Presentation on theme: "First Department of Internal Medicine, General Hospital of Rhodes,"— Presentation transcript:
1First Department of Internal Medicine, General Hospital of Rhodes, Tacrolimus-associated posterior reversible encephalopathy syndrome (PRES) in a bone marrow transplant recipient.G. Ntetskas, E. Spanou, V. Papastergiou, M. Stampori, E. Asonitis, E. Anastasiou, F. Alourda,F. Lambrianou, A. Kotis, S. KaratapanisFirst Department of Internal Medicine, General Hospital of Rhodes,
2Posterior Reversible Encephalopathy Syndrome (PRES) Clinicoradiological entityDescribed by Hinchey et al in 1996Reversible ischemia of the posterior cerebral vasculatureVasogenic edema (parietal-occipital region)
3Posterior Reversible Encephalopathy Syndrome (PRES) Neurologic features (consciousness impairment, seizures, headaches, visual abnormalities, nausea/vomit, focal neurological signs)Cerebral imaging abnormalities (often symmetric and predominate in the posterior white matter)
4Posterior Reversible Encephalopathy Syndrome (PRES) Unknown incidence (rare)Most commonly occur in middle-aged adults (39-47 years)Female predominanceAssociated comorbidities: Hypertension, bone marrow or solid organ transplantation, chronic renal failure, medications, eclampsia.Usually reversible once the cause is removedNeed for mechanical ventilation in 35-40%Permanent neurological impairment or death (up to 15%) may occur in a minority of patients
5Posterior Reversible Encephalopathy Syndrome (PRES) Pathogenesis is unknownHypertensive PRES: failure of cerebrovascular autoregulationNon-hypertensive PRES: autoimmune or immune response to various stimuliThere are no consensual guidelines to validate diagnosis of PRES
6Case presentation Female 55 years old History of acute myeloid leukemia treated with bone marrow transplantation 12 months agoSince the last 3 months the patient was under Tacrolimus to prevent graft-vs-host disease.
7Case presentation Presentation to the ER Altered mental status ConfusedDisorientedGCS score was 10 (eye response to verbal command, incomprehensive speech, purposeful movements to painful stimulus)
8Case presentationHistory obtained from the patient’s husband revealed no recent infection, fever, weight loss or trauma.She was moving her extremities equally, bilaterally.Reflexes were brisk throughout with equivocal plantar responseRest of the neurological exam was limited as the patient was not following commands consistently.
9Case presentations blood pressure was 220/110 mmHg Blood count, routine biochemical tests and ABG were normalNo ECG abnormalitiesChest X-Ray was normal