Encefalopatia posterior reversible
Sofia Jorge, José António Lopes, Edgar de Almeida, Mateus Martins Prata
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array:11 [ "idiomaDefecto" => true "titulo" => "Encefalopatia posterior reversible" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "650" ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sofia Jorge, José António Lopes, Edgar de Almeida, Mateus Martins Prata" "autores" => array:1 [ 0 => array:1 [ "nombre" => "Sofia Jorge, José António Lopes, Edgar de Almeida, Mateus Martins Prata" ] ] ] ] "textoCompleto" => "  <span class="elsevierStyleBold">Posterior reversible encephalopathy syndrome and chronic kidney disease </span> <span class="elsevierStyleBold"></span>Sofia Jorge, José António Lopes, Edgar de Almeida, M Martins Prata <p class="elsevierStylePara">Serviço de Nefrologia e Transplantação Renal, Hospital de Santa Maria, Lisboa, Portugal</p> <p class="elsevierStylePara"><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />   </p> <p class="elsevierStylePara">Corresponding author: Dra. Sofia Jorge, Serviço de Nefrologia e Transplantação Renal, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal, tel. 00351-217805317, e-mail: <a href="mailto:sofiacjorge@sapo.pt" class="elsevierStyleCrossRefs">sofiacjorge@sapo.pt</a></p> <p class="elsevierStylePara">   </p> <p class="elsevierStylePara">Key-words: seizures, chronic kidney disease, peritoneal dialysis, posterior reversible encephalopathy </p> <p class="elsevierStylePara">   </p> <p class="elsevierStylePara"> </p> <p class="elsevierStylePara">Posterior reversible encephalopathy syndrome (PRES) is a recently described clinical and neuroimaging entity characterized by headaches, vomiting, visual field deficits, conscious changes and seizures, and by typical neuroimaging features corresponding to areas of subcortical edema, occasionally cortical, involving predominantly the occipital and parietal lobes of both hemispheres (1). Hypertension, uraemia, cyclosporine A neurotoxicity and eclampsia are the most comon etiologies of PRES (1). Although its pathophysiology is currently unknown, two main theories are considered: cerebral hyperperfusion, which considers the existence of vasogenic edema; and great vessels vasospasm, which points the presence of citotoxic edema (2); these two mechanisms may occur sequentially (2, 3). Tomodensitometric features are variable and unspecific; thus MRI is the gold-standard method to establish the precise diagnosis of PRES, which permits a timely therapeutic intervention essential to reverse clinical manifestations (4). Typically, lesions occur predominantly in the posterior white matter of subcortical region, and some involvement of the cortex can also exist. Generally, these lesions are hyperintense on T2 and hypointense on T1-weighted images or isointense on diffusion-weighted images traducing vasogenic edema (4); thus MRI shows cerebral edema in tipical location and allows distinguishing between vasogenic and citotoxic edema, contributing to the knowledge of pathophysiology of PRES (2,3,4). The reversibility of this syndrome depends on timely diagnosis and therapy and therefore it should be kept in mind in the differential diagnosis of seizures or coma on chronic kidney disease patients. </p> An example was a  young hypertensive chronic kidney disease patient on peritoneal dialysis, brought to the emergency room comatous with generalized tonic-clonic seizures; the cerebral computorized tomography scan showed a diffuse pattern of brain edema, not conclusive, and cerebral magnetic resonance imaging (MRI) (Figure 2) was performed and evidenced subcortical edema of the parietal, occipital and temporal lobes. These changes were suggestive of hypertensive or metabolic encephalopathy.  Anti-hypertensive therapy and hemodialysis allowed complete recovery, including restarting peritoneal dialysis as self-carer. <p class="elsevierStylePara"> </p> <p class="elsevierStylePara">In this case, we consider that PRES was associated with hypertensive crisis following anti-hypertensive therapy (minoxidil) interruption. We highlight the impressive neuroimaging features and stress the importance of considering this syndrome in the differential diagnosis of seizures or coma in chronic kidney disease patients.</p> <p class="elsevierStylePara">   </p> <p class="elsevierStylePara"><span class="elsevierStyleBold">References </span></p> <p class="elsevierStylePara">1. Hinchey J, Chaves C, Appignani B et al. A reversible posterior leukoencephalopathy syndrome.<span class="elsevierStyleItalic"> N Engl J Med </span>1996; 334: 494-500 </p> <p class="elsevierStylePara">2. Brubaker LM, Smith JK, Lee YZ, Lin W, Castillo M. Hemodynamic and permeability changes in posterior reversible encephalopathy syndrome measured by dynamic susceptibility perfusion-weighted MR imaging. <span class="elsevierStyleItalic">Am J Neuroradiol</span> 2005; 26: 825-830<br />3. Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. <span class="elsevierStyleItalic">Am J Neuroradiol</span> 2002; 23: 1038-1048 </p> <p class="elsevierStylePara">4. Lamy C, Oppenheim C, Meder JF, Mas JL. Neuroimaging in posterior reversible encephalopathy syndrome. <span class="elsevierStyleItalic">J Neuroimaging</span> 2004; 14: 89-96 </p> var message="Atencion, accion no permitida.\n\nSi desea pegar un documento de WORD,utilice\nla opcion \"PEGAR DESDE WORD\" del editor web."; function clickIE() {if (document.all) {alert(message);return false;}} function clickNS(e) {if (document.layers||(document.getElementById&&!document.all)) { if (e.which==2||e.which==3) {alert(message);return false;}}} if (document.layers) {document.captureEvents(Event.MOUSEDOWN);document.onmousedown=clickNS;} else{document.onmouseup=clickNS;document.oncontextmenu=clickIE;} document.oncontextmenu=new Function("alert(message);return false") // --> " "pdfFichero" => "P1-E260-S122-A4803.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec430428" "palabras" => array:1 [ 0 => "convulsiones, doença renal cronica, dialisis peritoneal, encefalopatia posterior reversible" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec430429" "palabras" => array:1 [ 0 => "seizures, chronic kidney disease, peritoneal dialysis, posterior reversible encephalopathy" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Posterior reversible encephalopaty (PRES) es una entidad recientemente descrita, definida por aspectos clinicos y neuroimagiologicos. Los doentes renales cronicos son particularmente sensibles a su ocurrencia debido a la frequencia con que presentan numerosas de sus possibles causas, incluso la uremia y la hipertensión. En su forma mas severa, PRES puede presentarse con convulsiones y mismo coma, y si no tratado, puede conducir a consequencias irreversibles o mismo a la muerte. Todabia, la atempada institución de terapeutica pude reverter completamente todo lo quadro; para esó és fundamental la ressonancia magnetica cerebral, que mostra el edema cerebral en localizacion característica. Un exemplo ilustrativo de la importancia del diagnostico y terapeutica atempada es lo caso de un enfermo joven, en diálisis peritoneal, llevado al departamento de emergencia medica en coma, despues de presentar convulsiones tonico-clonicas generalizadas; la ressonacia magnetica cerebral era impresionante. Con hemodiálisis y medicacion anti-hipertensora, la recuperacion ha sido completa. La reversibilidad de lo síndrome depende del correcto y atempado diagnostico y terapeutica, por lo que este síndrome deberá ser considerado en lo diagnostico diferencial de convulsiones y coma en lo doente renal cronico. " ] "en" => array:1 [ "resumen" => "Posterior reversible encephalopathy (PRES) is a recently described syndrome, defined by clinical and neuroimaging features. Chronic kidney disease patients may be especially vulnerable to this syndrome because they are frequently exposed to several of its possible causes, including uremia and hypertension. In its most severe form, PRES can manifest clinically as seizures, coma or death. However, if properly diagnosed and treated, this syndrome can be completely reversible. Therefore, neuroimaging methods, especially brain magnetic ressoance is fundamental for its diagnosis because it shows barin edema in characteristic pattern, and excludes causes of seizures or coma. An important example is the case of a young hypertensive chronic kidney disease patient on peritoneal dialysis, brought to the emergency room comatous with generalized tonic-clonic seizures; the cerebral magnetic resonance imaging features were impressive. Anti-hypertensive therapy and hemodialysis allowed complete recovery. The reversibility of this syndrome depends on timely diagnosis and therapy and therefore it should be kept in mind in the differential diagnosis of seizures. or coma in chronic kidney disease patients. 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ISSN: 02116995Idioma original: Inglés
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