Reversible Posterior Leukoencephalopathy in a Venomous Snake (Bothrops asper) Bite Victim

Delgado, Miguel E.; Brutto, Oscar H. Del

doi:10.4269/ajtmh.2012.11-0610

Cited by 12 publications

(11 citation statements)

References 18 publications

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“…Among these cases, minimal occipital intraparenchymal (20,36), microbleeds in the cerebellum (30) and sylvian fissure (43), and subarachnoid hemorrhage (31) were reported. Regarding contrast enhancement (19,20,22,23,30,31,38,52), only one case described gyriform enhancement (20). In this case of PRES induced by kratom, brain MRI showed multifocal areas of abnormal T2 FLAIR; restricted diffusion in the superior parietal lobes, both occipital lobes, and both cerebellar hemispheres; and minimal hemorrhage in the left superior parietal lobe consistent with atypical PRES (20).…”

Section: Radiological Featuresmentioning

confidence: 76%

“…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). The median time required to hospital discharge was 14 days (IQR 7-18).…”

Section: Demographic Characteristics and Clinico-biological Findingsmentioning

confidence: 99%

“…Radiological diagnosis was based on brain MRI and CT scans in 91% (38/42) and 9% (4/42) (35,38,40,43), respectively. 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.…”

Section: Radiological Featuresmentioning

confidence: 99%

“…In venom-induced PRES, snake bites [Cerastes cerastes (39), Bothrops asper (38), pit viper (42), Bungarus caeruleus (12)] were involved in four patients, scorpion stings in two cases [Tityus bahiensis (13), Androctonus mauretanicus (14)], and multiple wasp stings in two patients (40,48). PRES was associated with mushroom (46) and licorice (16,17,(43)(44)(45) in one and five patients, respectively.…”

Section: Natural Toxinmentioning

confidence: 99%

“…In 36% (5/14) of patients (12,16,17,40,43), the time from exposure start to PRES onset was more than 1 week. Patients required mechanical ventilation in 29% (4/14) of cases (14,38,46,48); the duration of mechanical ventilation ranged from 2 (46) to 14 days (38). Acute kidney failure occurred in 36% (5/14) of patients (13,40,42,44,48), requiring hemodialysis in two cases (40,42).…”

Section: Natural Toxinmentioning

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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