Posterior reversible encephalopathy syndrome following septicemia in patient with myasthenia gravis

• Published in: Radiology case reports Vol. 18; no. 4; pp. 1549 - 1551
• Main Authors: Hai, Pham Dang, Duc, Vu Anh, Hung, Vu Quang, Thang, Nguyen Van Viet
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-04-2023; Elsevier
• Subjects: Case Report; Myasthenia gravis; Posterior reversible encephalopathy syndrome; Seizure; Sepsis; Myasthenia gravis; Posterior reversible encephalopathy syndrome; PRES; MRI; RT-PCR; Sepsis; Seizure; RT-PCR, Reverse transcriptase-polymerase chain reaction; MRI, Magnetic resonance imaging; PRES, Posterior reversible encephalopathy syndrome
• ISSN: 1930-0433; 1930-0433
• DOI: 10.1016/j.radcr.2023.01.050

Posterior reversible encephalopathy syndrome is a clinicoradiologic entity characterized by seizure, headaches, visual symptoms, impaired consciousness, and vasogenic cerebral edema of occipital and parietal lobes of the brain. Magnetic resonance imaging (MRI) is the diagnostic gold standard. The pathophysiology of posterior reversible encephalopathy syndrome is still unknown, but it is thought to be closely related to several medical conditions including hypertension, preeclampsia, eclampsia, immunosuppressive agents, transplantation, and sepsis. We report a rare case of posterior reversible encephalopathy syndrome in patient with myasthenia gravis and sepsis. A 22-year-old male was diagnosed with myasthenia gravis combined with sepsis due to pneumonia. During his recovery, the patient suffered multiple generalized convulsions and subsequent loss of consciousness. On cranial MRI, the abnormalities were observed with hyperintense within the subcortical white matter of the temporal, parietal, and bilateral occipital lobes on T2-weighted and T2 FLAIR. Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of posterior reversible encephalopathy syndrome. Early recognition and management of posterior reversible encephalopathy syndrome as a cause of encephalopathy in patients with septicemia and myasthenia gravis is necessary to prevent secondary complications in this condition.