A case of posterior reversible encephalopathy syndrome associated with acute pancreatitis and chronic alcoholism

Baek, Hyun Seok; Lee, Se-Jin

doi:10.1016/j.genhosppsych.2014.12.004

Cited by 13 publications

(25 citation statements)

References 13 publications

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“…To the extent of our knowledge, we report the ninth case of PRES described in the context of acute pancreatitis [3][4][5][6][7][8][9][10] (six reported in the MEDLINE database). [3][4][5][7][8][9] From the analysis of the previous clinical cases, five of the eight reported cases had at least one comorbid medical condition that has been implicated as a cause of PRES besides acute pancreatitis (AP).…”

Section: Discussionmentioning

confidence: 99%

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Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

et al. 2016

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RESUMOA síndrome de enfalopatia posterior reversível é uma síndrome neurológica caracterizada por cefaleias, confusão, alterações visuais e convulsões associada a áreas de edema cerebral identificável em exames de neuroimagem. Os autores relatam o caso de um homem, 33 anos, leucodérmico, com história de alcoolismo e tabagismo crónico, que recorre ao serviço de urgência por epigastralgia em cinturão e vómitos com cerca de seis horas de evolução e cefaleia holocraneana intensa há duas horas. Ao exame objectivo, apresentava tensão arterial de 190/100 mmHg e empastamento no epigastro. Analiticamente, amilase 193 U/L e lipase 934 U/L. Durante a observação no serviço de urgência, apresentou uma crise tónico-clónica generalizada. A ecografia abdominal realizada foi sugestiva de pancreatite, sem sinais de litíase biliar. A tomografia computorizada crânio-encefálica demonstrou hemorragia subaracnoideia e pequena hemorragia cortical frontal direita. A ressonância magnética nuclear crânio-encefálica realizada uma semana após a admissão revelou áreas de hipersinal T2/FLAIR bilaterais e simétricas na substância branca subcortical das regiões parietais e frontais superiores, sugerindo o diagnóstico de síndrome de enfalopatia posterior reversível. Na tomografia computorizada abdominal (10 dias após a admissão) visualizou-se pâncreas espessado, em relação com processo inflamatório e dois pequenos focos hipodensos na parte anterior do corpo, traduzindo pequenos focos de necrose. A investigação de defeitos trombofílicos revelou uma mutação do gene G20210A da protrombina em heterozigotia. O doente teve alta sem sequelas neurológicas, e assintomático. A ressonância magnética nuclear crânio-encefálica de controlo confirmou a reversão das lesões, confirmando o diagnóstico. Palavras-chave: Alcoolismo/complicações; Edema Cerebral; Pancreatite Alcoólica; Síndrome de Enfalopatia Posterior Reversível. ABSTRACTThe posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visual disturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the case of a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergency department for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headache for two hours. His physical examination was remarkable for a blood pressure of 190/100 mmHg and tenderness in epigastrium. His analytical results revealed emphasis on amylase 193 U/L and lipase 934 U/L. During the observation in the emergency department, he presented a generalized tonic-clonic seizure. Abdominal ultrasonography was performed and suggestive of pancreatitis without gallstones signals. Head computed tomography showed subarachnoid haemorrhage and a small right frontal cortical haemorrhage. The brain magnetic resonance imaging done one week after admission showed areas of a bilateral and symmetrical T2 / FLAIR hyperinte...

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Section: Discussionmentioning

confidence: 99%

“…2 There are as well numerous associations rarely or anecdotally reported. In the context of acute pancreatitis there have been reported only eight cases, [3][4][5][6][7][8][9][10] six of them available on PubMed/MEDLINE database. [3][4][5][7][8][9] With early diagnosis and prompt treatment, the syndrome is usually fully reversible.…”

Section: Introductionmentioning

confidence: 99%

Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

et al. 2016

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“…DWI was positive in 60% of patients (12/20), totally or partially in correspondence with T2/FLAIR hyperintensities, with focal or larger extent (20,25,26,29,30,36,37,39,(47)(48)(49). When data related to ADC were provided, positive DWI due to vasogenic edema (i.e., no restricted ADC) (16, 17, 19, 21, 23, 25, 26, 28-31, 33, 34, 36, 45, 47-49) and cytotoxic edema (i.e., restricted ADC) (20,24,39,49) were found in 86 and 19% of cases, respectively.…”

Section: Radiological Featuresmentioning

confidence: 99%

“…When data related to ADC were provided, positive DWI due to vasogenic edema (i.e., no restricted ADC) (16, 17, 19, 21, 23, 25, 26, 28-31, 33, 34, 36, 45, 47-49) and cytotoxic edema (i.e., restricted ADC) (20,24,39,49) were found in 86 and 19% of cases, respectively. T2 * (gradient echo) or susceptibility weighted imaging revealed intracranial hemorrhage in 14% of patients (16,20,30,31,36,43). The median time of follow-up imaging was 21 days (IQR 11-60).…”

Section: Radiological Featuresmentioning

confidence: 99%

“…In alcohol-induced PRES, three different situations have been described: chronic alcohol intoxication (29)(30)(31)(32)41), acute alcohol intoxication (22)(23)(24)(25), and alcohol withdrawal (26)(27)(28). PRES in chronic alcohol abusers occurred in conjunction with other complications of alcoholism such as acute pancreatitis (26,30,41) and hepatic encephalopathy due to severe acute alcoholic hepatitis (32). PRES onset occurred at the same time as acute pancreatitis (26,30) or 1 week later (41), whereas it occurred 3 weeks after acute alcoholic hepatitis onset (32).…”

Section: Alcoholmentioning

confidence: 99%

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Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

et al. 2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Methods: Medline/PubMed, Web of Science, and PsycINFO were screened through May 31, 2019, to systematically identify case reports and case series describing PRES associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical substances) in accidental context, intentional overdose, and substance abuse. The methodological quality of eligible case reports/series was assessed. Patients and exposure characteristics were recorded; relevant toxicological, radiological, and clinical data were extracted. Results: Forty-one case reports and one case series reporting 42 unique cases were included. The median time to PRES onset from the start of exposure was 3 days (IQR 2-10). Acute high blood pressure, visual disturbance, and seizure were reported in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. One-third of patients had at least one risk factor for PRES such as chronic hypertension (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the combination of classical parieto-occipital edema with another anatomical region (e.g., frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance Largeau et al. PRES in Clinical Toxicology imaging. The median time required to hospital discharge was 14 days (IQR 7-18). Mortality and neurological recurrence rate were null. Conclusions: Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored.

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Arginine Vasopressin and Posterior Reversible Encephalopathy Syndrome Pathophysiology: the Missing Link?

et al. 2019

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A case of posterior reversible encephalopathy syndrome associated with acute pancreatitis and chronic alcoholism

Cited by 13 publications

References 13 publications

Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

Arginine Vasopressin and Posterior Reversible Encephalopathy Syndrome Pathophysiology: the Missing Link?

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