Brain Neurorehabil.  2014 Mar;7(1):66-70. 10.12786/bn.2014.7.1.66.

Posterior Reversible Encephalopathy Syndrome (PRES) in a Chronic Alcoholic Patient after Having Steam Bath: A Case Report

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, National Health Insurance Corporation Ilsan Hospital, Korea. cielewme@naver.com
  • 2Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Korea.

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare disorder that is associated with hypertensive crises. In this article, we present a 59-year-old male patient with posterior reversible encephalopathy syndrome (PRES) caused by an acute hypertensive crisis after entering a steam bath in alcohol intoxicated status. In our case, oxidative stress resulting from alcohol metabolism may have lead to blood brain barrier (BBB) breakdown, serving as an aggravating factor in PRES. Thus we must always consider the possibility of PRES when treating chronic alcoholic patients with abnormal neurologic symptoms.

Keyword

alcoholics; hypertension; reversible posterior leukoencephalopathy syndrome

MeSH Terms

Alcoholics*
Blood-Brain Barrier
Humans
Hypertension
Male
Metabolism
Middle Aged
Neurologic Manifestations
Oxidative Stress
Posterior Leukoencephalopathy Syndrome*
Steam Bath*
Steam*
Steam

Figure

  • Fig. 1 Magnetic resonance imaging in PRES. T2 weighted axial MRI images on admission (A) Diffusion weighted axial MRI on admission (B), shows increased signal intensities in the subcortical white matter of bilateral parietal and occipital lobes.

  • Fig. 2 Positron Emission Tomography (PET) brain scan axial images done 30 days after onset shows decreased glucose uptake in bilateral parietal and occipital lobes.

  • Fig. 3 Follow-up T2-weighted axial MRI (2 months after onset) shows that the previously recognized T2 high-signal lesions had slight resolved but still remained.


Reference

1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996; 334:494–500.
2. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol. 2008; 29:1036–1042.
3. Lee VH, Eelco FM, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008; 65:205–210.
4. Kimura R, Yanagida M, Kugo A, Taguchi S, Matsunaga H. Posterior reversible encephalopathy syndrome in chronic alcoholism with acute psychiatric symptoms. Gen Hosp Psychiatry. 2010; 32:447.
5. Bhagavati S, Choi J. Atypical cases of posterior reversible encephalopathy syndrome: clinical and MRI features. Cerebrovasc Dis. 2008; 26:564–566.
6. Gharabawy R, Pothula VR, Rubinshteyn V, Silverberg M, Gave AA. Epinephrine-induced posterior reversible encephalopathy syndrome: a case report. J Clin Anesth. 2011; 23:505–507.
7. Stott VL, Hurrell MA, Anderson TJ. Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed. Intern Med J. 2005; 35:83–90.
8. Finsterer J, Schlager T, Kopsa W, Wild E. Nitroglycerin-aggravated preeclamptic posterior reversible encephalopathy syndrome (PRES). Neurology. 2003; 61:715–716.
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