Posterior reversible encephalopathy syndrome – A pathology that should not be overlooked in the era of COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes Coronavirus Disease 2019 (COVID-19) may determine a series of neurological complications directly, by invasion of the nervous system or indirectly, secondary to systemic organ failure. Posterior reversible encephalopathy syndro...

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Bibliographic Details
Published in:The American journal of emergency medicine 2022-06, Vol.56, p.393.e5-393.e8
Main Authors: Ioan, Patricia, Ribigan, Athena Cristina, Rusu, Octaviana, Bratu, Ionut Flavius, Badea, Raluca Stefania, Antochi, Florina
Format: Article
Language:English
Subjects:
Adult
Antibiotics
Aphasia
Autoimmune diseases
Blindness
Brain
Computed tomography
Consciousness
Coronaviruses
Corticoids
Corticosteroids
Cough
COVID-19
COVID-19 - complications
Cytotoxicity
delta variant
Diabetes
Diagnosis
Dyspnea
Eclampsia
Edema
Emergency medical care
Emergency medical services
Encephalitis
Encephalopathy
Female
Fever
Glucose
Humans
Hypertension
Hypoxia
Infections
Infectious diseases
Ischemia
Laboratories
Magnetic resonance imaging
Male
Medical imaging
Medical treatment
Nervous system
Neurological complications
Oxygen saturation
Pathology
Patients
Posterior Leukoencephalopathy Syndrome - diagnostic imaging
Posterior Leukoencephalopathy Syndrome - etiology
Posterior reversible encephalopathy syndrome
Pregnancy
Pregnancy Complications, Infectious
PRES
Respiration
SARS-COV-2
Seizures
Seizures - complications
Sepsis
Severe acute respiratory syndrome coronavirus 2
Steroids
Thorax
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Summary:Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes Coronavirus Disease 2019 (COVID-19) may determine a series of neurological complications directly, by invasion of the nervous system or indirectly, secondary to systemic organ failure. Posterior reversible encephalopathy syndrome (PRES) represents a clinical and radiological neurological entity involving predominantly the occipital lobes. PRES was observed in patients receiving cytotoxic drugs, patients suffering from infectious diseases and sepsis, hypertensive emergencies and eclampsia, renal or autoimmune diseases. As more infectious SARS-COV-2 variants are now dominant in most of the Europe, an increasing number of patients is presenting to the Emergency Department. Case report of a 38-year-old patient, with previous exposure to SARS-COV-2 presented to the Emergency Department (ED) with generalized tonic-clonic seizures, dyspnea, cortical blindness and aphasia. The patient had been exhibiting fever, cough and shortness of breath in the previous 10 days. He had no relevant medical history and was receiving antibiotics and corticosteroids as prescribed by his general practitioner. Laboratory findings together with the thoracic computed tomography scan were consistent with the diagnosis of severe SARS-COV-2 pneumonia. The cerebral MRI scans showed bilateral T2-weighted/FLAIR hyperintensities that were suggestive for PRES. The patient was diagnosed with COVID-19 complicated with PRES. He received adequate treatment and the symptoms resolved in 48 h. This is a rare and interesting case of a patient with PRES and COVID-19 as underlying pathology, in whom rapid diagnosis in the ED and early initiation of appropriate treatment led to full recovery. Immediate extensive work-up in patients with COVID-19 and neurological symptoms proves to be paramount for best outcome. To our knowledge this is the first case of PRES described in a patient with Delta variant of SARS-COV-2. •work-up in patients with COVID-19 and neurological symptoms.•Posterior reversible encephalopathy syndrome in COVID-19.•Seizures, visual impairment and global aphasia.•Cerebral MRI Covid-19.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2022.03.005