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Rare Case of Posterior Reversible Leukoencephalopathy Syndrome Secondary to Acute Chest Syndrome

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ABSTRACT

We present a case of 29/m with a history of sickle cell disease who presented to the emergency department with sudden onset of chest, trunk, extremity, and back pain, consistent in quality and severity with the patient's usual pain crises. Soon after admission to the medical unit for acute chest syndrome (ACS), the patient developed sudden onset of hypertension associated with left sided hemiplegia, lethargy, dysarthria, aphasia, and left sided facial droop. Neuroimaging revealed that on MRI Brain there was multifocal extensive signal abnormality and a small focal areas of hemorrhage compatible with posterior reversible leukoencephalopathy syndrome (PRES). Patient was treated with levetiracetam and phenytoin and improved soon afterwards, with resolution seen on follow-up MRI two months later.

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CT Head-Axial images demonstrate extensive multifocal areas of white matter hypoattenuation/edema.
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fig1: CT Head-Axial images demonstrate extensive multifocal areas of white matter hypoattenuation/edema.

Mentions: While on the inpatient medical floor, patient's pain was managed by the pain management team. After two weeks, the patient had a sudden onset of hypertension secondary to acute kidney injury (creatinine: 5.19 mg/dL, blood urine nitrogen: 57 mg/dL), with a blood pressure reading of 212/96, and was found to have witnessed generalized tonic-clonic seizure lasting 1 minute. After the seizure, patient was found to have on examination, left facial droop, left upper extremity power of 3/5, left lower extremity power of 3/5, sensory neglect, dysarthria, perservation, and confusion. Based on neurological clinical findings, the weakness was likely due to a right focal onset with secondary generalization. Left hemiparesis was clearly present and was initially suspected to be due to an infarct. After Computed Tomography (CT) head imaging was performed it was reported as abnormal signal intensity in periventricular white matter, subcortical internal and external capsules, basal ganglia, and corpus callosum suspicious for posterior reversible encephalopathy syndrome (PRES) (Figures 1(a), 1(b), and 1(c)).


Rare Case of Posterior Reversible Leukoencephalopathy Syndrome Secondary to Acute Chest Syndrome
CT Head-Axial images demonstrate extensive multifocal areas of white matter hypoattenuation/edema.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5121436&req=5

fig1: CT Head-Axial images demonstrate extensive multifocal areas of white matter hypoattenuation/edema.
Mentions: While on the inpatient medical floor, patient's pain was managed by the pain management team. After two weeks, the patient had a sudden onset of hypertension secondary to acute kidney injury (creatinine: 5.19 mg/dL, blood urine nitrogen: 57 mg/dL), with a blood pressure reading of 212/96, and was found to have witnessed generalized tonic-clonic seizure lasting 1 minute. After the seizure, patient was found to have on examination, left facial droop, left upper extremity power of 3/5, left lower extremity power of 3/5, sensory neglect, dysarthria, perservation, and confusion. Based on neurological clinical findings, the weakness was likely due to a right focal onset with secondary generalization. Left hemiparesis was clearly present and was initially suspected to be due to an infarct. After Computed Tomography (CT) head imaging was performed it was reported as abnormal signal intensity in periventricular white matter, subcortical internal and external capsules, basal ganglia, and corpus callosum suspicious for posterior reversible encephalopathy syndrome (PRES) (Figures 1(a), 1(b), and 1(c)).

View Article: PubMed Central - PubMed

ABSTRACT

We present a case of 29/m with a history of sickle cell disease who presented to the emergency department with sudden onset of chest, trunk, extremity, and back pain, consistent in quality and severity with the patient's usual pain crises. Soon after admission to the medical unit for acute chest syndrome (ACS), the patient developed sudden onset of hypertension associated with left sided hemiplegia, lethargy, dysarthria, aphasia, and left sided facial droop. Neuroimaging revealed that on MRI Brain there was multifocal extensive signal abnormality and a small focal areas of hemorrhage compatible with posterior reversible leukoencephalopathy syndrome (PRES). Patient was treated with levetiracetam and phenytoin and improved soon afterwards, with resolution seen on follow-up MRI two months later.

No MeSH data available.


Related in: MedlinePlus