Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience

Abstract

A bstract Background Though epileptic seizures are common in posterior reversible encephalopathy syndrome (PRES), status epilepticus (SE) as the presenting feature is rare. Objective To study the clinical spectrum and outcome of patients with SE as presenting feature of PRES. Methods This is a retrospective study. PRES was diagnosed based on the clinical features and imaging findings on brain MRI ( n = 40) which became normal after 6 months follow-up imaging. Patients with SE as the initial manifestation of PRES were identified. Baseline information regarding the clinical presentation, etiology, past history of illness, treatment history, imaging findings, EEG and long-term clinical outcome. Result Seizure was the most common presentation seen in 31 patients (77.5%). The etiologies in PRES were preeclampsia, or eclampsia [ n = 33 (82.5%)], hypertensive encephalopathy [ n = 3 (7.5%)], systemic lupus erythematosus (SLE), AIP, and chronic renal failure (CRF) in one patient each [ n = 01 (2.5%)]. Brain MRI showed the involvement of parieto-occipital lobes ( n = 33 [82.5%]) mostly. Status epilepticus (generalized convulsive) was the presenting feature in eight cases (20%). Among them, five cases (0.5%) had a history of chronic epilepsy. In the remaining three patients, SLE and acute intermittent porphyria, CRF precipitated the SE. Conclusion The study highlights the clinico-etiological spectrum of PRES and the identification of SE within its context leading to the early diagnosis and management if treated early. The role of antenatal care is important for the identification and treatment of etiologies, blood pressure, proper antiepileptic drug compliance and appropriate counseling. How to cite this article Prasad P. Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience. Indian J Crit Care Med 2023;27(7):488–492.

Antiglomerular basement membrane antibody type rapidly progressive glomerulonephritis with seizures: Two cases and literature review

“…Currently, the recognized pathogenesis of PRES mainly includes the following two aspects, including cerebrovascular automatic regulation mechanism disorders and endothelial cell dysfunction caused by various reasons. 25 , 26 When the cerebrovascular autoregulation mechanism is blocked, excessive blood pressure breaks through the automatic regulation range of cerebral blood flow (usually 50–150 mmHg), resulting in brain hyperperfusion. 27 The posterior cerebral circulation area is more vulnerable to damage due to weak sympathetic regulation.…”