Autonomic Dysreflexia and Posterior Reversible Encephalopathy Syndrome

From the Physical Medicine and Rehabilitation Department (ACM, MEC) and the Neurology Department (JMR, JMP), Hospital de Braga, Braga, Portugal.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists (Impact Factor: 2.2). 10/2012; 92(5). DOI: 10.1097/PHM.0b013e3182744889
Source: PubMed


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.

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    ABSTRACT: Unlabelled: 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.
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    ABSTRACT: The definition of the clinicoradiologic syndrome posterior reversible leukoencephalopathy syndrome (PRES) has been stretched over the last decade.(1) Many regard PRES as a final common denominator for various cerebral insults, without a single etiopathogenic trigger.(1,2) The hallmark of classic PRES is hydrostatic pressure breakthrough causing cerebral vasogenic edema, commonly coupled with a history of refractory hypertension, ictal surge in blood pressure (BP), and a concomitant systemic inflammatory or uremic process.(1) High BP may be absent in PRES if there is renal failure; infection or any systemic inflammatory response syndrome; or immunomodulation as seen in eclampsia, autoimmune disorders, or chemotherapy.(1-3) PRES may thus be better defined as a neurotoxic syndrome(2) with blood-brain barrier opening or with disruption of cerebral autoregulation leading to dysperfusion with either vasogenic or cytotoxic edema.(2,3) The phenotypic umbrella of PRES now includes transient, isolated splenial edematous lesions(4) and extensive spinal cord edema. A mounting number of cases of longitudinally extensive central cord edema in the absence of infectious, demyelinating, or ischemic causes or venous engorgement from an arteriovenous fistula now warrant codifying this entity as a discrete clinical syndrome and perusal for specific risk factors.
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    ABSTRACT: Posterior reversible encephalopathy syndrome (PRES) is widely held to be a benign and potentially reversible disease. However, severe cases have been described in the literature. Data on the long-term outcome of these severe cases are scarce. Furthermore, there are no data focusing on potential benefits of neurological early rehabilitation in these patients. Here we present the clinical picture, neuroimaging features, rehabilitative course and long-term outcome of a patient with severe PRES who underwent early neurological rehabilitation. © Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Dec 2014 · Fortschritte der Neurologie · Psychiatrie
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