Babici Denis, Hindi Fawzi, Hanafy Khalid A
Department of Neurology, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.
Department of Neurocritical Care, Marcus Neuroscience Institute, Boca Raton, Florida, USA.
Brain Circ. 2022 Jun 30;8(2):108-111. doi: 10.4103/bc.bc_14_22. eCollection 2022 Apr-Jun.
A tricenarian female with a past medical history of status epilepticus secondary to posterior reversible encephalopathy syndrome (PRES) of unknown etiology presented with a 2-week history of double vision, dizziness, elevated blood pressure, and altered mental status. On hospital day 2, she experienced status epilepticus, during which her blood pressure rose to 240/160 from her baseline of around 140/90. The patient was subsequently intubated for airway protection and transferred to the intensive care unit, where she was started on a nicardipine drip. Due to her history of thrombotic microangiopathy, empiric treatment with plasma exchange and prednisone was started but discontinued when ADAMTS13 came back negative. Urine metanephrines also were found to be negative. Computed tomography angiography of the abdomen showed left renal artery stenosis and stent was placed. Remarkably, over the coming days, her blood pressure normalized, and her neurologic symptoms significantly improved. As a result, antihypertensive medications were titrated down, and the patient was finally provided with a cause of her repetitive, life-threatening episodes of PRES.
一名30岁女性，既往有病因不明的后可逆性脑病综合征（PRES）继发癫痫持续状态病史，出现复视、头晕、血压升高和精神状态改变2周。住院第2天，她发生癫痫持续状态，期间血压从基线水平约140/90升至240/160。患者随后因气道保护需要插管，并转入重症监护病房，在那里开始使用尼卡地平静脉滴注。由于她有血栓性微血管病病史，开始进行血浆置换和泼尼松经验性治疗，但当ADAMTS13结果为阴性时停药。尿甲氧基肾上腺素也呈阴性。腹部计算机断层扫描血管造影显示左肾动脉狭窄，并置入了支架。值得注意的是，在接下来的几天里，她的血压恢复正常，神经症状明显改善。因此，降压药物逐渐减量，最终找到了该患者反复发生危及生命的PRES发作的病因。
