Arslan Zehra İpek, Turna Canan Kamile, Özerdem Çiğdem Yasemin, Yavuz Sara, Baykara Nur, Solak Mine
Department of Anaesthesiology and Reanimation, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
Department of Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
Turk J Anaesthesiol Reanim. 2015 Aug;43(4):291-4. doi: 10.5152/TJAR.2015.13540. Epub 2015 Mar 3.
Posterior reversible encephalopathy syndrome is characterized by visual and mental disturbances, nausea and vomiting and generalized or focal convulsions and often represents itself with parietal and occipital oedema formation. We want to report the treatment of posterior reversible encephalopathy syndrome with plasmapheresis, which developed in a 35-year-old woman with systemic lupus erythematosus diagnosed by renal biopsy 3 years ago. She has been followed up in the intensive care unit three times. However, she had been transferred to the nephrology department of our university hospital because of her uncontrolled blood pressure. Oral antihypertensive therapy, corticosteroid 500 mg 1 × 1 and cyclophosphamide were started for the activation of lupus. After the detection of low complement levels, systemic lupus erythematosus activation was suspected. She developed mental deterioration after her first plasmapheresis treatment and was then consulted by the neurology and intensive care unit doctors. Diffusion cranial magnetic resonance imaging was found compatible with posterior reversible encephalopathy syndrome. The patient was transferred to our intensive care unit. The patient gained consciousness after her second plasmapheresis. After 5 days of follow-up in our intensive care unit and after significant regression was observed in the magnetic resonance imaging analysis, the patient was transferred to the nephrology service conscious, cooperated and orientated. At the nephrology service, after a total of 13 times of plasmapheresis, complement levels were increased and she was discharged with corticosteroid therapy. Posterior reversible encephalopathy syndrome can be observed in patients with systemic lupus erythematosus and intensive care unit treatment may be required. To control the hypertension, plasmapheresis should be kept in mind in addition to the multiple antihypertensive therapy in these patients.
后部可逆性脑病综合征的特征为视觉和精神障碍、恶心呕吐以及全身性或局灶性惊厥，常表现为顶叶和枕叶水肿形成。我们想报告1例35岁女性系统性红斑狼疮患者采用血浆置换治疗后部可逆性脑病综合征的情况。该患者3年前经肾活检确诊为系统性红斑狼疮。她曾3次入住重症监护病房。然而，由于血压控制不佳，她被转至我校医院肾内科。开始口服抗高血压药物、500 mg糖皮质激素每日1次以及环磷酰胺以激活狼疮。检测到补体水平降低后，怀疑系统性红斑狼疮活动。她在首次血浆置换治疗后出现精神恶化，随后由神经内科和重症监护病房医生会诊。头颅扩散磁共振成像结果与后部可逆性脑病综合征相符。患者被转至我们的重症监护病房。患者在第二次血浆置换后意识恢复。在我们的重症监护病房随访5天后，磁共振成像分析显示明显好转，患者意识清醒、配合且定向力正常，随后转至肾内科。在肾内科，总共进行了13次血浆置换后，补体水平升高，她在接受糖皮质激素治疗后出院。系统性红斑狼疮患者可出现后部可逆性脑病综合征，可能需要重症监护病房治疗。为控制高血压，除多种抗高血压治疗外，还应考虑血浆置换。
