Reversible Posterior Leukoencephalopathy Syndrome in Systemic Lupus Erythematosus With Thrombocytopenia Treated With Cyclosporine

Shin, Kyusoon; Choi, Hyo Jin; Bae, Yeong Deok; Lee, Jung Chan; Lee, Eun Bong; Song, Yeong Wook

doi:10.1097/01.rhu.0000164825.63063.43

Cited by 45 publications

(23 citation statements)

References 10 publications

(12 reference statements)

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“…The exact pathophysiological mechanism of PRES is still unclear [12]. Three hypotheses have been proposed till now, which include 1) cerebral vasoconstriction causing subsequent infarcts in the brain, 2) failure of cerebral auto-regulation with vasogenic edema, and 3) endothelial damage with blood-brain barrier disruption further leading to fluid and protein transudation in the brain [12][13][14]. The distinct imaging patterns in PRES are represented in Table 2 [15].…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Case Report

Sodalagunta¹,

Sudulagunta

Kumbhat

et al. 2016

J Neurol Res

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Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome characterized by headache, seizures, altered mental status, and visual loss, as well as white matter vasogenic edema affecting the posterior occipital and parietal lobes of the brain predominantly. This clinical syndrome is increasingly recognized due to improvement and availability of brain imaging, specifically magnetic resonance imaging (MRI). A 35-year-old female with history of unsafe abortion and massive blood transfusion 10 days ago was brought to the emergency room with three episodes of generalized tonic clonic seizures, urinary incontinence and altered sensorium since 3 hours. Brain MRI showed bilateral occipital, parietal, frontal cortex and subcortical white matter T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities, suggestive of PRES. Patient improved after management with intravenous fluids, antibiotics, antiepileptics and monitoring of blood pressure. If recognized and treated early, the clinical syndrome commonly resolves within a week. PRES can be a major problem in rapid and massive blood transfusion. High index of suspicion and prompt treatment can reduce morbidity and mortality, and pave the path for early recovery.

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Case Report

Sodalagunta¹,

Sudulagunta

Kumbhat

et al. 2016

J Neurol Res

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“…Reviewing previous reports on RPLS in patients with SLE, there are two types of RPLS-SLE: ''hypertensive RPLS,'' being reversible with conventional antihypertensive and anticonvulsive treatments concomitant with inactive SLE, and ''immunological RPLS,'' which requires immunosuppressive therapy and is considered a neurological manifestation of active SLE. Table 1 summarizes RPLS-SLE cases from the literature review [4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Among these reports, there were 28 patients with SLE for whom adequate clinical information was provided for meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of reversible posterior leukoencephalopathy syndrome in patients with systemic lupus erythematosus

et al. 2011

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To characterize reversible posterior leukoencephalopathy syndrome (RPLS) in systemic lupus erythematosus (SLE) in terms of treatments for resolution and its clinical course, we reviewed 28 cases of RPLS in SLE including our cases in view of the treatment. Of these, 15 cases improved with blood pressure control and 13 required immunosuppressive therapy for activity of SLE presenting neurological manifestations. Patients without immunosuppressants at onset of RPLS more frequently required immunosuppressive therapy to recover it than those precedingly using these agents [31% (4/13) versus 87% (13/15), p = 0.008, chi-square test]. Brain magnetic resonance imaging (MRI) is important for diagnosis of RPLS-SLE in the patient with SLE who develops neurological disturbance and rapidly increasing blood pressure. When 7-day therapy for hypertension and convulsion does not reverse the manifestations, immunosuppressive treatments would be recommended to reverse RPLS.

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“…PRES has been described as an uncommon neurological manifestation in systemic lupus erythematosus (SLE), mainly associated with hypertension, renal insufficiency, and use of immunosuppressive drugs 2 . Cases without hypertension and/or renal dysfunction are very rare 3,4 . Endothelium dysfunction caused by systemic inflammation in SLE has been proposed as an alternative mechanism to the hypertension-induced cerebral autoregulatory dysfunction 5 .…”

Section: To the Editormentioning

confidence: 99%