Posterior reversible encephalopathy syndrome: The endothelial hypotheses

Marra, Annachiara; Vargas, Maria; Striano, Pasquale; Guercio, Luca del; Buonanno, Pasquale; Servillo, Giuseppe

doi:10.1016/j.mehy.2014.02.022

Cited by 186 publications

(157 citation statements)

References 18 publications

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“…1 Deregulation of cerebral vascular tone in RCVS may be induced by sympathetic overactivity, endothelial dysfunction, and oxidative stress. 3,5,11,12,23,48,49 The association of RCVS with blood pressure surges, ingestion of sympathomimetic vasoactive substances, and pheochromocytoma support the role of sympathetic overactivity in its pathogenesis. On the other hand, a significant overlap between RCVS and PRES supports the importance of endothelial dysfunction, which is known to play an important pathophysiologic role in the latter.…”

Section: Pathogenesismentioning

confidence: 96%

Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course

Miller

Shivashankar

Mossa‐Basha

et al. 2015

AJNR Am J Neuroradiol

204

194

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SUMMARY:Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.ABBREVIATIONS: RCVS ϭ reversible cerebral vasoconstriction syndrome; PRES ϭ posterior reversible encephalopathy syndrome

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Section: Pathogenesismentioning

confidence: 96%

Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course

Miller

Shivashankar

Mossa‐Basha

et al. 2015

AJNR Am J Neuroradiol

204

194

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“…It has been described in the literature in association with pregnancy, eclampsia, drug toxicity and autoimmune conditions such as systemic lupus erythematosus (SLE), as was the case for our patient. The underlying pathophysiology is focused around the endothelial hypothesis and high blood pressure [7,8]. These theories purport an inciting factor for sustained or uncontrolled hypertension leading to endothelial dysfunction and loss of nitric oxide production.…”

Section: Discussionmentioning

confidence: 99%

Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus

Mehta¹

2018

Int J Case Rep Images

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We present a case of a 25-year-old African-American woman with a history of chronic pelvic pain secondary to recurrent endometriosis presenting with chief complaints of fever and pelvic pain. She was treated with laparoscopic ablation three months prior. Workup revealed bilateral tuboovarian abscesses and the patient underwent total abdominal hysterectomy and bilateral salpingooophorectomy. Postoperatively, the patient had new onset hypertension which eventually lead to a seizure episode. The patient was transferred to the ICU, started on nicardipine and Keppra and her hypertension improved within several hours. Neuroimaging findings on MRI scan revealed lesions in the occipital and parietal lobes consistent with PRES. Outpatient workup conducted several months afterwards uncovered a diagnosis of systemic lupus erythematosus, leading us to conclude that the postoperative hypertensive emergency and PRES were secondary to undiagnosed SLE. IJCRI publishes Conclusion:The rare complication of PRES has been described in a variety of settings including SLE in which endothelial dysfunction of the intracerebral vasculature leads to characteristic PRES symptoms. Patients, especially those in the postoperative setting covered by multiple specialty providers, with new onset hypertension and neurological symptoms should warrant further workup as they may indicate underlying etiologies such as SLE or other described risk factors for PRES.

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“…15 Endothelial dysfunction seems to better account for the mechanisms of PRES, given that both vasogenic and cytotoxic edema could occur in PRES, as well as hypoperfusion or hyperperfusion. 16 Forced dilation of cerebral arteries and disruption of the integrity of the BBB are considered the most important mechanisms underlying vasogenic edema observed in patients with PRES and hypertension. Alternatively, ischemia triggered by systemic inflammation, endothelial injury, and vascular dysfunction is also suggested to contribute to vasogenic edema observed in PRES, as well as active leakage of fluid due to other processes affecting the vascular wall.…”

Section: Discussionmentioning

confidence: 99%

Cytotoxic Edema in Posterior Reversible Encephalopathy Syndrome: Correlation of MRI Features with Serum Albumin Levels

Gao

et al. 2015

AJNR Am J Neuroradiol

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Posterior reversible encephalopathy syndrome: The endothelial hypotheses

Cited by 186 publications

References 18 publications

Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course

Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course

Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus

Cytotoxic Edema in Posterior Reversible Encephalopathy Syndrome: Correlation of MRI Features with Serum Albumin Levels

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