Brainstem posterior reversible encephalopathy syndrome in a case with Guillain–Barré syndrome

Jun Yokoyama, Hiroo Yamaguchi, Junpei Koge, Takuya Matsushita, Noriko Isobe, Ryo Yamasaki, Jun-Ichi Kira

研究成果: ジャーナルへの寄稿記事

抄録

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic brain edema on magnetic resonance imaging. PRES is frequently associated with blood pressure (BP) fluctuation. Although Guillain–Barré syndrome (GBS) is often complicated by BP fluctuation, PRES is rarely reported. Here, we describe the first reported case of GBS in a patient who developed PRES mainly affecting the brainstem. Case presentation: A 43-year-old man presented with impaired consciousness and was hospitalized after a diagnosis of infectious meningoencephalitis. His consciousness was improved by treatment; however, he presented with polyneuropathy and BP fluctuation. We diagnosed him with GBS and started intravenous immunoglobulin therapy (IVIg); however, his consciousness became impaired again after IVIg. Brain magnetic resonance imaging showed hyperintense areas of the pons, cerebellar peduncle, midbrain and basal ganglia in the apparent diffusion coefficient image and the fluid-attenuated inversion recovery image. Diffusion-weighted imaging showed that hyperintense and hypointense lesions were present within the same regions. We diagnosed brainstem PRES complicated with GBS. Achievement of BP control improved his consciousness and hyperintense lesions on the diffusion-weighted imaging and apparent diffusion coefficient image map. Conclusions: BP fluctuation and IVIg might have caused PRES in the present case. Neurologists should consider PRES as a differential diagnosis when consciousness is impaired in GBS, especially at the time of IVIg therapy or BP fluctuation.

元の言語英語
ジャーナルClinical and Experimental Neuroimmunology
DOI
出版物ステータス出版済み - 1 1 2019

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Posterior Leukoencephalopathy Syndrome
Brain Stem
Consciousness
Passive Immunization
Intravenous Immunoglobulins
Blood Pressure
Magnetic Resonance Imaging
Meningoencephalitis
Pons
Polyneuropathies
Brain Edema
Mesencephalon
Basal Ganglia
Differential Diagnosis
Brain
Therapeutics

All Science Journal Classification (ASJC) codes

  • Neuroscience (miscellaneous)
  • Immunology
  • Immunology and Microbiology (miscellaneous)
  • Clinical Neurology

これを引用

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title = "Brainstem posterior reversible encephalopathy syndrome in a case with Guillain–Barr{\'e} syndrome",
abstract = "Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic brain edema on magnetic resonance imaging. PRES is frequently associated with blood pressure (BP) fluctuation. Although Guillain–Barr{\'e} syndrome (GBS) is often complicated by BP fluctuation, PRES is rarely reported. Here, we describe the first reported case of GBS in a patient who developed PRES mainly affecting the brainstem. Case presentation: A 43-year-old man presented with impaired consciousness and was hospitalized after a diagnosis of infectious meningoencephalitis. His consciousness was improved by treatment; however, he presented with polyneuropathy and BP fluctuation. We diagnosed him with GBS and started intravenous immunoglobulin therapy (IVIg); however, his consciousness became impaired again after IVIg. Brain magnetic resonance imaging showed hyperintense areas of the pons, cerebellar peduncle, midbrain and basal ganglia in the apparent diffusion coefficient image and the fluid-attenuated inversion recovery image. Diffusion-weighted imaging showed that hyperintense and hypointense lesions were present within the same regions. We diagnosed brainstem PRES complicated with GBS. Achievement of BP control improved his consciousness and hyperintense lesions on the diffusion-weighted imaging and apparent diffusion coefficient image map. Conclusions: BP fluctuation and IVIg might have caused PRES in the present case. Neurologists should consider PRES as a differential diagnosis when consciousness is impaired in GBS, especially at the time of IVIg therapy or BP fluctuation.",
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T1 - Brainstem posterior reversible encephalopathy syndrome in a case with Guillain–Barré syndrome

AU - Yokoyama, Jun

AU - Yamaguchi, Hiroo

AU - Koge, Junpei

AU - Matsushita, Takuya

AU - Isobe, Noriko

AU - Yamasaki, Ryo

AU - Kira, Jun-Ichi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic brain edema on magnetic resonance imaging. PRES is frequently associated with blood pressure (BP) fluctuation. Although Guillain–Barré syndrome (GBS) is often complicated by BP fluctuation, PRES is rarely reported. Here, we describe the first reported case of GBS in a patient who developed PRES mainly affecting the brainstem. Case presentation: A 43-year-old man presented with impaired consciousness and was hospitalized after a diagnosis of infectious meningoencephalitis. His consciousness was improved by treatment; however, he presented with polyneuropathy and BP fluctuation. We diagnosed him with GBS and started intravenous immunoglobulin therapy (IVIg); however, his consciousness became impaired again after IVIg. Brain magnetic resonance imaging showed hyperintense areas of the pons, cerebellar peduncle, midbrain and basal ganglia in the apparent diffusion coefficient image and the fluid-attenuated inversion recovery image. Diffusion-weighted imaging showed that hyperintense and hypointense lesions were present within the same regions. We diagnosed brainstem PRES complicated with GBS. Achievement of BP control improved his consciousness and hyperintense lesions on the diffusion-weighted imaging and apparent diffusion coefficient image map. Conclusions: BP fluctuation and IVIg might have caused PRES in the present case. Neurologists should consider PRES as a differential diagnosis when consciousness is impaired in GBS, especially at the time of IVIg therapy or BP fluctuation.

AB - Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic brain edema on magnetic resonance imaging. PRES is frequently associated with blood pressure (BP) fluctuation. Although Guillain–Barré syndrome (GBS) is often complicated by BP fluctuation, PRES is rarely reported. Here, we describe the first reported case of GBS in a patient who developed PRES mainly affecting the brainstem. Case presentation: A 43-year-old man presented with impaired consciousness and was hospitalized after a diagnosis of infectious meningoencephalitis. His consciousness was improved by treatment; however, he presented with polyneuropathy and BP fluctuation. We diagnosed him with GBS and started intravenous immunoglobulin therapy (IVIg); however, his consciousness became impaired again after IVIg. Brain magnetic resonance imaging showed hyperintense areas of the pons, cerebellar peduncle, midbrain and basal ganglia in the apparent diffusion coefficient image and the fluid-attenuated inversion recovery image. Diffusion-weighted imaging showed that hyperintense and hypointense lesions were present within the same regions. We diagnosed brainstem PRES complicated with GBS. Achievement of BP control improved his consciousness and hyperintense lesions on the diffusion-weighted imaging and apparent diffusion coefficient image map. Conclusions: BP fluctuation and IVIg might have caused PRES in the present case. Neurologists should consider PRES as a differential diagnosis when consciousness is impaired in GBS, especially at the time of IVIg therapy or BP fluctuation.

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