Posterior reversible encephalopathy and cerebral vasoconstriction in a patient with hemolytic uremic syndrome

Rajkumar Agarwal, Cresha Davis, Deniz Altinok, Fatema J. Serajee

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background We report a patient with hemolytic uremic syndrome who presented with radiological manifestations suggestive of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome. Patient A 13-year-old girl presented with fever and bloody diarrhea and progressed to develop hemolytic uremic syndrome. She subsequently developed encephalopathy, aphasia, and right-sided weakness. Results Brain magnetic resonance imaging showed presence of vasogenic edema in the left frontal lobe, in addition to T2 and fluid-attenuated inversion recovery changes in white matter bilaterally, compatible with posterior reversible encephalopathy syndrome. Magnetic resonance angiography showed beading of the cerebral vessels. Neurological deficits reversed 8 days after symptom onset, with resolution of the beading pattern on follow-up magnetic resonance angiography after 3 weeks, suggesting reversible cerebral vasoconstriction syndrome. Conclusions Both posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome may represent manifestations of similar underlying pathophysiologic mechanisms. Recognition of the co-existence of these processes in patients with hemolytic uremic syndrome may aid in judicious management of these patients and avoidance of inappropriate therapeutic interventions.

Original languageEnglish
Pages (from-to)518-521
Number of pages4
JournalPediatric Neurology
Volume50
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • PRES
  • RCVS
  • hemolytic-uremic syndrome
  • vasospasm

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