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A global amnesia associated with the specific variant of posterior reversible encephalopathy syndrome (PRES) that developed due to severe preeclampsia and malignant hypertension.

Borovac JA, Božić J, Žaja N, Kolić K, Hrboka V - Oxf Med Case Reports (2016)

Bottom Line: A post-partum magnetic resonance imaging of the brain in FLAIR mode revealed multiple cortico-subcortical areas of hyperintense signals suggestive of edematous lesions that chiefly involved occipital and parietal lobes with additional atypical manifestations.Such radiologic findings suggested a posterior reversible encephalopathy syndrome variant with the global amnesia as an extraordinary constituent.This unique feature should be acknowledged when treating a preeclamptic or hypertensive patient that exhibits neurological symptomatology and vision disturbances.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathophysiology , University of Split School of Medicine , Šoltanska 2, 21 000 Split , Croatia.

ABSTRACT
A case is reported of a 26-year-old primiparous woman in the 32nd week of gestation who presented to the emergency department with the symptoms of a severe headache, nausea and vomiting. The patient was diagnosed with preeclampsia that later progressed to eclampsia. This state was characterized by a sudden onset of a headache and diplopia that advanced to cortical blindness and precipitated significant alterations in mental status, most notable being global amnesia that resolved within 48 h. A post-partum magnetic resonance imaging of the brain in FLAIR mode revealed multiple cortico-subcortical areas of hyperintense signals suggestive of edematous lesions that chiefly involved occipital and parietal lobes with additional atypical manifestations. Such radiologic findings suggested a posterior reversible encephalopathy syndrome variant with the global amnesia as an extraordinary constituent. This unique feature should be acknowledged when treating a preeclamptic or hypertensive patient that exhibits neurological symptomatology and vision disturbances.

No MeSH data available.


Related in: MedlinePlus

A coronal FLAIR MRI mode revealing hyperintense vasogenic edematous lesions in temporo-occipital brain regions.
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OMW016F2: A coronal FLAIR MRI mode revealing hyperintense vasogenic edematous lesions in temporo-occipital brain regions.

Mentions: We suggest that this unique representation of symptoms might correlate with the specific anatomical pattern of cerebral lesions. This pattern of lesions within PRES could perhaps be seen as a variant that precipitates altered mental status and functional deficits in the form of global amnesia. In addition to these atypical lesions, a classic PRES pattern of brain vasogenic edema in FLAIR imaging mode on the MRI was preserved. As suggested by Bartynski et al., this edema is often widespread but predominates in the parietal and occipital white matter, followed by the frontal lobes, the inferior temporal–occipital junction and the cerebellum [7]. While the majority of lesions in our case followed classical PRES distribution, we found additional elements that could precipitate amnesia or amnesia-like clinical symptoms. On a FLAIR coronal MRI section of the brain, an edematous infiltrate of 21.6 mm in diameter was implicated in the right temporo-occipital junction, most likely affecting inferior temporal and lateral occipitotemporal gyri (Fig. 2). Likewise, a temporal–occipital junction on the left side of the brain was affected (Fig. 2B). In addition, the horizontal FLAIR MRI sections revealed unilateral subcortical lesion found in the left cerebellar hemisphere, measuring 27.2 mm in diameter (Fig. 3). The same MRI mode discovered bilateral hyperintense lesions in parieto-occiptal cortex, frontal cortex and lateral periventricular areas (Fig. 1). Such imaging patterns and lesion distribution in PRES have been elaborated in the literature—a relevant study showed that lesions in the frontal lobe were present in 68% of PRES cases, while inferior temporal lobe and cerebellar hemisphere manifestations are not uncommon [8]. A recent study by Kastrup et al. conducted in Europe found involvement of posterior regions in 65.3% of cases, temporal lesions in 10.6% of cases, cerebellum lesions in 6.5% and basal ganglia in 1.6% of total PRES cases [9].Figure 3:


A global amnesia associated with the specific variant of posterior reversible encephalopathy syndrome (PRES) that developed due to severe preeclampsia and malignant hypertension.

Borovac JA, Božić J, Žaja N, Kolić K, Hrboka V - Oxf Med Case Reports (2016)

A coronal FLAIR MRI mode revealing hyperintense vasogenic edematous lesions in temporo-occipital brain regions.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836601&req=5

OMW016F2: A coronal FLAIR MRI mode revealing hyperintense vasogenic edematous lesions in temporo-occipital brain regions.
Mentions: We suggest that this unique representation of symptoms might correlate with the specific anatomical pattern of cerebral lesions. This pattern of lesions within PRES could perhaps be seen as a variant that precipitates altered mental status and functional deficits in the form of global amnesia. In addition to these atypical lesions, a classic PRES pattern of brain vasogenic edema in FLAIR imaging mode on the MRI was preserved. As suggested by Bartynski et al., this edema is often widespread but predominates in the parietal and occipital white matter, followed by the frontal lobes, the inferior temporal–occipital junction and the cerebellum [7]. While the majority of lesions in our case followed classical PRES distribution, we found additional elements that could precipitate amnesia or amnesia-like clinical symptoms. On a FLAIR coronal MRI section of the brain, an edematous infiltrate of 21.6 mm in diameter was implicated in the right temporo-occipital junction, most likely affecting inferior temporal and lateral occipitotemporal gyri (Fig. 2). Likewise, a temporal–occipital junction on the left side of the brain was affected (Fig. 2B). In addition, the horizontal FLAIR MRI sections revealed unilateral subcortical lesion found in the left cerebellar hemisphere, measuring 27.2 mm in diameter (Fig. 3). The same MRI mode discovered bilateral hyperintense lesions in parieto-occiptal cortex, frontal cortex and lateral periventricular areas (Fig. 1). Such imaging patterns and lesion distribution in PRES have been elaborated in the literature—a relevant study showed that lesions in the frontal lobe were present in 68% of PRES cases, while inferior temporal lobe and cerebellar hemisphere manifestations are not uncommon [8]. A recent study by Kastrup et al. conducted in Europe found involvement of posterior regions in 65.3% of cases, temporal lesions in 10.6% of cases, cerebellum lesions in 6.5% and basal ganglia in 1.6% of total PRES cases [9].Figure 3:

Bottom Line: A post-partum magnetic resonance imaging of the brain in FLAIR mode revealed multiple cortico-subcortical areas of hyperintense signals suggestive of edematous lesions that chiefly involved occipital and parietal lobes with additional atypical manifestations.Such radiologic findings suggested a posterior reversible encephalopathy syndrome variant with the global amnesia as an extraordinary constituent.This unique feature should be acknowledged when treating a preeclamptic or hypertensive patient that exhibits neurological symptomatology and vision disturbances.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathophysiology , University of Split School of Medicine , Šoltanska 2, 21 000 Split , Croatia.

ABSTRACT
A case is reported of a 26-year-old primiparous woman in the 32nd week of gestation who presented to the emergency department with the symptoms of a severe headache, nausea and vomiting. The patient was diagnosed with preeclampsia that later progressed to eclampsia. This state was characterized by a sudden onset of a headache and diplopia that advanced to cortical blindness and precipitated significant alterations in mental status, most notable being global amnesia that resolved within 48 h. A post-partum magnetic resonance imaging of the brain in FLAIR mode revealed multiple cortico-subcortical areas of hyperintense signals suggestive of edematous lesions that chiefly involved occipital and parietal lobes with additional atypical manifestations. Such radiologic findings suggested a posterior reversible encephalopathy syndrome variant with the global amnesia as an extraordinary constituent. This unique feature should be acknowledged when treating a preeclamptic or hypertensive patient that exhibits neurological symptomatology and vision disturbances.

No MeSH data available.


Related in: MedlinePlus