Dube Mukesh, Rathore Rashi
Department of Medicine, Rajshree Medical Research Institute and Hospital Bareilly, Bareilly, Uttar Pradesh, India.
Department of Radiology, Clara Swain Mission Hospital JV, Bareilly, Uttar Pradesh, India.
Brain Circ. 2020 Dec 29;6(4):269-273. doi: 10.4103/bc.bc_9_20. eCollection 2020 Oct-Dec.
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome associated with headache, altered mental status, seizures, and visual disturbances and characterized by white matter vasogenic edema affecting predominantly the posterior occipital and parietal lobes of the brain. Neurological complications of blood transfusion are uncommon, and blood-transfusion-related PRES is seldom reported. We report here one such case of PRES. A 61-year-old Asian woman with chronic anemia presented with a history of fall, causing fracture of the left femur neck. As her hemoglobin was 5 g per deciliter, she was transfused with four units of packed cells in three consecutive days. At the time of admission, she was alert, normotensive, and afebrile. Later, she developed mild headache and had a generalized tonic-clonic seizure. Her brain magnetic resonance (MR) imaging showed edema in bilateral frontal lobes and parieto-occipital lobes with normal MR venogram, consistent with PRES. We described her disorder as blood-transfusion-related PRES. Immunologic, as well as non-immunologic complications of blood transfusion, are known but, PRES is rare. Cumulative effects of blood transfusion on blood flow, blood viscosity, endothelial dysfunction leads to blood-brain barrier dysfunction, which culminates into vasogenic edema and vasoconstriction despite normal systemic blood pressure, leading to blood-transfusion-related PRES.
后部可逆性脑病综合征(PRES)是一种神经综合征,与头痛、精神状态改变、癫痫发作及视觉障碍相关,其特征为主要影响大脑枕叶后部和顶叶的白质血管源性水肿。输血的神经并发症并不常见,与输血相关的PRES鲜有报道。我们在此报告一例此类PRES病例。一名61岁的亚洲慢性贫血女性,有跌倒史,导致左股骨颈骨折。因她的血红蛋白为每分升5克,连续三天输注了4单位的红细胞悬液。入院时,她神志清醒,血压正常,无发热。后来,她出现轻度头痛并发生全身性强直阵挛发作。她的脑部磁共振成像显示双侧额叶及顶枕叶水肿,磁共振静脉血管造影正常,符合PRES。我们将她的病症描述为与输血相关的PRES。输血的免疫及非免疫并发症是已知的,但PRES很罕见。输血对血流、血液黏度、内皮功能障碍的累积效应导致血脑屏障功能障碍,尽管全身血压正常,但最终会导致血管源性水肿和血管收缩,从而引发与输血相关的PRES。