Korean J Crit Care Med.  2015 Feb;30(1):46-51. 10.4266/kjccm.2015.30.1.46.

Posterior Reversible Encephalopathy Syndrome in a Critically Ill Postoperative Patient

• Keum MA
• No HK
• Lee CW
• Jeon SB
• Hong SK

• KMID: 2227702
• DOI: http://doi.org/10.4266/kjccm.2015.30.1.46

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.

Keyword

intensive care units; posterior leukoencephalopathy syndrome; postoperative period

MeSH Terms

Aged
Critical Illness*
Delayed Diagnosis
Headache
Humans
Intensive Care Units
Male
Neurologic Manifestations
Posterior Leukoencephalopathy Syndrome*
Postoperative Period
Seizures

Figure

• 

  Fig. 1. MRI assessment of chronic changes related to PRES with internal intracerebral hemorrhage. Axial T1-weighted imaging (A) and axial T2-weighted imaging (B) revealed subacute intracerebral hemorrhages in the bilateral occipital lobes, which were seen as high signal intensities on T1-weighted imaging and as a dark rim on T2-weighted imaging. In the deep and subcortical white matter of the bilateral occipital lobes, cerebral edema was also seen as high signal intensities on T2-weighted (B) and fluid-attenuated inversion recovery imaging (C). MRI: magnetic resonance imaging; PRES: posterior reversible encephalopathy syndrome.

• 

  Fig. 2. MRI assessment of chronic change related to PRES with internal intracerebral hemorrhage. DWI (A) and ADC map imaging (B) did not reveal significant signal changes in the corresponding areas, except in the hemorrhagic foci. MRI: magnetic resonance imaging; PRES: posterior reversible encephalopathy syndrome; DWI: diffusion weighted imaging; ADC: apparent diffusion coefficient.

Reference

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