DOI: https://dx.doi.org/10.18203/2349-2902.isj20221165
Published: 2022-04-26

A case of post-splenectomy posterior reversible encephalopathy syndrome: a reversible event

Samir Shukla, Sanjay Sisodiya, Mohd Riyaz, A. P. Sharath, Sukantth R. J.

Abstract


Posterior reversible encephalopathy syndrome (PRES) is a disease characterized by features of clinical and neuroimaging findings. The basics of recognizing the entity include a combination of clinical features and radiological findings in the presence of triggering factors. Clinically the patient can have various presentations like nausea, vomiting, blurring of vision, seizures, altered consciousness, transient motor deficits, or cortical blindness. Radiologically the findings can be picked up by computed tomography (CT), magnetic resonance imaging (MRI), or diffusion-weighted imaging. The usual factors that can trigger the PRES include blood pressure fluctuations, eclampsia/preeclampsia, renal failure, cytotoxic agents, and autoimmune conditions. With vigilant suspicion and prompt treatment, patients can be saved from serious complications. Here we wish to report a case of a 22-year male patient who developed PRES syndrome after undergoing an emergency splenectomy and recovered with conservative medical management for the condition. This syndrome can be managed well with an early diagnosis which needs keen suspicion and prompt treatment.


Keywords


Post-splenectomy, PRES syndrome, Posterior reversible encephalopathy syndrome

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References


Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494-500.

Kim SJ, I'm SA, Lee JW, Chung NG, Cho B, Kim HK, et al. Predisposing factors of posterior reversible encephalopathy syndrome in acute childhood leukaemia. Pediatr Neurol. 2012;47:436-42.

Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159:379-83.

Bartynski WS, Grabb BC, Zeigler Z, Lin L, Andrews DF. Watershed imaging features and clinical vascular injury in cyclosporin A neurotoxicity. J Comput Assist Tomogr. 1997;21:872-80.

Bartynski WS, Zeigler Z, Spearman MP, Lin L, Shadduck RK, Lister J. Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity. AJNR Am J Neuroradiol. 2001;22:1901-14.

Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007;28:1320-7.

Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65:205-10.

Girişgen I, Tosun A, Sönmez F, Özsunar Y. Recurrent and atypical posterior reversible encephalopathy syndrome in a child with peritoneal dialysis. Turk J Pediatr. 2010;52:416-9.

Hinduja A. Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome. Front Neurol. 2020;11:71.

Liman TG, Bohner G, Heuschmann PU, Scheel M, Endres M, Siebert E. Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia-eclampsia and other predisposing diseases. Eur J Neurol. 2012;19:935-43.

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;85:427-32.

Kastrup O, Gerwig M, Frings M, Diener HC. Posterior reversible encephalopathy syndrome (PRES): electroencephalographic findings and seizure patterns. J Neurol. 2012;259:1383-9.

Datar S, Singh T, Rabinstein AA, Fugate JE, Hocker S. Long-term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome. Epilepsia. 2015;56:564-8.

McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904-12.

Gao B, Lyu C, Lerner A, McKinney AM. Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years? J Neurol Neurosurg Psychiatry. 2018;89:14-20.

Sengar AR, Gupta RK, Dhanuka AK, Roy R, Das K. MR imaging, MR angiography, and MR spectroscopy of the brain in eclampsia. AJNR Am J Neuroradiol. 1997;18:1485-90.

Faille LD, Fieuws S, Van Paesschen W. Clinical predictors and differential diagnosis of posterior reversible encephalopathy syndrome. Acta Neurol Belg. 2017;117:469-75.

Zou LP, Liu LY, Li H, Wang YY, Liu Y, Chen J, et al. Establishment and utility assessment of posterior reversible encephalopathy syndrome early warning scoring (PEWS) scale establishment and utility assessment of PEWS scale. BMC Neurol. 2019;19:30.

De Laat P, Te Winkel ML, Devos AS, Catsman-Berrevoets CE, Pieters R, van den Heuvel-Eibrink MM. Posterior reversible encephalopathy syndrome in childhood cancer. Ann Oncol. 2011;22:472-8.

Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356:411-7.