Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome

Ribeiro, Bruno Niemeyer de Freitas; Salata, Tiago Medina; Borges, Rafael Silveira; Marchiori, Edson

doi:10.1590/0100-3984.2015.0129

Cited by 14 publications

(6 citation statements)

References 11 publications

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“…Although previous reports have suggested that PRES could be the presenting manifestation of GBS [10, 11] and could occur in patients with GBS variants, such as Miller-Fisher syndrome (MFS) or BBE (Table 2), our case, in contrast to most of the cases, presented with PRES as the first manifestation of BBE with overlapping GBS prior to any intervention. Three previous cases have shown the co-occurrence of MFS or MFS/ BBE-overlap syndrome and non-hypertensive PRES; however, in these cases, IVIG treatment was considered to be the culprit of PRES [4, 5, 12]. One recent case demonstrated extensive vasogenic edema in BBE without any intervention; however, whether the vasogenic edema of the deep white matter, brainstem, and cerebellum was attributable to PRES is uncertain [13].…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy as the first manifestation of Bickerstaff’s brainstem encephalitis

Chen

2016

BMC Neurol

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BackgroundPosterior reversible encephalopathy syndrome (PRES) has been associated with Guillain-Barre syndrome in rare cases. Here we report a patient in whom PRES was the presenting manifestation of Bickerstaff’s brainstem encephalitis.Case presentationA 75-year-old woman presented with acute onset of hypertension, headache, blurred vision, and left eyelid drooping. Magnetic resonance imaging of the brain showed characteristic PRES lesions involving the parietal and occipital lobes bilaterally. On the 6th day after symptom onset, the patient developed complete ptosis and external ophthalmoplegia of both eyes, progressive ataxia, and bilateral lower limb weakness. Cerebrospinal fluid analyses revealed albuminocytological dissociation (protein: 66.6 mg/dL, WBC: 0/μl), and nerve conduction studies showed demyelinating sensorimotor polyneuropathy. The patient developed somnolence and a left extensor plantar response on the 8th day. A diagnosis of Bickerstaff’s brainstem encephalitis was made. Treatment with plasmapheresis led to a rapid improvement of clinical symptoms. To date, only five similar cases have been reported, but this is the only case in which PRES developed prior to treatment.ConclusionsPRES can be a comorbid condition with Bickerstaff’s brainstem encephalitis, either preceding or following treatment; caution should be used in patients with either syndrome who exhibit atypical presentations.

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Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy as the first manifestation of Bickerstaff’s brainstem encephalitis

Chen

2016

BMC Neurol

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“…In 2005, Nakajia ( 68 ) reported a patient with Miller–Fisher syndrome who developed PRES following IVIG therapy. Stetefeld et al ( 69 ) and Ribeiro et al ( 70 ) later reported additional patients with Miller–Fisher syndrome who developed PRES during immunoglobulin infusion. The clinical manifestations in these patients include an acute onset characterized by headache, generalized seizure, visual impairment, and an altered mental state ( 69 – 71 ).…”

Section: Classification Of Adverse Effectsmentioning

confidence: 99%

Adverse Effects of Immunoglobulin Therapy

et al. 2018

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Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.

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“…Posterior reversible encephalopathy syndrome (PRES) is a rare neurological adverse effect of immunoglobulin ( Guo et al, 2018 ). PRES was also reported in MFS patient with immunoglobulin therapy ( Ribeiro et al, 2016 ). The dilation and constriction in the secondary and tertiary branches of intracranial artery is one of neuroimaging features of PRES ( Chen et al, 2016 ).…”

Section: Discussionmentioning

confidence: 87%

Fulminant Guillain–Barré Syndrome and Spontaneous Intraventricular Hemorrhage: A Case Report and Literature Review

Luo

Wang

et al. 2020

Front. Neurosci.

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Guillain–Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy that is characterized by flaccid paralysis. A few cases have reported that GBS can be caused by head trauma or neurosurgery, but it has never been associated with intraventricular hemorrhage. Here, we report an uncommon case of fulminant GBS that occurred after spontaneous intraventricular hemorrhage. A 73-year-old woman was admitted to the hospital after sudden unconsciousness and vomiting. A head computed tomography (CT) scan following the incident showed a newly developed intraventricular hemorrhage, which led to an immediate ventriculostomy. After 5 days, the endotracheal tube was removed. Two days later, the external ventricular drainage tube was also removed. At this time, the patient was alert and the neurological examination was normal. However, the patient suddenly presented with acute respiratory failure and bilateral limb weakness 3 days later. An analysis of the patient’s cerebrospinal fluid (CSF) revealed that albuminocytologic dissociation was present. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days. Despite timely medical intervention in the hospital, the patient passed away 2 months later. After a cerebral hemorrhagic injury, limb and respiratory muscle weakness can occur on occasion in the ICU. In this context, the potential involvement of GBS should not be ignored. Importantly, the pathogenic mechanism of GBS has been discussed for over a century, and it still remains a mystery. We speculate that the TLR4/NF-κB signaling pathway may be involved in the pathogenesis of GBS following intraventricular hemorrhage. The prognosis of most patients with GBS is usually good, but cerebral hemorrhage and mechanical ventilation may serve as risk factors that exacerbate the condition. This case is reported to remind clinicians to consider the possibility of GBS when patients present limb and respiratory muscle weakness after intraventricular hemorrhage, and to provide a starting point to discuss potential mechanisms of GBS after intraventricular hemorrhage.

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Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome

Cited by 14 publications

References 11 publications

Posterior reversible encephalopathy as the first manifestation of Bickerstaff’s brainstem encephalitis

Posterior reversible encephalopathy as the first manifestation of Bickerstaff’s brainstem encephalitis

Adverse Effects of Immunoglobulin Therapy

Fulminant Guillain–Barré Syndrome and Spontaneous Intraventricular Hemorrhage: A Case Report and Literature Review

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