J Yeungnam Med Sci.  2022 Oct;39(4):336-340. 10.12701/yujm.2021.01375.

Posterior reversible encephalopathy syndrome related to anemia correction in a patient with uterine myoma: a case report

• Lee J
• Lee HJ

• KMID: 2534662
• DOI: http://doi.org/10.12701/yujm.2021.01375

Abstract

Although posterior reversible encephalopathy syndrome (PRES) is induced by various causes, a few cases have occurred after severe anemia correction. In this case report, a 45-year-old female patient visited emergency department with a chief complaint of dizziness due to severe anemia related to hypermenorrhea caused by uterine myoma. Before her operation, she had an abrupt headache and seizure during anemia correction with transfusion and injection of gonadotropin-releasing hormone agonist. Immediately after the operation, she experienced visual disturbances, followed by limb weakness and tonic-clonic movements. Magnetic resonance imaging showed alterations in parietal and occipital lobes suggesting cerebrovascular edema with hypoperfusion. Here, we presented and discussed the clinical and radiologic features of PRES related to anemia correction.

Keyword

Anemia; Blood transfusion; Posterior reversible encephalopathy syndrome; Magnetic resonance imaging

Figure

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  Fig. 1. A 45-year-old female patient with anemia. Her hemoglobin and hematocrit levels were followed up after her first visit to an emergency department with a chief complaint of dizziness. The clinical flow chart shows that transfusions were performed within 3 days. The first seizure occurred on day 34, while the second seizure occurred on day 61. GnRH, gonadotropin-releasing hormone; OPD, outpatient department; BMR, brain magnetic resonance imaging.

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  Fig. 2. The magnetic resonance imaging findings after the first seizure. (A) The T2-weighted image (T2WI) and (B) fluid-attenuated inversion recovery (FLAIR) show an increased signal intensity (arrows) in the gray and white matter of the left parietal lobes. The follow-up (C) T2WI and (D) FLAIR after 1 week reveal the disappearance (arrows) of the previous lesions without any complications.

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  Fig. 3. After 2 months, the magnetic resonance imaging (MRI) findings show the extensive signal change in the left frontal (white arrowheads), parietal (empty arrowheads) and occipital (white arrows) lobes and right occipital lobe at the level of centrum semiovale, foremen Monro and occipital horn of lateral ventricle (1, upper; 2, middle; 3, lower raw) on (A) T2-weighted image, (B) contrast-enhanced T1-weighted image, (C) diffusion-weighted image, and (D) apparent diffusion coefficient map. (E) MRI perfusion shows an increase in mean transit time mainly in the white matter of the parietal and occipital lobes (black arrows), suggesting hypoperfusion.

Reference

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