<p>Posterior Reversible Encephalopathy Syndrome Due to Acute Water Intoxication in a Patient with Schizophrenia</p>

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome that presents as transient cerebral edema (vasogenic edema), usually on a background of hypertensive encephalopathy, puerperal eclampsia, or immunosuppressant drug use. We describe a case of PRES that arose in the context of a psychiatric disorder. The patient was a 26-year-old woman with schizophrenia who was hospitalized upon falling into a catatonic stupor and then suffered acute anxiety leading to impulsive polydipsia and subsequent water intoxication. She lost consciousness, and brain magnetic resonance imaging revealed a high density area, primarily affecting the cortex and subcortical white matter in areas in the occipital and parietal lobes, leading to the diagnosis. We did not treat the hyponatremia by means of aggressive sodium supplementation but rather balanced the extracellular fluid by continuous infusion of isotonic electrolyte replacement fluid. The patient's level of consciousness improved gradually, but a total 141 days passed before hospital discharge was appropriate. The prognosis for PRES is generally favorable, but irreversible neurological damage can occur. We believe, therefore, that brain magnetic resonance imaging should be performed promptly whenever PRES is suspected and that timely, appropriate treatment is of utmost importance. If PRES is observed in a psychiatric patient, it is important to investigate whether the condition might have been caused by water intoxication and to treat the condition accordingly.

Severe Posterior Reversible Encephalopathy Syndrome Secondary to Hyponatremia in a Patient with Water Intoxication

“…This case illustrates severe PRES caused by acute hyponatremia due to water intoxication, 4 a rare condition with limited reports in literature. [5][6][7][8] PRES is characterized by varying clinical symptoms, including seizures, visual disturbances and encephalopathy. 9 Vasogenic edema is predominantly but not limited to parietooccipital regions, with restricted diffusion and intracerebral hemorrhage present in severe cases.…”

“…This case illustrates severe PRES caused by acute hyponatremia due to water intoxication, 4 a rare condition with limited reports in literature. 5-8

Figure 1.Axial brain MRI (A) and (B) Bilateral and relatively symmetric hyperintense lesions on FLAIR affecting the cerebral white matter with cortical extension, diffuse in the parietal and occipital lobes, extending to the posterior temporal lobes, centrum semiovale, and to the upper part of the frontal lobes, with sulcal enhancement (vasogenic edema). (C) Convexity subarachnoid hemorrhage (purple dotted circle) and mild intraparenchymal hemorrhage (arrows) predominantly in the posterior cerebral hemispheres characterized by subarachnoid and cortical-subcortical hypointense foci on T2*.

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