Posterior reversible encephalopathy syndrome

Abstract is not required for Clinical Imagesis not required for Clinical Images (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(9):612–614. www.ijcasereportsandimages.com Siddiqui et al. 612 CASE REPORT OPEN ACCESS Posterior reversible encephalopathy syndrome Abdullah Siddiqui, Yasir Ahmed


DISCUSSION
Posterior reversible encephalopathy syndrome is a clinico-radiological entity characterized clinically by headache, confusion, seizures and visual disturbances and radiologically by bilateral white matter abnormalities mostly in posterior regions of brain [1]. The suggested mechanism is disruption of blood-brain barrier due to failure of central nervous system auto-regulation leading to vasogenic edema [2]. The PRES is an uncommon clinico-radiological condition that can result in severe brain injury [3]. The PRES can develop in a wide array of situations including pregnancy, post-partum, sepsis, autoimmune diseases, solid organ transplantations and end stage renal disease patients [3][4]. Classic pattern is the involvement of dominant parietal occipital area [1]. Rarely, it can present with fever and significant pleocytosis CSF that may mimic infectious meningoencephalitis as seen in the present case [5]. Our patient may had a seizure episode that could explain pleocytosis in CSF; although Electroencephalogram was normal. In contrast to its name posterior reversible encephalopathy syndrome, it is not always localized to posterior brain and may not be always reversible or benign and mortality can be as high as 28% [5]. Supportive care, removal of offending agent and to control blood pressure is the cornerstone treatment, which follow with complete resolution of neurological symptoms in most of the cases like the present case.

CONCLUSION
While the outcome of posterior reversible encephalopathy syndrome (PRES) is mostly benign, a delay in diagnosis may lead to permanent neurologic deficits, and misdiagnosis can be fatal. The cornerstone of treatment is to control the blood pressure or removal of offending agent. One should have a high clinical suspicion for PRES in a patient with predisposing risk factors and compatible clinical scenario to achieve good outcome as in present case.

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