Case Report: Posterior Reversible Leukoencephalopathy Syndrome (PRES) as a Biologically Predictable Neurological Association in Severe COVID-19. First Reported Case From Australia and Review of Internationally Published Cases

Frontiers in Neurology

Carmela Sales¹  Leila Karimi²  Tissa Wijeratne²  Chanith Wijeratne³  Sheila Gillard Crewther⁶ 

[1] Education (WHCRE), Sunshine Hospital, St Albans, VIC, Australia;;University Melbourne, Australian Institute for Musculoskeletal Science (AIMSS), Western Centre for Health Research &Department of Medicine, Faculty of Medicine, University of Rajarata, Anuradhapura, Sri Lanka;;Department of Neurology, Western Health &Monash Medical School, Clayton, VIC, Australia;School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia;

关键词: posterior reversible encephalopathy syndrome (PRES);    COVID-19;    SARS-CoV-2;    hypertension;    case report;   

DOI  :  10.3389/fneur.2020.600544

来源: DOAJ

【 摘 要 】

Reports of different types of neurological manifestations of COVID-19 are rapidly increasing, including changes of posterior reversible leukoencephalopathy syndrome (PRES). Here we describe the first reported case of COVID-19 and PRES in Australia diagnosed on basis of MRI brain imaging and confirmed clinically by presence of confusion, delirium, headaches, also associated with hypertension and blood pressure variability and stable long-term kidney problems. He made full recovery as his blood pressure was controlled and clinical status was supported with appropriate supportive therapy. Although traditionally a rare condition, PRES is likely to be more common among patients with COVID-19 pathobiology there is Renin downregulation of ACE2 receptors, involvement of Renin-Angiotensin-Aldosterone system, endotheliitis, cytokine storm, and hyper-immune response. Thus we advocate clinical suspicion and early brain imaging with MRI brain among vulnerable patients with known co-morbidities, and diagnosed with COVID-19 given that hypertension and blood pressure variability are often exacerbated by acute SARS-CoV-2 immune reactions. Such acute hypertensive encephalopathy was able to be reversed with timely supportive therapy ensuring re-hydration and re-establishment of blood pressure control.

【 授权许可】

Unknown