Hypertensive brainstem encephalopathy: a diagnosis often overlooked

Tan, Yin Yin; Tan, Kenny

doi:10.7861/clinmed.2019-0247

Cited by 5 publications

(8 citation statements)

References 8 publications

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“…Second, when blood pressure reaches the level of a hypertensive crisis or when large fluctuations occur in BP beyond the range of cerebrovascular autoregulation mechanisms, disruption of the blood-brain barrier causes cerebrovascular hyperperfusion and cerebrovascular leakage, leading to vasogenic edema, which is one of the most common mechanisms for the development of PRES. [10,12] Extremely high blood has been reported in some patients with PRES associated with COVID-19, which may account for the onset of PRES in these patients. However, the proportion of hypertension in patients with COVID-19-associated PRES is not high, as shown in a Meta-analysis of Iftikhar et al, [4] which revealed that only 28.6% of patients with COVID-19-associated PRES had hypertension.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 may play a direct role in the pathogenesis of posterior reversible encephalopathy syndrome (PRES) associated with COVID-19: A CARE-compliant case report and literature review

Wang,

Huang

et al. 2024

Medicine

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Rationale: During the past 3 years of the corona virus disease 2019 (COVID-19) pandemic, COVID-19 has been recognized to cause various neurological complications, including rare posterior reversible encephalopathy syndrome (PRES). In previously reported cases of PRES associated with COVID-19, the majority of patients had severe COVID-19 infection and known predisposing factors for PRES, such as uncontrolled hypertension, renal dysfunction, and use of immunosuppressants. It remains unclear whether these risk factors or infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributes to the development of PRES in these patients. Here we report a special case of PRES associated with COVID-19 without any known risk factors for PRES, indicating the SARS-CoV-2’s direct role in the pathogenesis of PRES associated with COVID-19. Patient concerns: An 18-year-old female patient presented to the emergency department with abdominal pain. Preliminary investigations showed no abnormalities, except for positive results in novel coronavirus nucleic acid tests using oropharyngeal swabs. However, the patient subsequently developed tonic–clonic seizures, headaches, and vomiting on the second day. Extensive investigations have been performed, including brain MRI and lumbar puncture. Brain MRI showed hypointense T1-weighted and hyperintense T2-weighted lesions in the bilateral occipital, frontal, and parietal cortices without enhancement effect. Blood and cerebrospinal fluid analyses yielded negative results. The patient had no hypertension, renal insufficiency, autoimmune disease, or the use of immunosuppressants or cytotoxic drugs. Diagnoses: PRES was diagnosed based on the clinical features and typical MRI findings of PRES. Interventions: Symptomatic treatments such as anticonvulsants were administered to the patients. Outcomes: The patient fully recovered within 1 week. The initial MRI abnormalities also disappeared completely on a second MR examination performed 11 days later, supporting the diagnosis of PRES. The patient was followed up for 6 months and remained in a normal state. Lessons: The current case had no classical risk factors for PRES, indicating that although the cause of PRES in COVID-19 patients may be multifactorial, the infection of SARS-CoV-2 may play a direct role in the pathogenesis of PRES associated with COVID-19.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 may play a direct role in the pathogenesis of posterior reversible encephalopathy syndrome (PRES) associated with COVID-19: A CARE-compliant case report and literature review

Wang,

Huang

et al. 2024

Medicine

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“…The patient suffered from brainstem hypertensive encephalopathy, which is a subset of posterior reversible encephalopathy syndrome (PRES). 1 , 2 PRES is characterized by widespread vasogenic edema particularly in the parietal and occipital lobes. 1 , 3 Patients can present with a wide variety of symptoms including headache and altered mental status.…”

Section: Diagnosismentioning

confidence: 99%

Patient presenting with progressive altered mental status and hypertension

Kaoutzani

Paré

2023

JACEP Open

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“…Editor -Tan and Tan reported a case of severe hypertension in which the patient had mild symptoms and normal neurological examination. 1 Although interesting, we are concerned about the diagnosis of such a case.…”

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confidence: 99%

“…3 As mentioned in their abstract, 'hypertensive encephalopathy (HE) is a subset of posterior reversible encephalopathy syndrome'. 1 This appears problematic, as the latter should be a subset of the former. HE may occur with or without abnormal neuroimaging findings, the former of which may be diagnosed as PRES.…”

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confidence: 99%

“…Editor -I read with interest the retrospective study from Bahl et al highlighting cardiac aetiologies (up to 24%) in an unselected young population with acute ischaemic stroke (n=167). 1 Atrial fibrillation (AF) is responsible for up to one-third of acute ischaemic strokes and may be the index presentation of AF. 2 With an established efficacy of oral anticoagulation in the prevention of stroke associated with thromboembolic events and AF, thorough cardiac investigations are warranted to reduce morbidity and mortality, particularly in a young patent population.…”

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confidence: 99%

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