Posterior reversible encephalopathy syndrome in an adult patient undergoing peritoneal dialysis: a case report and literature review

BMC Nephrology

George B Pylypchuk²  Brett R Graham¹ 

[1] Department of Medicine, Division of Neurology, University of Saskatchewan, Room 3544 RUH, 103 Hospital Drive, Saskatoon, SK, Canada;Department of Medicine, Division of Nephrology, University of Saskatchewan, Room 3544 RUH, 103 Hospital Drive, Saskatoon, SK, Canada

关键词: Hypertension;    End-stage renal disease;    Posterior reversible encephalopathy syndrome;    Peritoneal dialysis;   

Others  :  1082749
DOI  :  10.1186/1471-2369-15-10

 received in 2013-03-11, accepted in 2014-01-09,  发布年份 2014

【 摘 要 】

Background

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized clinically by headache, altered mental status, seizures, visual disturbances, and other focal neurological signs, and radiographically by reversible changes on imaging. A variety of different etiologies have been reported, but the underlying mechanism is thought to be failed cerebral autoregulation. To the best of our knowledge, we report the third known case of PRES in an adult receiving intermittent peritoneal dialysis (PD).

Case presentation

A 23-year-old male receiving PD was brought to hospital after experiencing a generalized seizure. On presentation he was confused and hypertensive. An MRI brain was obtained and showed multiple regions of cortical and subcortical increased T2 signal, predominantly involving the posterior and paramedian parietal and occipital lobes with relative symmetry, reported as being consistent with PRES. A repeat MRI brain obtained three months later showed resolution of the previous findings.

Conclusion

Due to having a large number of endothelium-disrupting risk factors, including hypertension, uremia, and medications known to disrupt the cerebrovascular endothelium, we suggest that those with end-stage renal disease (ESRD) receiving PD are at high risk of developing PRES. Furthermore, we surmise that PRES is likely more prevalent in the ESRD population but is under recognized. Physicians treating those with ESRD must have a high index of suspicion of PRES in patients presenting with neurological disturbances to assure timely diagnosis and treatment.

【 授权许可】

   
2014 Graham and Pylypchuk; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996, 334(8):494-500.
• [2]Maizlin ZV, Ghandehari H, Maizels L, Shewchuk JR, Kirby JM, Vora P, Clement JJ: Linguistic history of posterior reversible encephalopathy syndrome: mirror of developing knowledge. J Neuroimaging 2011, 21(1):1-4.
• [3]Lee VH, Wijdicks EF, Manno EM, Rabinstein AA: Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008, 65(2):205-210.
• [4]Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA: Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 2010, 85(5):427-432.
• [5]Roth C, Ferbert A: The posterior reversible encephalopathy syndrome: what’s certain, what’s new? Pract Neurol 2011, 11(3):136-144.
• [6]Feske SK: Posterior reversible encephalopathy syndrome: a review. Semin Neurol 2011, 31(2):202-215.
• [7]Ay H, Buonanno FS, Schaefer PW, Le DA, Wang B, Gonzalez RG, Koroshetz WJ: Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology 1998, 51(5):1369-1376.
• [8]Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J: Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol 2006, 27(10):2179-2190.
• [9]Sibai BM: Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol 1990, 163(3):1049-1054.
• [10]Schwartz RB, Bravo SM, Klufas RA, Hsu L, Barnes PD, Robson CD, Antin JH: Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol 1995, 165(3):627-631.
• [11]Bartynski WS, Boardman JF: Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 2007, 28(7):1320-1327.
• [12]Casey SO, Sampaio RC, Michel E, Truwit CL: Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 2000, 21(7):1199-1206.
• [13]Schaefer PW, Buonanno FS, Gonzalez RG, Schwamm LH: Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke 1997, 28(5):1082-1085.
• [14]Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E: The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol 2012, 259(1):155-164.
• [15]Girisgen I, Tosun A, Sonmez F, Ozsunar Y: Recurrent and atypical posterior reversible encephalopathy syndrome in a child with peritoneal dialysis. Turk J Pediatr 2010, 52(4):416-419.
• [16]Legriel S, Merceron S, Pico F, Cordoliani YS, Bedos JP: A rare cause of status epilepticus. Intensive Care Med 2011, 37(10):1718-1719.
• [17]Paulson OB, Strandgaard S, Edvinsson L: Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990, 2(2):161-192.
• [18]Lassen NA: Cerebral blood flow and oxygen consumption in man. Physiol Rev 1959, 39(2):183-238.
• [19]Beausang-Linder M, Bill A: Cerebral circulation in acute arterial hypertension–protective effects of sympathetic nervous activity. Acta Physiol Scand 1981, 111(2):193-199.
• [20]Johansson B, Li CL, Olsson Y, Klatzo I: The effect of acute arterial hypertension on the blood-brain barrier to protein tracers. Acta Neuropathol 1970, 16(2):117-124.
• [21]Olsson Y, Hossmann KA: Fine structural localization of exudated protein tracers in the brain. Acta Neuropathol 1970, 16(2):103-116.
• [22]Onder AM, Lopez R, Teomete U, Francoeur D, Bhatia R, Knowbi O, Hizaji R, Chandar J, Abitbol C, Zilleruelo G: Posterior reversible encephalopathy syndrome in the pediatric renal population. Pediatr Nephrol 2007, 22(11):1921-1929.
• [23]Gokce M, Dogan E, Nacitarhan S, Demirpolat G: Posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy and acute uremia. Neurocrit Care 2006, 4(2):133-136.
• [24]Kadikoy H, Haque W, Hoang V, Maliakkal J, Nisbet J, Abdellatif A: Posterior reversible encephalopathy syndrome in a patient with lupus nephritis. Saudi J Kidney Dis Transpl 2012, 23(3):572-576.
• [25]Delanty N, Vaughan C, Frucht S, Stubgen P: Erythropoietin-associated hypertensive posterior leukoencephalopathy. Neurology 1997, 49(3):686-689.
• [26]Spivak JL: The mechanism of action of erythropoietin. Int J Cell Cloning 1986, 4(3):139-166.
• [27]Vaziri ND: Mechanism of erythropoietin-induced hypertension. Am J Kidney Dis 1999, 33(5):821-828.
• [28]Nakabou M, Kai T, Maeshima T, Kanamasa K: Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases. Clin Exp Nephrol 2010, 14(3):256-262.
• [29]Geyskes GG, Boer P, Dorhout Mees EJ: Clonidine withdrawal. Mechanism and frequency of rebound hypertension. Br J Clin Pharmacol 1979, 7(1):55-62.
• [30]Kitamura M, Furusu A, Hirose M, Nishino T, Obata Y, Uramatsu T, Kohno S: A case of reversible posterior leukoencephalopathy syndrome in a patient on peritoneal dialysis. Clin Exp Nephrol 2010, 14(6):633-636.
• [31]Ogawa A, Sugiyama H, Nakayama K, Morinaga H, Akagi S, Makino H: Reversible posterior leukoencephalopathy syndrome in a young adult patient receiving peritoneal dialysis. Perit Dial Int 2012, 32(6):587-589.