恶性后可逆性脑病综合征——对神经重症监护医师的一项严峻挑战。
Malignant Posterior Reversible Encephalopathy Syndrome-An Exacting Challenge for Neurocritical Care Physicians.
作者信息
Magsi Shahvaiz, Zafar Atif
机构信息
Aga Khan University, Karachi, Pakistan.
Cleveland Clinic, Cleveland, OH, USA.
出版信息
Neurohospitalist. 2017 Oct;7(4):196-199. doi: 10.1177/1941874416688989. Epub 2017 Feb 8.
Abstract
We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.
摘要
我们报告一例62岁白种女性的恶性可逆性后部脑病综合征（PRES），该患者有复杂的病史和多种合并症，因肠粘连松解、医源性肠粘连和肠皮肤瘘的肠切除入院。术后，患者突然出现双侧视力丧失，无其他神经功能缺损。计算机断层扫描显示非常严重的PRES样改变，磁共振成像（MRI）证实。收缩压维持在170mmHg左右。患者意识模糊，MRI检查后仍无反应，反应极小，临床状况恶化。给予患者甘露醇推注进行高渗治疗。她恢复良好，影像学表现几乎完全消退。
相似文献
1
Malignant Posterior Reversible Encephalopathy Syndrome-An Exacting Challenge for Neurocritical Care Physicians.
Neurohospitalist. 2017 Oct;7(4):196-199. doi: 10.1177/1941874416688989. Epub 2017 Feb 8.
2
Posterior reversible encephalopathy syndrome following elevated mean arterial pressures for cervical spinal cord injury.
J Spinal Cord Med. 2018 Jan;41(1):111-114. doi: 10.1080/10790268.2016.1250030. Epub 2016 Dec 5.
3
Sequential occurrence of eclampsia-associated posterior reversible encephalopathy syndrome and reversible splenial lesion syndrome (a case report): proposal of a novel pathogenesis for reversible splenial lesion syndrome.
BMC Med Imaging. 2019 Apr 30;19(1):35. doi: 10.1186/s12880-019-0323-7.
4
Posterior Reversible Encephalopathy Syndrome Causing Vision Loss After Endoscopic Endonasal Resection of Pituitary Adenoma.
World Neurosurg. 2017 Apr;100:708.e1-708.e10. doi: 10.1016/j.wneu.2017.02.050. Epub 2017 Feb 16.
5
Posterior reversible encephalopathy syndrome in a woman with focal segmental glomerulosclerosis.
Neuropsychiatr Dis Treat. 2015 Apr 21;11:1111-4. doi: 10.2147/NDT.S84010. eCollection 2015.
6
Variant Type of Posterior Reversible Encephalopathy Syndrome Associated with Deep Brain Hemorrhage: Case Report and Review of the Literature.
World Neurosurg. 2020 Feb;134:176-181. doi: 10.1016/j.wneu.2019.10.196. Epub 2019 Nov 8.
7
Delayed Posterior Reversible Leukoencephalopathy Syndrome Triggered by FLOT Chemotherapy.
Front Neurol. 2020 Jan 30;10:1405. doi: 10.3389/fneur.2019.01405. eCollection 2019.
8
[Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a case report].
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Dec 18;50(6):1102-1107.
9
Seizure and Acute Vision Loss in a Filipino Lupus Patient: A Case of Posterior Reversible Encephalopathy Syndrome with Intraparenchymal Hemorrhage.
Case Rep Med. 2018 Dec 9;2018:4238676. doi: 10.1155/2018/4238676. eCollection 2018.
10
Management and outcomes of malignant posterior reversible encephalopathy syndrome.
Clin Neurol Neurosurg. 2014 Oct;125:52-7. doi: 10.1016/j.clineuro.2014.06.034. Epub 2014 Jul 1.
引用本文的文献
1
Intracranial hemorrhage in posterior reversible encephalopathy syndrome: a systematic review and meta-analysis.
Ann Med Surg (Lond). 2025 Aug 5;87(9):6023-6032. doi: 10.1097/MS9.0000000000003676. eCollection 2025 Sep.
2
Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?
Brain Sci. 2023 Apr 23;13(5):706. doi: 10.3390/brainsci13050706.
3
Clinical and MRI Features of Posterior Reversible Encephalopathy Syndrome With Atypical Regions: A Descriptive Study With a Large Sample Size.
Front Neurol. 2020 Mar 24;11:194. doi: 10.3389/fneur.2020.00194. eCollection 2020.
本文引用的文献
1
Calcineurin Inhibitors Associated Posterior Reversible Encephalopathy Syndrome in Solid Organ Transplantation: Report of 2 Cases and Literature Review.
Medicine (Baltimore). 2016 Apr;95(14):e3173. doi: 10.1097/MD.0000000000003173.
2
Posterior reversible encephalopathy syndrome in a hypertensive patient with renal failure.
Saudi J Kidney Dis Transpl. 2016 Mar;27(2):411-4. doi: 10.4103/1319-2442.178586.
3
Malignant Posterior Reversible Encephalopathy Syndrome: A Case of Posterior Irreversible Encephalopathy Syndrome.
J Clin Neurol. 2016 Apr;12(2):236-7. doi: 10.3988/jcn.2016.12.2.236. Epub 2015 Nov 4.
4
Therapy and differential diagnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum.
Arch Gynecol Obstet. 2015 Dec;292(6):1217-23. doi: 10.1007/s00404-015-3800-4. Epub 2015 Jun 30.
5
A unique case of rituximab-related posterior reversible encephalopathy syndrome in a heart transplant recipient with posttransplant lymphoproliferative disorder.
Am J Transplant. 2015 Mar;15(3):823-6. doi: 10.1111/ajt.13021. Epub 2015 Feb 3.
6
Posterior reversible encephalopathy syndrome in a patient with systemic lupus erythematosus/systemic sclerosis overlap syndrome.
Case Rep Rheumatol. 2014;2014:862570. doi: 10.1155/2014/862570. Epub 2014 Nov 20.
7
A multi-disciplinary model of risk factors for fatal outcome in posterior reversible encephalopathy syndrome.
J Neurol Sci. 2014 Dec 15;347(1-2):59-65. doi: 10.1016/j.jns.2014.09.019. Epub 2014 Sep 22.
8
Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report.
BMC Res Notes. 2014 Sep 13;7:644. doi: 10.1186/1756-0500-7-644.
9
Management and outcomes of malignant posterior reversible encephalopathy syndrome.
Clin Neurol Neurosurg. 2014 Oct;125:52-7. doi: 10.1016/j.clineuro.2014.06.034. Epub 2014 Jul 1.
10
Tacrolimus associated posterior reversible encephalopathy syndrome - a case series and review.
Mediterr J Hematol Infect Dis. 2014 Feb 18;6(1):e2014014. doi: 10.4084/MJHID.2014.014. eCollection 2014.
Zotero 插件