Información de la revista
Vol. 34. Núm. 6.Noviembre 2014
Páginas 693-810
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 34. Núm. 6.Noviembre 2014
Páginas 693-810
DOI: 10.3265/Nefrologia.pre2014.Sep.12510
Acceso a texto completo
Complicación de la poliarteritis nodosa por síndrome de encefalopatía posterior reversible. Caso clínico
Polyarteritis nodosa complicated by posterior reversible encephalopathy syndrome: a case report
Visitas
6701
Alper Alpa, Hakan Akdama, Harun Akara, Kutsi Koseoglub, Ayca Ozkulc, Ibrahim Meteoglud, Yavuz Yenicerioglua
a Department of Nephrology, Adnan Menderes University. School of Medicine, Aydin, Turkey,
b Department of Radiology, Adnan Menderes University. School of Medicine, Aydin, Turkey,
c Department of Neurology, Adnan Menderes University. School of Medicine, Aydin, Turkey,
d Department of Pathology, Adnan Menderes University. School of Medicine, Aydin, Turkey,
Este artículo ha recibido
6701
Visitas
Información del artículo

La hipertensión es uno de los principales problemas de salud pública, que afecta a muchas personas en todo el mundo. Se sabe que es un importante factor de riesgo para el desarrollo de enfermedades cerebrovasculares y cardiovasculares. Su clasificación como “primaria” o “secundaria” depende del proceso subyacente. En el 5-10% de los pacientes hipertensos, se trata de un problema “secundario” a otro proceso de creciente frecuencia en los centros de atención terciaria. Las causas más frecuentes de la hipertensión secundaria son: enfermedades del parénquima renal, estenosis de la arteria renal, hiperaldosteronismo primario, feocromocitoma y el síndrome de Cushing. La poliarteritis nodosa puede afectar a cualquier órgano y en diferentes grados. A continuación presentamos a un paciente joven hipertenso al que se le ha diagnosticado poliarteritis nodosa, cuya angiografía muestra múltiples microaneurismas que afectan al tronco celíaco, a la arteria renal y a la arteria mesentérica superior, asociada a un síndrome de encefalopatía posterior reversible de entidad neurológica poco visto.

Palabras clave:
síndrome de encefalopatía posterior reversible
Palabras clave:
Insuficiencia renal
Palabras clave:
Hipertensión
Palabras clave:
Poliarteritis nodosa
Palabras clave:
Angiografía visceral

Hypertension (HT) represents a major public health problem affecting many individuals worldwide. It is well known to be an important risk factor for the development of cerebrovascular and cardiovascular diseases. Classifying hypertension as ‘primary’ or ‘secondary’ depends on the underlying mechanism. In 5 to 10% of hypertensive patients, HT develops ‘secondary’ to a separate mechanism that has been encountered with increasing frequency in the tertiary refferral centers. The frequent causes of secondary hypertension include renal parenchymal disease, renal artery stenosis, primary hyperaldosteronism, phaeochromocytoma and Cushing's syndrome. Polyarteritis nodosa (PAN) can involve any organ and in varying degrees. Here we present a young hypertensive patient diagnosed as PAN with the angiographic findings of multiple microaneurysms involving celiac, renal and superior mesenteric arteries and associated with a rarely seen neurological entity-PRES syndrome.

Keywords:
Posterior reversible encephalopathy syndrome
Keywords:
Renal failure
Keywords:
Hypertension
Keywords:
Polyarteritis nodosa
Keywords:
Visceral angiography
El Texto completo está disponible en PDF
Bibliografía
[1]
Ebert EC, Hagspiel KD, Nagar M, Schlesinger N. Gastrointestinal involvement in polyarteritis nodosa. Clin Gastroenterol Hepatol 2008;6:960-6. [Pubmed]
[2]
Martine G, Lo??c G, Philippe LT, Pascal C, Fran??ois L, Philippe C, et al. Long-term follow up of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: Analysis of four prospective trials including 278 patients. Arthritis Rheum 2001;44(3):666-75. [Pubmed]
[3]
Lie JT. Systemic, pulmonary and cerebral vasculitis. In: Stehbens WE, Lie JT, eds. Vascular pathology. London: Chapman & Hall; 1995. pp. 623-56.
[4]
Zeek PM. Periarteritis nodosa and other forms of necrotizing angiitis. N Engl J Med 1953;278:764-22.
[5]
Watts RA, Lane SE, Bentham G, Scott DG. Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom. Arthritis Rheum 2000;43:414-9. [Pubmed]
[6]
Lightfoot RW Jr, Michel BA, Bloch DA, Hunder GG, Zvaifler NC, McShane DJ, et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990;33:1088-93. [Pubmed]
[7]
Stone JH. Polyarteritis nodosa. JAMA 2002;288:1632-9. [Pubmed]
[8]
Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French vasculitis study group database. Arthritis Rheum 2010;62:616-26. [Pubmed]
[9]
JCS Joint Working Group. Guideline for management of vasculitis syndrome (JCS 2008). Japanese Circulation Society. Circ J 2011;75:474-503.
[10]
Yang HC, Lee S, Kim W, Park SK, Han YM, Kang KP. Spontaneous perirenal hematoma due to multiple renal artery aneurysms in a patient with presumed polyarteritis nodosa. Vasc Med 2012;17:427-8. [Pubmed]
[11]
Schmidt WA, Both M, Reinhold-Keller E. Imaging procedures in rheumatology: imaging in vasculitis. Z Rheumatol 2006;65:652-6, 658-61. [Pubmed]
[12]
Hekali P, Kajander H, Pajari R, Stenman S, Somer T. Diagnostic significance of angiographically observed visceral aneurysms with regard to polyarteritis nodosa. Acta Radiol 1991;32:143-8. [Pubmed]
[13]
Scully RE, Mark EJ, McNeely BU. Case records of the Massachusetts General Hospital. N Engl J Med 1985;313:622-31. [Pubmed]
[14]
Morgan AJ, Schwartz RA. Cutaneous polyarteritis nodosa: a comprehensive review. Int J Dermatol 2010;49:750-6. [Pubmed]
[15]
Golovine SG, Parikh S, Lu L. A case of polyarteritis nodosa presenting initially as peripheral vascular disease. J Gen Intern Med 2008;23:1528-31. [Pubmed]
[16]
Vora J, Cooper J, Thomas JP. Polyarteritis nodosa presenting with hypertensive encephalopathy. Br J Clin Pract 1992;46:144-5. [Pubmed]
[17]
Balkaran BN, Teelucksingh S, Singh VR. Hepatitis B-associated polyarteritis nodosa and hypertensive encephalopathy. West Indian Med J 2000;49:170-1. [Pubmed]
[18]
Moore PM, Fauci AS. Neurologic manifestations of systemic vasculitis: a retrospective and prospective study of the clinicopathologic features and responses to therapy in 25 patients. Am J Med 1981;71:517-24. [Pubmed]
[19]
Rosenberg MR, Parshley M, Gibson S, Wernick R. Central nervous system polyarteritis nodosa. West J Med 1990;153:553-6. [Pubmed]
[20]
Stanzani L, Fusi L, Gomitoni A, Roncoroni M, Villa P, Grampa G. A case of posterior reversible encephalopathy during polyarteritis nodosa vasculitis. Neurol Sci 2008;29:163-7. [Pubmed]
[21]
Papanikolaou J, Tsirantonaki M, Koukoulitsios G, Papageorgiou D, Mandila C, Karakitsos D, et al. Reversible posterior leukoencephalopathy syndrome and takotsubo cardiomyopathy: the role of echocardiographic monitoring in the ICU. Hellenic J Cardiol 2009;50:436-8. [Pubmed]
[22]
Burrus TM, Wijdicks EF, Rabinstein AA. Brain lesions are most often reversible in acute thrombotic thrombocytopenic purpura. Neurology 2009;73:66-70. [Pubmed]
[23]
L??scher TF, Keller HM, Imhof HG, Greminger P, Kuhlmann U, Largiad??r F, et al. Fibromuscular hyperplasia: extension of the disease and therapeutic outcome. Nephron 1986;44 Suppl 1:109-14. [Pubmed]
[24]
Watada S, Obara H, Shimoda M, Matsubara K, Matsumoto K, Kitajima M. Multiple aneurysms of the splenic artery caused by fibromuscular dysplasia. Ann Vasc Surg 2009;23:411.e5-7.
[25]
Siegert CE, Macfarlane JD, Hollander AM, Kemenade FV. Systemic fibromuscular dysplasia masquerading as polyarteritis nodosa. Nephrol Dial Transplant 1996;11:1356-8. [Pubmed]
[26]
Pontes TC, Rufino GP, Gurgel MG, Medeiros AC, Freire EA. Fibromuscular dysplasia: a differential diagnosis of vasculitis. Rev Bras Reumatol 2012;52:70-4. [Pubmed]
[27]
Yoon SD, Cho BM, Oh SM, Park SH, Jang IB, Lee JY. Clinical and radiological spectrum of posterior reversible encephalopathy syndrome. J Cerebrovasc Endovasc Neurosurg 2013;15:206-13. [Pubmed]
Idiomas
Nefrología

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.