Posterior Reversible Encephalopathy Syndrome and Acute Post-Streptococcal Glomerulonephritis Mimicking Breakthrough Seizures.
Bottom Line: Cranial magnetic resonance imaging (MRI) demonstrated changes consistent with posterior reversible encephalopathy syndrome.Brain MRI changes returned normal within 2 weeks.Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient.
Affiliation: Neurology Unit , Trinidad and Tobago.
We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated anti-streptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI) demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.
No MeSH data available.
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Mentions: On examination, there was drowsiness (Glasgow Coma Scale 14/15) and some mild respiratory distress. Vital signs revealed an elevated blood pressure at 167/106 mmHg, pulse 106/minute, temperature 36.9°C with a respiratory rate of 24 bpm. Dipstick urinalysis showed 4+ blood, but no protein. The chest examination revealed crepitations bi-basally and there was obvious facial and periorbital edema. There were no focal neurological deficits or signs of meningism. Plantar reflexes were upgoing bilaterally. Pupils were 3 mm and reactive to light and fundoscopy was normal. On both legs there were multiple excoriated papular lesions which were attributed to scratched mosquito bites (Figure 1).
No MeSH data available.