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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.

No MeSH data available.


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MRI Brain-Axial gradient echo-weighted images demonstrate susceptibility effect in the genu and splenium of the corpus collosum as well as the left frontal periventricular white matter compatible with multifocal hemorrhage.
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fig3: MRI Brain-Axial gradient echo-weighted images demonstrate susceptibility effect in the genu and splenium of the corpus collosum as well as the left frontal periventricular white matter compatible with multifocal hemorrhage.

Mentions: These findings prompted further neuroradiological imaging. Subsequently, magnetic resonance imaging (MRI GE, 3 Tesla) of the brain, with and without gadolinium (DTPA), was ordered. MRI indicated that the patient had extensive white matter signal abnormality within the bilateral frontal and parietal lobes with extension into the temporal lobes supporting and initial impression of PRES (Figures 2(a), 2(b), 3(a), and 3(b)). As a result, patient was started on levetiracetam 500 milligrams intravenous q12h and phenytoin 100 milligrams intravenous q8h and placed on a video electroencephalogram (vEEG). The vEEG demonstrated focal slowing in right hemisphere, suggestive of underlying structural lesion. After a few days, the patient's symptoms resolved and became neurologically stable, and the patient was discharged on oral preparation of phenytoin 100 mg q8h and levetiracetam 500 milligrams q12h. After 8 weeks, the patient was tapered off phenytoin, and after 8 months the patient continues to be treated at the same dose of oral levetiracetam.


Rare Case of Posterior Reversible Leukoencephalopathy Syndrome Secondary to Acute Chest Syndrome
MRI Brain-Axial gradient echo-weighted images demonstrate susceptibility effect in the genu and splenium of the corpus collosum as well as the left frontal periventricular white matter compatible with multifocal hemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: MRI Brain-Axial gradient echo-weighted images demonstrate susceptibility effect in the genu and splenium of the corpus collosum as well as the left frontal periventricular white matter compatible with multifocal hemorrhage.
Mentions: These findings prompted further neuroradiological imaging. Subsequently, magnetic resonance imaging (MRI GE, 3 Tesla) of the brain, with and without gadolinium (DTPA), was ordered. MRI indicated that the patient had extensive white matter signal abnormality within the bilateral frontal and parietal lobes with extension into the temporal lobes supporting and initial impression of PRES (Figures 2(a), 2(b), 3(a), and 3(b)). As a result, patient was started on levetiracetam 500 milligrams intravenous q12h and phenytoin 100 milligrams intravenous q8h and placed on a video electroencephalogram (vEEG). The vEEG demonstrated focal slowing in right hemisphere, suggestive of underlying structural lesion. After a few days, the patient's symptoms resolved and became neurologically stable, and the patient was discharged on oral preparation of phenytoin 100 mg q8h and levetiracetam 500 milligrams q12h. After 8 weeks, the patient was tapered off phenytoin, and after 8 months the patient continues to be treated at the same dose of oral levetiracetam.

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