Recurrent posterior reversible encephalopathy syndrome with cerebellar involvement leading to acute hydrocephalus

Hage, Paul; Kseib, Cedric; Hmaimess, Ghassan; Jaoude, Pauline Abou; Noun, Peter

doi:10.1016/j.clineuro.2018.07.005

Cited by 5 publications

(9 citation statements)

References 4 publications

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“…32 Renal conditions predisposing to the syndrome include severe azotemic dysfunction, acute glomerulonephritis, and small-vessel thrombotic microangiopathies. 31,32,211,212,[229][230][231] Onder and colleagues 31 remarkably described the development of PRES in 9% of patients with end-stage renal dysfunction, putatively consequent to the renal dysfunction proper, azotemia, hypertension, solid organ transplantation, or calcineurin inhibitor immunosuppressive therapy. 31 Thavamani and Umapathi 32 identified PRES among 0.45% of pediatric patients with any pathology afflicting the kidneys.…”

Section: Hypertension and Renal Diseasementioning

confidence: 99%

“…201 Hematologic malignancies 18,25,39,[202][203][204][205] which may cause PRES in pediatric patients include acute lymphoblastic leukemia (ALL), 206 acute myeloblastic leukemia, 18 non-Hodgkin's lymphoma, 65 diffuse large B-cell lymphoma, 207 Burkitt's lymphoma, 39 anaplastic large cell lymphoma, 205 and hemophagocytic lymphohistiocytosis. 202 Other causes of PRES include, though not limited to, nonmalignant hematologic disease, 22,40 sickle cell anemia, 33 thalassemia, 22,208,209 essential thrombocythemia, 210 thrombotic thrombocytopenic purpura, 40 typical 211 and atypical 212 hemolytic uremic syndrome, blood transfusions, 32 infection, 38 connective tissue disorders and autoimmune disease, 32 pancreatitis, 213 electrolyte disturbances (e.g., hypomagnesemia, hypocalcemia, and hypercalcemia), licorice, 214 head trauma, 215 and eclamptic cerebrovascular dysautoregulation. 4,5, 22,34,49,52,54,58,113,165,195,[216][217][218][219][220]…”

Section: Etiologymentioning

confidence: 99%

“…Serum levels of lactate dehydrogenase curiously appear to correlate with the severity and extent of cerebral edema. 212,313,314 Complete radiographic resolution occurs in approximately 50 to 70% of patients. 107,307…”

Section: Imagingmentioning

confidence: 99%

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Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

Ghali

Styler

2020

Journal of Pediatric Neurology

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The posterior reversible encephalopathy syndrome was characterized by Hinchey and colleagues in the 1990s. The condition frequently afflicts patients suffering from hematologic and solid organ malignancy and individuals undergoing transplantation. Cases are more frequently described in the adult population compared with children. In the pediatric population, malignancy, transplantation, renal disease, and hypertension represent the most common etiologies. Theories on pathogenesis have centered upon cerebrovascular dysautoregulation with increases in blood–brain barrier permeability. This generates vasogenic edema of the cerebral parenchyma and consequent neurologic deficits. The parietal and occipital lobes are affected with greatest prevalence, though frontal and temporal lobe involvement is frequent, and that of the contents of the infratentorial posterior cranial fossa are occasionally described. The clinical presentation involves a characteristic constellation of neurologic signs and symptoms, most typically inclusive of headache, visual-field disturbances, abnormalities of visual acuity, and seizures. Supportive care, withdrawal of the offending agent, antihypertensive therapy, and prophylactic anticonvulsants affect convalescence in majority of cases. The principal challenge lies in identifying the responsible agent precipitating the condition in patients with malignancy and those having undergone transplantation and thus deciding which medication among a multidrug treatment regimen to withhold, the duration of drug cessation required to effect clinical resolution, and the safety of resuming treatment with the compound. We accordingly reviewed and evaluated the literature discussing the posterior reversible encephalopathy syndrome in children.

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Section: Hypertension and Renal Diseasementioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

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Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

Ghali

Styler

2020

Journal of Pediatric Neurology

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“…So a composite effect of endothelial injury, leaky tight junctions, leukocyte passage & vasoconstriction leads to brain oedema. 8,9,10 This theory explains the often seen watershed pattern of distribution, the ischemia and infarcts in a subset of cases, the petechial haemorrhages, transudation of fluid and large vessel vasospasm that has been encountered on catheter angiography and MR angiography(MRA). 11 Conditions Diverse renal parenchymal diseases have been encountered in association with PRES like Lupus nephritis, Focal segmental glomerulonephritis (FSGS), Membranoproliferative glomerulonephritis (MPGN), Post streptococcal glomerulonephritis (PSGN), renovascular hypertension, Henoch-Schonlein purpura(HSP) etc.…”

Section: Toxic Leukoencephalopathymentioning

confidence: 99%

“…Computed tomography (CT) scan of the brain shows nonspecific low attenuation lesions. 2,8,23 Complications such as cerebral ischemia and cerebral haemorrhage also can be detected radiologically. 12…”

Section: Radiological Characteristicsmentioning

confidence: 99%

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)- CASE REPORT & REVIEW OF LITERATURE

Raman¹,

Behera²,

Senapati³

2019

jemds

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A seven-year-old male child presented with generalised progressive swelling all over body with decreased urine output and nephrotic range proteinuria. He had history of headache & visual impairment since 6 months. No history of fever, arthralgia, rashes or any other symptoms present. His blood pressure was 160/90 mmHg. Investigations: Hb-6.37 gm/dl, TLC-20,110/cmm, TPC-4.1 lakh/cmm, Sr. Urea-63 mg/dl, Sr. Creatinine-1.1 mg/dl, Sr. Total Protein-3.7 gm/dl, Serum albumin-1.4 gm/dl, Total cholesterol-351 mg/dl, ANA-1+Positive, ASO-Negative, Sickling test-Negative, Sr. C3-78 mg/dl, HIV/HBsAg-Negative, Urine RE/ME-Albumin 4+, pus cells-0-2/HPF, RBCs-4-6/HPF, hyaline cast-0-2/LPF, Spot urine protein-814.8 mg/dl, spot urine creatinine-32.15 mg/dl, Urine protein creatinine ratio-25.343 mg/gm, Stool RE/ME-Strongyloides stercoralis, USG Abdomen &pelvis showed cholelithiasis, ascites. MRI brain revealed bilateral occipital cortex cortical atrophy. Clinical diagnosis was Nephrotic syndrome associated PRES. Renal percutaneous biopsy was done. Histopathology showed presence of fetal glomeruli & mild mesangial matrix accentuation in one glomerulus. (Fig. 1, 2) Features of acute tubular injury with atrophic tubules seen with moderate chronic inflammatory cell infiltration in interstitium. (Fig. 3) Blood vessels were unremarkable. Immunofluorescence study showed minimal positivity for IgM& C3 antisera. So, the diagnosis of tubulointerstitial nephritis with mild mesangial sclerosis in association with PRES was given. DIFFERENTIAL DIAGNOSIS The non-specific clinical manifestations and multiplicity of radiological patterns increases the diagnostic challenges as various other conditions mimic PRES. 12 1. Acute Cerebral Ischaemia: Unilateral lesions with a decreased diffusion coefficient. 2. Cerebral Venous Thrombosis: Asymmetric, diffuse lesions. 3. Transient Cerebral Hyperaemia: Develops after an episode of seizure or end arterectomy.

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Antineoplastics/etoposide/immune globulin

2018

Reactions Weekly

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Recurrent posterior reversible encephalopathy syndrome with cerebellar involvement leading to acute hydrocephalus

Cited by 5 publications

References 4 publications

Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)- CASE REPORT & REVIEW OF LITERATURE

Antineoplastics/etoposide/immune globulin

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