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Acute posterior reversible encephalopathy syndrome (PRES) in setting of interferon-beta use : case presentation with reduction of edema in 72 h after cessation of interferon-beta therapy with sub-clinical inflammation

Dietz, Nicholas ; Mufti, Zarmina ; Yousaf, Muhammed ; Brown, Randal ; Counts, Christopher ; Bjurström, Martin F. LU ; Williams, Brian J. and Robertson, David (2021) In BMC Neurology 21(1).
Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) represents a transient change in mental status with associated vasogenic edema of cortical and subcortical brain structures. It is often attributed to multifactorial etiology including hypertension and altered hemodynamics and disruption of vessel integrity. Patients with autoimmune disease and certain immune modulator therapies are at greater risk. Case presentation: A 54-year-old female with past medical history of well-controlled multiple sclerosis on interferon-beta since 2013, presented with witnessed tonic colonic seizure. She also was noted to demonstrate left gaze deviation and left-sided hemiparesis. MRI fluid-attenuated inversion recovery sequence showed... (More)

Background: Posterior reversible encephalopathy syndrome (PRES) represents a transient change in mental status with associated vasogenic edema of cortical and subcortical brain structures. It is often attributed to multifactorial etiology including hypertension and altered hemodynamics and disruption of vessel integrity. Patients with autoimmune disease and certain immune modulator therapies are at greater risk. Case presentation: A 54-year-old female with past medical history of well-controlled multiple sclerosis on interferon-beta since 2013, presented with witnessed tonic colonic seizure. She also was noted to demonstrate left gaze deviation and left-sided hemiparesis. MRI fluid-attenuated inversion recovery sequence showed hyperintensity of the subcortical U fibers, concentrated in the occipital, parietal lobes and frontal lobes. Systolic blood pressure was 160 mmHg on arrival. The patient was started on seizure prophylxis and Interferon beta was discontinued. The patient’s mentation, seizures and hemiapresis significantly improved in next 72 h with tight blood pressure control, and had notble improvement on MRI imaging and inflammatory markers. Lumbar puncture CSF results were devoid of infectious and autoimmune pathology. Conclusions: A middle-aged female with multiple sclerosis who was on chronic IFN-beta presented to the emergency room with a witnessed tonic-clonic seizure, with MRI T2 FLAIR imaging consistent with PRES. She had notable clinical improvement with decreased edema on imaging and improved inflammatory markers 72 h after cessation of IFN-beta therapy.

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author
; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Case report, Hypertension, Interferon, Multiple sclerosis, Posterior reversible encephalopathy syndrome, Seizure
in
BMC Neurology
volume
21
issue
1
article number
445
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85118807783
  • pmid:34758765
ISSN
1471-2377
DOI
10.1186/s12883-021-02471-7
language
English
LU publication?
no
additional info
Publisher Copyright: © 2021, The Author(s).
id
8408c12c-1542-42d3-8417-9105c408766f
date added to LUP
2022-01-21 16:24:01
date last changed
2024-06-16 00:16:29
@article{8408c12c-1542-42d3-8417-9105c408766f,
  abstract     = {{<p>Background: Posterior reversible encephalopathy syndrome (PRES) represents a transient change in mental status with associated vasogenic edema of cortical and subcortical brain structures. It is often attributed to multifactorial etiology including hypertension and altered hemodynamics and disruption of vessel integrity. Patients with autoimmune disease and certain immune modulator therapies are at greater risk. Case presentation: A 54-year-old female with past medical history of well-controlled multiple sclerosis on interferon-beta since 2013, presented with witnessed tonic colonic seizure. She also was noted to demonstrate left gaze deviation and left-sided hemiparesis. MRI fluid-attenuated inversion recovery sequence showed hyperintensity of the subcortical U fibers, concentrated in the occipital, parietal lobes and frontal lobes. Systolic blood pressure was 160 mmHg on arrival. The patient was started on seizure prophylxis and Interferon beta was discontinued. The patient’s mentation, seizures and hemiapresis significantly improved in next 72 h with tight blood pressure control, and had notble improvement on MRI imaging and inflammatory markers. Lumbar puncture CSF results were devoid of infectious and autoimmune pathology. Conclusions: A middle-aged female with multiple sclerosis who was on chronic IFN-beta presented to the emergency room with a witnessed tonic-clonic seizure, with MRI T2 FLAIR imaging consistent with PRES. She had notable clinical improvement with decreased edema on imaging and improved inflammatory markers 72 h after cessation of IFN-beta therapy.</p>}},
  author       = {{Dietz, Nicholas and Mufti, Zarmina and Yousaf, Muhammed and Brown, Randal and Counts, Christopher and Bjurström, Martin F. and Williams, Brian J. and Robertson, David}},
  issn         = {{1471-2377}},
  keywords     = {{Case report; Hypertension; Interferon; Multiple sclerosis; Posterior reversible encephalopathy syndrome; Seizure}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Neurology}},
  title        = {{Acute posterior reversible encephalopathy syndrome (PRES) in setting of interferon-beta use : case presentation with reduction of edema in 72 h after cessation of interferon-beta therapy with sub-clinical inflammation}},
  url          = {{http://dx.doi.org/10.1186/s12883-021-02471-7}},
  doi          = {{10.1186/s12883-021-02471-7}},
  volume       = {{21}},
  year         = {{2021}},
}