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Hypertensive encephalopathy

Sara Vilas-Boas, Ana Corte-Real
Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome that presents with neurological manifestations, often associated with arterial hypertension. Magnetic resonance imaging (MRI) shows bilateral white matter oedema in the posterior vascular territories. Immunosuppression, (pre) eclampsia and autoimmune diseases can be implicated. A 27-year-old woman, with mixed connective tissue disease under azathioprine, was admitted in the emergency room in status epilepticus and with severe hypertension...
2019: European Journal of Case Reports in Internal Medicine
Nandakrishna Bolanthakodi, Sudha Vidyasagar, Muralidhar Varma, Avinash Holla
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity described by Hinchey et al in late 90's, characterised by variable associations of seizure activity, consciousness impairment ranging from confusion to coma, headaches, visual abnormalities, nausea/vomiting and focal neurological signs. Common causes are accelerated hypertension, eclampsia, preeclampsia, cytotoxic drug use and autoimmune diseases like systemic lupus erythematosus.We report a case of PRES in a 62-year-old female patient due to hypercalcemia secondary to vitamin D toxicity on treatment with calcium supplements and vitamin D for secondary hypoparathyroidism...
February 11, 2019: BMJ Case Reports
Wen-Fang Chiang, Pei-Ti Chen, Yen-Lin Chen, Ming-Hua Chen
Posterior reversible encephalopathy syndrome (PRES) is a reversible vasogenic brain edema in patients who present with seizure, headache, visual disturbance, and altered mental status, and a characteristic neuroimaging profile. Although PRES predominantly affects the bilateral parieto-occipital areas, involvement of the frontal and temporal lobes, basal ganglia, brainstem, and cerebellum is not uncommon. Isolated involvement of the brainstem and cerebellum sparing the parieto-occipital lobe is rarely reported...
February 8, 2019: Hemodialysis International
Bushra Afzal, Praveen Chandrasekharan, Daniel J Tancredi, James Russell, Robin H Steinhorn, Satyan Lakshminrusimha
OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York...
February 2019: Pediatric Critical Care Medicine
Matthias Christian Reichert, Cristina Ripoll, Markus Casper, Robin Greinert, Edith Vandieken, Frank Grünhage, Beate Appenrodt, Alexander Zipprich, Frank Lammert
OBJECTIVES: Common nucleotide-binding oligomerization domain containing 2 (NOD2) gene variants have been associated with bacterial infections (BIs) in cirrhosis, in particular, spontaneous bacterial peritonitis, and mortality. Our aim was to evaluate the independent association of NOD2 variants with BI according to the decompensation stage. METHODS: Consecutive patients with cirrhosis in 2 academic medical centers were included and genotyped for the NOD2 variants p...
January 2019: Clinical and Translational Gastroenterology
Faris Haddadin, Alba Munoz Estrella, Eyal Herzog
Hypertensive crisis is a serious medical condition defined as severely elevated blood pressure; typically the systolic blood pressure is above 180 mmHg, and/or the diastolic blood pressure is above 120 mmHg. Hypertensive crises are divided into two categories: hypertensive urgency and hypertensive emergency. Hypertensive urgency is asymptomatic while hypertensive emergency presents with end-organ damage requiring more aggressive blood-pressure lowering. The common presentations for neurological end-organ dysfunction in conjunction with hypertensive emergency include ischemic strokes, intracranial hemorrhage, subarachnoid hemorrhage, head trauma, and hypertensive encephalopathy...
January 2019: Journal of Cardiology Cases
Hao-Jie Zhong, Huan-Huan Sun, Lan-Feng Xue, Eileen M McGowan, Yu Chen
BACKGROUND: Cirrhosis is a chronic late stage liver disease associated with hepatitis viruses, alcoholism, and metabolic disorders, such as Wilson disease (WD). There are no clear markers or clinical features that define cirrhosis originating from these disparate origins. We hypothesized that cirrhosis is not one disease and cirrhosis of different etiology may have differential clinical hepatic features. AIM: To delineate the liver features between WD-associated cirrhosis and hepatitis B-associated cirrhosis in the Chinese population...
January 21, 2019: World Journal of Gastroenterology: WJG
Vinzenz Boos, Anna Tietze, Felix Berger, Christoph Bührer
OBJECTIVES: Patients with severe congenital heart disease and cardiac anomalies such as restrictive foramen ovale, intact atrial septum, or narrowing of ductus arteriosus are at risk for perinatal asphyxia, leading to hypoxic-ischemic encephalopathy. We hypothesize that therapeutic hypothermia can be applied to these patients and seek to investigate feasibility and safety of this method. DESIGN: A retrospective observational study. SETTING: The Department of Neonatology of Charité, University Hospital, Berlin, Germany...
January 22, 2019: Pediatric Critical Care Medicine
Peipei Zhang, Keda Lu, Hong Xia
PURPOSE: This study investigates some clinical characteristics of maintenance hemodialysis patients with new-onset epilepsy. METHODS: Thirty-five patients with new-onset epilepsy who underwent maintenance hemodialysis were selected for study. Sixty patients undergoing routine hemodialysis were selected as the control group. We evaluated and compared the general characteristics, clinical features, and prognosis of patients in both groups. RESULTS: Investigation of the etiology of the 35 cases of new-onset epilepsy identified 17 cases of metabolic encephalopathy, 6 cases of viral encephalitis, 5 cases of cerebral infarction, 5 cases of cerebral hemorrhage, and 2 cases of purulent meningitis...
January 23, 2019: Therapeutic Apheresis and Dialysis
Gennadiy A Katsevman, Ryan C Turner, Cletus Cheyuo, Charles L Rosen, Matthew S Smith
Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis...
January 18, 2019: Acta Neurochirurgica
Felipe B Maegawa, Lauren Shehorn, Hassan Aziz, John Kettelle, Tun Jie, Taylor S Riall
Importance: The selection criteria for hepatectomy for hepatocellular carcinoma (HCC) is not well established. The role of noninvasive fibrosis markers in this setting is unknown in the US population. Objective: To evaluate whether aspartate aminotransferase-platelet ratio index (APRI) and fibrosis 4 (Fib4) values are associated with perioperative mortality and overall survival after hepatectomy for HCC. Design, Setting, and Participants: In a multicenter cohort study, Veterans Administration Corporate Data Warehouse was used to evaluate a retrospective cohort of 475 veterans who underwent hepatectomy for HCC between January 1, 2000, and December 31, 2012, in Veterans Administration hospitals...
January 4, 2019: JAMA network open
Carli Wittgrove, Harleen Kaur, Junaid H Siddiqui
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic syndrome resulting in subcortical vasogenic edema appreciated on T2/fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI). PRES classically involves bilateral parieto-occipital lobes and is usually reversible. Atypical variant of PRES includes the involvement of brainstem, basal ganglia, thalami, or periventricular white matter. We report an unusual case of PRES with isolated brainstem involvement with periventricular white matter changes in a patient with renovascular hypertension from unilateral renal artery stenosis...
November 12, 2018: Curēus
Jacqueline Marie Gowan, Antonio Liu
Recognition of central variant PRES is key to avoiding detrimental treatment. The pons may be the most vulnerable area in central PRES, and delayed presentation may result in greater damage. CSF reporting may lead to eventual recognition of a common profile, and possible aid in future diagnosis.
January 2019: Clinical Case Reports
P G Muñoz, A M Santiago, C B Bellido, C C Franco, J M Á Martínez, L M M Gómez, G S Artacho, J M C Tuñón, L N Morales, F J P Ruíz, M Á G Bravo
Herein we report a case of liver dysfunction caused by consumption of vitamin A supplements leading to liver transplantation. The patient was a 48-year-old male with a medical history of congenital ichthyosiform erythroderma in treatment with vitamin A until 12 years of age, at which point he discontinued the supplements because he had developed ascites. Liver cirrhosis was diagnosed as secondary to hypervitaminosis A on the basis of histologic examination of liver biopsy and the absence of other potential causes of chronic liver disease...
January 14, 2019: Transplantation Proceedings
Xuefeng Luo, Xiaoze Wang, Yongjun Zhu, Xiaotan Xi, Ying Zhao, Jinlin Yang, Xiao Li, Li Yang
PURPOSE: Conflicting data exist regarding the appropriate shunt diameter for transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhotic patients. This study was designed to compare the clinical efficacy of TIPS using stent-grafts with 8- and 10-mm diameters. METHODS: In this retrospective study, cirrhotic patients who underwent TIPS technical successfully for the prevention of variceal rebleeding from December 2011 to June 2015 were included. Thirty-four patients with 8-mm TIPS and 380 patients with 10-mm TIPS were identified...
January 14, 2019: Cardiovascular and Interventional Radiology
Lu Liu, Dawei Dai, Fan Cao, Liming Zhang, Xun Wang
RATIONALE: Posterior reversible encephalopathy syndrome (PRES) was termed by Hinchey in 1996. Patients have a reversible vasogenic brain edema in imaging and acute neurological symptoms such as headache, seizures, encephalopathy, and visual disturbances when suffering from hypertension, pre-eclampsia/eclampsia, renal failure, immunosuppressive medications, autoimmune disorders, sepsis, thrombocytopaenia, hypocalcaemia, alcohol withdrawal, and many other potential causes. de Havenon A et al have proposed a new syndrome named PRES with spinal cord involvement (PRES-SCI)...
January 2019: Medicine (Baltimore)
Xiafei Leng, Feng Zhang, Ming Zhang, Huiwen Guo, Xiaochun Yin, Jiangqiang Xiao, Yi Wang, Xiaoping Zou, Yuzheng Zhuge
BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications in cirrhosis. Spontaneous portosystemic shunts (SPSSs) may increase the risk of post-TIPS complications and mortality. This study was done to evaluate the safety and efficacy of TIPS for treating variceal bleeding between patients with and without SPSSs. PATIENTS AND METHODS: The clinical data of 467 consecutive patients with cirrhosis who received TIPS for variceal bleeding from January 2012 to January 2018 were screened...
January 9, 2019: European Journal of Gastroenterology & Hepatology
Sergio Racchiusa, Enricomaria Mormina, Antonietta Ax, Olimpia Musumeci, Marcello Longo, Francesca Granata
Posterior reversible encephalopathy syndrome (PRES) is an encephalopathy characterized by a rapid onset of symptoms including headache, seizures, confusion, blurred vision, and nausea associated with a typical magnetic resonance imaging appearance of reversible subcortical vasogenic edema prominent and not exclusive of parieto-occipital lobes. Vasogenic edema is caused by a blood-brain barrier leak induced by endothelial damage or a severe arterial hypertension exceeding the limits of cerebral blood flow autoregulation...
January 2, 2019: Neurological Sciences
Marta Hernández-Conde, Carlos Fernández-Carrillo, Elba Llop, Christie Perelló, Marta López-Gómez, José L Martínez-Porras, Natalia Fernández-Puga, José L Calleja
INTRODUCTION AND AIMS: To determine the prevalence of minimal hepatic encephalopathy (MHE) in patients with liver cirrosis (LC) due to hepatitis C virus (HCV) infection and to evaluate the impact of sustained viral response (SVR) on MHE. MATERIAL AND METHODS: We performed a prospective study using MHE screening and follow-up on patients with HCV and LC. The patients were evaluated at the beginning of treatment and 24 weeks after treatment. RESULTS: 64 patients were included...
December 13, 2018: Annals of Hepatology
Gabriela N Kuftinec, Robert Levy, Dorothy A Kieffer, Valentina Medici
INTRODUCTION AND AIM: Hepatocellular carcinoma (HCC) is the most common type of liver cancer in adults and has seen a rapid increase in incidence in the United States. Racial and ethnic differences in HCC incidence have been observed, with Latinos showing the greatest increase over the past four decades, highlighting a concerning health disparity. The goal of the present study was to compare the clinical features at the time of diagnosis of HCC in Latino and Caucasian patients. MATERIAL AND METHODS: We retrospectively screened a total of 556 charts of Latino and Caucasian patients with HCC...
December 13, 2018: Annals of Hepatology
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