to be hypertensive to 200/100 mmHg. She subsequently experienced two tonic-clonic seizures with right gaze deviation. Laboratory results are shown in Table 1. Emergent brain CT and follow-up brain MRI demonstrated multiple large areas of edema in the occipitoparietal regions on T2 FLAIR images consistent with PRES (Figure 1). Diffusion weighted images showed no restriction.


Recurrent posterior reversible encephalopathy syndrome potentially related to AIDS and end-stage renal disease: a case report and review of the literature.

Chang OH, Stanculescu A, Dola C, Rothwell WB - Case Rep Med (2012)

(a) At presentation: axial T2-weighted fluid-attenuated inversion recovery MRI showed multiple large areas of edema in the occipitoparietal regions. (b) At presentation: axial T2-weighted FLAIR MRI showed multiple large areas of edema in the occipitoparietal lobe, with the right greater than the left with no mass effect. (c) At 2-week followup: axial T2-weighted FLAIR MRI showed resolving edema. (d) At 5-month followup: axial T2-weighted FLAIR MRI showed no further edema.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475013&req=5

fig1: (a) At presentation: axial T2-weighted fluid-attenuated inversion recovery MRI showed multiple large areas of edema in the occipitoparietal regions. (b) At presentation: axial T2-weighted FLAIR MRI showed multiple large areas of edema in the occipitoparietal lobe, with the right greater than the left with no mass effect. (c) At 2-week followup: axial T2-weighted FLAIR MRI showed resolving edema. (d) At 5-month followup: axial T2-weighted FLAIR MRI showed no further edema.
Mentions: On hospital day 2 the patient was afebrile, nontachycardic, but noted to be hypertensive to 200/100 mmHg. She subsequently experienced two tonic-clonic seizures with right gaze deviation. Laboratory results are shown in Table 1. Emergent brain CT and follow-up brain MRI demonstrated multiple large areas of edema in the occipitoparietal regions on T2 FLAIR images consistent with PRES (Figure 1). Diffusion weighted images showed no restriction.

Bottom Line: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome that is characterized by clinical features including headache, altered mental status, cortical blindness, seizures, and other focal neurological signs as well as subcortical edema without infarction on neuroimaging.The pathophysiology of PRES is thought to result from abnormalities in the transmembrane flow of intravascular fluid and proteins caused by two phenomena: one, cerebral autoregulatory failure and two, loss of integrity of the blood-brain barrier.Both the HIV and end-stage renal disease appear to further compromise the blood brain barrier.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Tulane University School of Medicine, SL-12, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA.

ABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome that is characterized by clinical features including headache, altered mental status, cortical blindness, seizures, and other focal neurological signs as well as subcortical edema without infarction on neuroimaging. Under the umbrella of hypertensive encephalopathy, PRES is defined by reversible cerebral edema due to dysfunction of the cerebrovascular blood-brain barrier unit. The pathophysiology of PRES is thought to result from abnormalities in the transmembrane flow of intravascular fluid and proteins caused by two phenomena: one, cerebral autoregulatory failure and two, loss of integrity of the blood-brain barrier. PRES is not a common disease in patients with human immunodeficiency virus (HIV) and AIDS with only three previously reported cases. Both the HIV and end-stage renal disease appear to further compromise the blood brain barrier. Although uncommon, PRES recurrence has been described. To the best of our knowledge, this is the first report demonstrating recurrent PRES in a HIV patient on hemodialysis for end-stage renal disease.

No MeSH data available.


Related in: MedlinePlus