Posterior Reversible Encephalopathy Syndrome Secondary to Hypertensive Encephalopathy Brought on by a MAO Inhibitor: A Case Report.
Robert StrotherHailon WongNathaniel E MillerPublished in: Journal of primary care & community health (2020)
An elderly woman was admitted to the Family Medicine inpatient service for altered mental status after being brought to the emergency room by a concerned neighbor, who had come across the patient speaking incoherently. Initial evaluation was notable for elevated blood pressures, but extensive lab testing and head computed tomographic imaging were within normal limits. However, subsequent magnetic resonance imaging showed white matter changes consistent with posterior reversible encephalopathy syndrome (PRES), a neurologic syndrome characterized by headache, altered mental status, loss of vision, and seizures as well as radiographic findings of posterior cerebral white matter edema. Multiple etiologies of PRES have been described and include hypertensive encephalopathy, immunosuppressant medications, and eclampsia. This case describes an episode of PRES secondary to hypertensive encephalopathy brought about by an inappropriate dose of a monoamine oxidase (MAO) inhibitor. The patient had significant improvement in symptoms with removal of the offending agent and control of her blood pressure. While PRES generally has a good prognosis, prompt recognition, and management are important in preventing significant disease morbidity and mortality.
Keyphrases
- blood pressure
- early onset
- case report
- white matter
- mental health
- magnetic resonance imaging
- healthcare
- hypertensive patients
- emergency department
- high resolution
- multiple sclerosis
- heart rate
- public health
- palliative care
- physical activity
- subarachnoid hemorrhage
- insulin resistance
- adipose tissue
- brain injury
- weight loss
- contrast enhanced
- blood glucose
- skeletal muscle
- acute care