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• W4387248548 abstract "SESSION TITLE: Critical Care Case Report Posters 73 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is a complex of symptoms characterized by varying degrees of altered mental status, seizures, visual impairment, and persistent headaches. Although its true incidence is unknown, case studies indicate that this condition may affect individuals of any age group. The pathophysiology of PRES is thought to be associated with cerebral autoregulation dysfunction, whereby an acute elevation in blood pressure and cerebral perfusion may interfere with the dilation of cerebral arterioles. Risk factors include hypertensive encephalopathy, renal diseases, vasculitis, immunomodulating agents, and sepsis. Imaging studies usually reveal bilateral white matter edema in the posterior cerebral hemispheres. We present a case of a 59-year-old female who presented to the hospital with PRES and an underlying hypertensive emergency. CASE PRESENTATION: A 59-year-old-female with a history of hypertension and seizures presented to the emergency department (ED) due to seizures, headaches, confusion, and gaze deviation. The patient had a total of five seizure episodes prior to arrival in the ED. She was treated with benzodiazepines during her seizure episodes. She was noted to have left-sided motor deficits at that time. In the ED, her vitals were most significant for blood pressure of 201/119 mmHg and heart rate of 112 bpm. Physical exam was significant for confusion, severe agitation, and periodic alternating gaze deviation and nystagmus. She was initiated on clevidipine for her hypertension and on antiepileptics for her seizures. Blood pressure was gradually decreased with a goal of 130-150/80-100 mmHg. Computed tomography (CT) of the brain revealed a large area of encephalomalacia extending to the right front, parietal, and temporal lobes. She was transferred to the intensive care unit for closer monitoring. Electroencephalogram (EEG) revealed mild to moderate diffuse background slowing indicating non-specific global or multifocal cerebral dysfunction. Magnetic resonance imaging (MRI) of the brain was delayed as the patient was refusing. It was eventually obtained three days after admission and revealed no acute findings. Given the patient's hypertensive crisis likely inducing seizures and altered mental status, we speculated this patient had PRES syndrome. The patient continued to clinically improve with blood pressure management and was discharged home. DISCUSSION: PRES is a clinicoradiologic entity that demands a high degree of suspicion from clinicians. Patients presenting with altered mental status, constant headache, seizures, and visual impairment, and who have risk factors such as hypertension or exposure to offending agents, should undergo neuroimaging. CT head imaging can often detect PRES, while MRI brain imaging provides more detailed features. Both CT and MRI can reveal white matter edema in the posterior cerebral hemisphere, while sparing the calcarine and paramedian parts of the occipital lobe. MRI of the brain typically shows hyperintense T2 signals involving the parieto-occipital lobes. Diffusion-weighted imaging can be used to rule out a stroke. The treatment typically involves gradual reduction of blood pressure, often through the use of titratable parenteral agents. CONCLUSIONS: PRES is a syndrome that consists of many general symptoms and it's imperative for clinicians to be aware of the diagnosis to adequately treat patients in a timely manner. REFERENCE #1: Sudulagunta, S. R., Sodalagunta, M. B., Kumbhat, M., & Nataraju, A. S. (2017). Posterior reversible encephalopathy syndrome(PRES). Oxford Medical Case Reports, 2017(4). https://doi.org/10.1093/omcr/omx011 REFERENCE #2: Triplett, J. D., Kutlubaev, M. A., Kermode, A. G., & Hardy, T. A. (2022). Posterior reversible encephalopathy syndrome (PRES): diagnosis and management. Practical Neurology, practneurol-003194. https://doi.org/10.1136/practneurol-2021-003194 REFERENCE #3: Cherniawsky, H., Merchant, N., Sawyer, M., & Ho, M. (2017). A case report of posterior reversible encephalopathy syndrome in a patient receiving gemcitabine and cisplatin. Medicine. https://doi.org/10.1097/md.0000000000005850 DISCLOSURES: No relevant relationships by Song Peng Ang No relevant relationships by Natalya Kozlova No relevant relationships by YUSRA MEDIK No relevant relationships by Nashwa Yosry" @default.
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• W4387248548 date "2023-10-01" @default.
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• W4387248548 title "IS IT ALL IN MY HEAD? A CASE OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)" @default.
• W4387248548 doi "https://doi.org/10.1016/j.chest.2023.07.1911" @default.
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