Posterior Reversible Leukoencephalopathy Syndrome After Kratom Ingestion

Castillo, Austin; Payne, Drew; Nugent, Kenneth

doi:10.1080/08998280.2017.11929647

Cited by 22 publications

(32 citation statements)

References 11 publications

(7 reference statements)

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“…The neuroimaging findings, including anatomical pattern, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), edema type, symmetry, and arterial characteristics, are summarized in Supplementary Table 3. Five patients (19,24,26,34,44) had normal initial brain CT (5/9, 56%) (19,20,24,26,34,42,44,48,50). All patients exhibited cortical and/or subcortical edema, characterized by hyperintensities in T2-weighted and/or T2 fluid-attenuated inversion recovery (FLAIR) imaging, which was consistent with PRES diagnosis in MRI.…”

Section: Radiological Featuressupporting

confidence: 55%

“…The initial clinical presentation was alertness disorders in 64% of patients (13)(14)(15). Visual disturbances were reported in 55% of patients ( (19,20,35), visual hallucination (21,23,26,27), and cortical blindness (15,16,24,29,34,37). Four patients had concurrent acute kidney failure with PRES (13,19,44,48).…”

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

“…When performed (33,39,43), hypomagnesemia was found in one patient (39). Cerebral spinal fluid (CSF) analysis (20,21,23,24,34,36,37,45,47,49) showed elevated CSF protein in one patient (34). Nine patients (21%) required mechanical ventilation (14,21,28,33,38,(46)(47)(48).…”

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

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Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

et al. 2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Methods: Medline/PubMed, Web of Science, and PsycINFO were screened through May 31, 2019, to systematically identify case reports and case series describing PRES associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical substances) in accidental context, intentional overdose, and substance abuse. The methodological quality of eligible case reports/series was assessed. Patients and exposure characteristics were recorded; relevant toxicological, radiological, and clinical data were extracted. Results: Forty-one case reports and one case series reporting 42 unique cases were included. The median time to PRES onset from the start of exposure was 3 days (IQR 2-10). Acute high blood pressure, visual disturbance, and seizure were reported in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. One-third of patients had at least one risk factor for PRES such as chronic hypertension (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the combination of classical parieto-occipital edema with another anatomical region (e.g., frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance Largeau et al. PRES in Clinical Toxicology imaging. The median time required to hospital discharge was 14 days (IQR 7-18). Mortality and neurological recurrence rate were null. Conclusions: Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored.

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Section: Radiological Featuressupporting

confidence: 55%

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

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Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

et al. 2020

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“…Central Nervous System Effects: Posterior Reversible Encephalopathy Syndrome and Seizure [51,66,67] Posterior reversible encephalopathy syndrome and seizure (PRES) has been reported in patients that combined kratom use with marijuana, fluoxetine, and quetiapine [66]. In this patient, supportive care and lowering blood pressure with nicardipine infusion helped to improve the patient's condition.…”

Section: Interventionmentioning

confidence: 90%

“…Overall, there were 41 cases on kratom-associated adverse events or toxicities (Table 1). Kratom-associated adverse events were as follows: kratom-associated withdrawal symptoms (KAWS) in adults [41][42][43][44][45][46][47][48][49][50][51][52], kratom-associated neonatal abstinence syndrome (KANAS) [48,[52][53][54][55][56], hypothyroidism [43], hypogonadism [57], kratom-induced hepatoxicity (KIH) [58][59][60][61][62][63][64][65], CNS effects causing seizure and coma or posterior reversible encephalopathy syndrome (PRES) [39,66,67], acute respiratory distress syndrome (ARDS) [68,69], overdose toxidrome [70,71], and fatalities [72][73][74][75][76][77][78][79][80]. There were six case series of aggregated patient's data [48,…”

Section: Literature Case Reviewmentioning

confidence: 99%

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

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Purpose of Review This review describes case reports for patients with kratom-associated adverse events in order to assist clinicians with patient management. A stepwise approach is proposed for assessing active kratom users as well as considerations for the management of toxicities or withdrawal. Recent Findings Multiple in vitro and in vivo studies illustrate the pharmacologic and toxicologic effects of kratom extract. No randomized controlled trials in humans exist that assess the safety and efficacy of the substance. Cross-sectional surveys from active users and reports from poison control centers have shown acute and chronic physiological and psychological adverse events. Summary Reports of adverse effects associated with kratom use have demonstrated hypothyroidism, hypogonadism, hepatitis, acute respiratory distress syndrome, posterior reversible encephalopathy syndrome, seizure, and coma. Overdose toxidrome leads to respiratory failure, cardiac arrest, and fatalities. Adult and neonatal withdrawal symptoms have also occurred. Clinicians should be aware of the risks and benefits of kratom use.

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Fatal combination of mitragynine and quetiapine – a case report with discussion of a potential herb-drug interaction

Hughes

2018

Forensic Sci Med Pathol

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Posterior Reversible Leukoencephalopathy Syndrome After Kratom Ingestion

Cited by 22 publications

References 11 publications

Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Fatal combination of mitragynine and quetiapine – a case report with discussion of a potential herb-drug interaction

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