Autonomic Dysreflexia and Posterior Reversible Encephalopathy Syndrome
ABSTRACT Autonomic dysreflexia is a syndrome of massive imbalanced reflex sympathetic discharge in patients who had a spinal cord injury above the splanchnic sympathetic outflow resulting in a sudden increase in blood pressure. Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiologic entity characterized by headache, consciousness impairment, visual disturbances, seizures, and posterior transient changes on neuroimaging (cerebral vasogenic edema). Hypertension is a common cause of PRES. The authors describe two case reports of patients with tetraplegia who developed PRES after an autonomic dysreflexia episode. One of them had recurrence of PRES in a similar clinical context. The authors discuss further aspects of PRES and its recurrence, which seems to be unusual particularly after autonomic dysreflexia.
SourceAvailable from: João Rocha[Show abstract] [Hide abstract]
ABSTRACT: Objective: Analyze the cases of posterior reversible encephalopathy syndrome (PRES) admitted in a Neurology Department during an 8-year period. Method: Retrospective observational study in a central hospital in the north of Portugal. Results: 14 patients were identified, mean age 52.3 years. Precipitating factors included: eclampsia, isolated arterial hypertension, spinal trauma and autonomic dysreflexia, Guillain-Barré syndrome, sepsis, sarcoidosis and pulmonary cryptococcosis and drugs. Most patients presented posterior-predominant vasogenic edema lesions, however 64.2% presented frontal lesions and in 42.8% cerebellum was involved. Four patients also had acute ischemic lesions and 1 had hemorrhagic lesions. During follow-up 10 patients recovered fully, 2 recovered partially, 1 suffered a recurrence and 2 died in hospital. Conclusion: PRES has many etiological factors. The terms posterior and reversible should be revised because PRES frequently involves other brain regions and it is not always reversible. PRES patients may develop life-threatening complications and mortality is not negligible.Arquivos de neuro-psiquiatria 01/2015; 73(1):36-40. DOI:10.1590/0004-282X20140176 · 1.01 Impact Factor
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ABSTRACT: The scope of paediatric autonomic disorders is not well recognised, and paediatricians seem to be generally unaware of the complexity and diversity of their clinical manifestations. We report a 12-year-old boy presenting with hypertensive encephalopathy caused by autonomic dysreflexia. Conclusion: This observation emphasises the importance of the recognition of this rare autonomic disorder, which can have potentially life-threatening neurological complications.European Journal of Pediatrics 02/2014; 173(12). DOI:10.1007/s00431-014-2281-y · 1.98 Impact Factor