Reversible posterior leukoencephalopathy syndrome in a patient with thrombotic thrombocytopenic purpura

Aridon, Paolo; Ragonese, Paolo; Mazzola, Maria Antonietta; Quintini, Gerlando; Re, Marianna Lo; Talamanca, Simona; Terruso, Valeria; D’Amelio, Marco; Savettieri, Giovanni

doi:10.1007/s10072-010-0465-4

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…31 TTP is a recognized cause of posterior reversible encephalopathy syndrome (PRES), a clinicoradiological diagnosis charac terized by extensive vasogenic oedema of the parietal and occipital lobes with concurrent clinical signs. 32 BBB breakdown. In one cohort of 415 patients with suspected TTP, 7% had an underlying diagnosis of sepsis alone.…”

Section: Sensitivity Of Conventional Imagingmentioning

confidence: 99%

Imaging in sepsis-associated encephalopathy—insights and opportunities

2013

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Sepsis-associated encephalopathy (SAE) refers to a clinical spectrum of acute neurological dysfunction that arises in the context of sepsis. Although the pathophysiology of SAE is incompletely understood, it is thought to involve endothelial activation, blood-brain barrier leakage, inflammatory cell migration, and neuronal loss with neurotransmitter imbalance. SAE is associated with a high risk of mortality. Imaging studies using MRI and CT have demonstrated changes in the brains of patients with SAE that are also seen in disorders such as stroke. Next-generation imaging techniques such as magnetic resonance spectroscopy, diffusion tensor imaging and PET, as well as experimental imaging modalities, provide options for early identification of patients with SAE, and could aid in identification of pathophysiological processes that represent possible therapeutic targets. In this Review, we explore the recent literature on imaging in SAE, relating the findings of these studies to pathological data and experimental studies to obtain insights into the pathophysiology of sepsis-associated neurological dysfunction. Furthermore, we suggest how novel imaging technologies can be used for early-stage proof-of-concept and proof-of-mechanism translational studies, which may help to improve diagnosis in SAE.

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Section: Sensitivity Of Conventional Imagingmentioning

confidence: 99%

Imaging in sepsis-associated encephalopathy—insights and opportunities

2013

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“…However, steroids are also used in the treatment of vasogenic edema, such as in patients with intracranial mass lesions [9]. Case reports have implicated steroids as both the precipitant [5, 8, 12, 19, 20, 23, 24, 30, 31, 34, 38, 47, 48] and treatment [1, 6, 8, 12, 13, 18, 25, 28, 30, 33, 36, 37] of PRES. Thus, the role of steroids in PRES remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome

Parikh

Schweitzer

Young

et al. 2017

Journal of the Neurological Sciences

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Background Posterior reversible encephalopathy syndrome (PRES) is a variable cerebrovascular syndrome associated with hypertension and autoregulatory failure. Steroids have been reported to both precipitate and treat PRES. We sought to determine the prevalence of steroid therapy at the time of PRES and to assess the relationship between steroid therapy and extent of vasogenic edema. Methods We performed a retrospective review of radiology reports between 2008 and 2014 from two academic medical centers to identify cases of PRES. Clinical and radiographic data were collected. Descriptive statistics were used to determine the prevalence of corticosteroid therapy at the time of PRES onset and the latency from steroid initiation to PRES onset. The association between steroid therapy and extent of vasogenic edema was assessed in multiple regression models. Results We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30–65) and 74% were women. Steroid therapy at time of PRES onset was identified in 44 of 99 cases. Excluding patients on chronic therapy, the median duration of steroid exposure before PRES onset was 6 (IQR, 3–10) days. Steroid therapy was not associated with extent of vasogenic edema in unadjusted or linear and logistic regression models adjusted for age, sex, and maximum systolic blood pressure on day of onset. Conclusion Corticosteroid therapy, often of brief duration, frequently preceded the onset of PRES and was not associated with severity of vasogenic edema.

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Posterior reversible encephalopathy syndrome associated with Guillain‐Barré syndrome: Case report and clinical management considerations

Salvalaggio

Cagnin

Marson³

et al. 2020

J of Clinical Apheresis

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Around half of the patients with Guillain‐Barré syndrome (GBS) present autonomic dysfunction requiring admission to intensive care unit in up to a quarter of patients. Treatment of GBS consists of plasma exchange (PE) and intravenous immunoglobulins (IVIG). Posterior reversible encephalopathy syndrome (PRES) consists in a reversible subcortical vasogenic brain edema caused by endothelial damage triggered by abrupt blood pressure changes. We report on a woman who presented with PRES in the course of GBS treated first with IVIG, and then with PE. The present report underlines the challenge that the clinicians face when these two rare syndromes concur. The literature is not helpful considering that both blood pressure fluctuations and IVIG are reported to be involved in the pathogenesis of PRES. In the present letter, both pathogenic mechanisms and clinical management considerations are discussed.

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Reversible posterior leukoencephalopathy syndrome in a patient with thrombotic thrombocytopenic purpura

Cited by 6 publications

References 10 publications

Imaging in sepsis-associated encephalopathy—insights and opportunities

Imaging in sepsis-associated encephalopathy—insights and opportunities

Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome associated with Guillain‐Barré syndrome: Case report and clinical management considerations

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