Posterior leukoencephalopathy without severe hypertension

Ay, Hakan; Buonanno, Ferdinando S.; Schaefer, Pamela W.; Le, Davis; Wang, Bing; González, Ramón; Koroshetz, Walter J.

doi:10.1212/wnl.51.5.1369

Cited by 450 publications

(399 citation statements)

References 22 publications

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“…Kuroiwa and coworkers 37 have demonstrated the relationship between increased Dav with the presence and severity of blood brain barrier breakdown associated with vasogenic brain edema in a feline cold cortical lesion model. Similar DWI profiles of elevated Dav were independently reported in humans by Ay and coworkers 38 and Schaefer and coworkers 39 on the vasogenic edema induced by posterior leukoencephalopathy syndrome and eclampsia, respectively. However, in the present cohort, delayed DWI expression of ischemic injury cannot be entirely excluded.…”

Section: Discussionsupporting

confidence: 83%

Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage

Carhuapoma

Wang

Beauchamp

et al. 2000

Stroke

114

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Background and Purpose-Cerebral ischemia has been proposed as contributing mechanism to secondary neuronal injury after intracerebral hemorrhage (ICH). Possible tools for investigating this hypothesis are diffusion-weighted (DWI) and proton magnetic resonance spectroscopic imaging ( 1 H-MRSI). However, magnetic field inhomogeneity induced by paramagnetic blood products may prohibit the application of such techniques on perihematoma tissue. We report on the feasibility of DWI and 1 H-MRSI in the study of human ICH and present preliminary data on their contribution to understanding perihematoma tissue functional and metabolic profiles. Methods-Patients with acute supratentorial ICH were prospectively evaluated using DWI and 1 H-MRSI. Obscuration of perihematoma tissue with both sequences was assessed. Obtainable apparent diffusion coefficient (Dav) and lactate spectra in perihematoma brain tissue were recorded and analyzed. Results-Nine patients with mean age of 63.4 (36 to 87) years were enrolled. Mean time from symptom onset to initial MRI was 3.4 (1 to 9) days; mean hematoma volume was 35.4 (5 to 80) cm 3 . Perihematoma diffusion values were attainable in 9 of 9 patients, and 1 H-MRSI measures were obtainable in 5 of 9 cases. Dav in perihematoma regions was 172.5 (120.0 to 302.5)ϫ10Ϫ5 mm 2 /s and 87.6 (76.5 to 102.1)ϫ10 Ϫ5 mm 2 /s in contralateral corresponding regions of interest (Pϭ0.002). One patient showed an additional area of reduced Dav with normal T 2 intensity, which suggests ischemia.1 H-MRSI revealed lactate surrounding the hematoma in 2 patients. Conclusions-DWI and 1 H-MRSI can be used in the study of ICH patients. Our preliminary data are inconsistent with ischemia as the primary mechanism for perihematoma tissue injury. Further investigation with advanced MRI techniques will give a clearer understanding of the role that ischemia plays in tissue injury after ICH. (Stroke. 2000;31:726-732.)

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Section: Discussionsupporting

confidence: 83%

Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage

Carhuapoma

Wang

Beauchamp

et al. 2000

Stroke

114

View full text Add to dashboard Cite

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“…Because thrombocytopenia and a reduction in the fibrinogen level were also seen concomitantly, we conjecture that the underlying pathogenesis involved disseminated intravascular coagulation. Although there have been previous reports of normotensive reversible posterior leukoencephalopathy syndrome, this is the first case to be involved in coagulation abnormality (4,27). Our case was successfully treated with anticoagulation therapy using heparin, but since we have no control case, the usefulness of this regimen cannot be conclusively deter-mined.…”

Section: Discussionmentioning

confidence: 74%

A Case of Reversible Posterior Leukoencephalopathy Syndrome Caused by Transient Hypercoagulable State Induced by Infection

et al. 2005

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“…MRI, however, is the imaging modality of choice as it resolves the hallmark subcortical vasogenic oedema of PRES from the cytotoxic oedema of acute cerebral infarction [10]. This is seen as increased T2 or fluid-attenuated inversion recovery (FLAIR) sequence signal without reduction in apparent diffusion co-efficient (ADC) signal on diffusion-weighted imaging [11]. Indeed, decreased ADC signal portends areas of permanent injury in PRES.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome: a report of a case with atypical features

Pratap¹,

Down

2008

Anaesthesia

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SummaryWe report a case of a young woman presenting with profound depression of consciousness and intra-uterine death in the late stages of an unbooked pregnancy. She proceeded to develop features of cardiovascular, renal, hepatic and haematological failures. The patient was challenging to manage in view of uncertainty regarding the underlying cause, and required multidisciplinary consultation. A diagnosis was subsequently made of posterior reversible encephalopathy syndrome in the context of pre-eclampsia. We review the typical presentation and wide-ranging associations of this recently described clinico-neuroradiological syndrome, and look at how appropriate management may lead to rapid resolution of its often life-threatening features. We highlight the importance to anaesthetists and critical care physicians of recognising even atypical cases such as this one in view of key differences in management from similarly presenting conditions. Posterior reversible encephalopathy syndrome (PRES) presents with a variety of neurological features which, although devastating, are potentially reversible on prompt recognition and institution of appropriate treatment [1], but clinicians often fail to suspect it [2]. Delayed diagnosis is frequent and can lead to long-term neurological disability. We describe a case presenting as coma and intra-uterine death in the late stages of an unbooked pregnancy. This patient was challenging to manage in view of uncertainty regarding the diagnosis and particularly serious features, and required consultation and co-ordination between obstetricians, anaesthetists, intensive care physicians, radiologists, neurosurgeons and neurologists. Case reportA 20-year-old woman was brought to a maternity hospital by ambulance having been found unconscious by her flatmates. On arrival, she was unable to maintain her own airway. An oral airway was inserted. Her respiration was laboured with a rate of 10 breaths.min . The blood pressure was 220 ⁄ 120 mmHg. Capillary refill time measured over the sternum was prolonged at 5 s. There was marked generalised oedema. The Glasgow Coma Score was 4 out of 15 (Motor 1, Eyes 1, Verbal 2). Her pupils were 5 mm in diameter, equal, and reactive. Normal tone and tendon jerk reflexes were present in both upper and lower limbs. Inspection of the abdomen revealed a third trimester pregnancy (of which her friends were unaware), and contractions of early labour. Marks on her thigh were consistent with several hours lying on the floor. Vaginal examination showed that the cervix was dilated to 2 cm with fresh meconium draining. Core temperature was elevated at 38.5°C.Initial arterial blood gas analysis showed pH 7.21, P a CO 2 6.9 kPa, P a O 2 37.0 kPa and standard base excess )6.5 mmol.l . Ultrasonography revealed a fetus with no heartbeat. Urinalysis showed ‡ 20 g.dl )1 proteinuria. A working diagnosis was made of severe preeclampsia or eclampsia with an unwitnessed seizure. Possible aetiologies of the ongoing coma were considered

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Posterior leukoencephalopathy without severe hypertension

Cited by 450 publications

References 22 publications

Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage

Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage

A Case of Reversible Posterior Leukoencephalopathy Syndrome Caused by Transient Hypercoagulable State Induced by Infection

Posterior reversible encephalopathy syndrome: a report of a case with atypical features

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