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Posterior Reversible Encephalopathy Syndrome and Acute Post-Streptococcal Glomerulonephritis Mimicking Breakthrough Seizures.

Abdool K, Ramcharan K, Bhagwandass N, Persad N, Temull V, Seegobin K, Mike C - Neurol Int (2015)

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.

View Article: PubMed Central - PubMed

Affiliation: Neurology Unit , Trinidad and Tobago.

ABSTRACT
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.


Related in: MedlinePlus

Magnetic resonance imaging of the brain: abnormal hyperintense signals seen in axial FLAIR in cortical and subcortical areas of occipital lobe and anterior parietal/posterior frontal lobes consistent with posterior reversible encephalopathy syndrome (A). Normal axial T2 image is shown 3 weeks later (B).
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fig002: Magnetic resonance imaging of the brain: abnormal hyperintense signals seen in axial FLAIR in cortical and subcortical areas of occipital lobe and anterior parietal/posterior frontal lobes consistent with posterior reversible encephalopathy syndrome (A). Normal axial T2 image is shown 3 weeks later (B).

Mentions: Urine microscopy revealed red blood cells: 216.3 per high power field with red cell casts. A chest X-ray was normal. Renal artery magnetic resonance angiogram, 5-hydoxyindole acetic acid, vanyllmandelic acid and metanephrine levels were all normal. Magnetic resonance imaging (MRI) changes of the brain are illustrated in Figure 2A, showing hyperintense signals bilaterally in the occipital lobes and posterior frontal/anterior parietal lobes on axial Flair image. Figure 2B shows normal T2 MRI 3 weeks later. An interictal EEG one month later was normal.


Posterior Reversible Encephalopathy Syndrome and Acute Post-Streptococcal Glomerulonephritis Mimicking Breakthrough Seizures.

Abdool K, Ramcharan K, Bhagwandass N, Persad N, Temull V, Seegobin K, Mike C - Neurol Int (2015)

Magnetic resonance imaging of the brain: abnormal hyperintense signals seen in axial FLAIR in cortical and subcortical areas of occipital lobe and anterior parietal/posterior frontal lobes consistent with posterior reversible encephalopathy syndrome (A). Normal axial T2 image is shown 3 weeks later (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508544&req=5

fig002: Magnetic resonance imaging of the brain: abnormal hyperintense signals seen in axial FLAIR in cortical and subcortical areas of occipital lobe and anterior parietal/posterior frontal lobes consistent with posterior reversible encephalopathy syndrome (A). Normal axial T2 image is shown 3 weeks later (B).
Mentions: Urine microscopy revealed red blood cells: 216.3 per high power field with red cell casts. A chest X-ray was normal. Renal artery magnetic resonance angiogram, 5-hydoxyindole acetic acid, vanyllmandelic acid and metanephrine levels were all normal. Magnetic resonance imaging (MRI) changes of the brain are illustrated in Figure 2A, showing hyperintense signals bilaterally in the occipital lobes and posterior frontal/anterior parietal lobes on axial Flair image. Figure 2B shows normal T2 MRI 3 weeks later. An interictal EEG one month later was normal.

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.

View Article: PubMed Central - PubMed

Affiliation: Neurology Unit , Trinidad and Tobago.

ABSTRACT
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.


Related in: MedlinePlus