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A case of posterior reversible encephalopathy syndrome in a patient undergoing automated peritoneal dialysis

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Abstract

A 44-year-old man undergoing automated peritoneal dialysis (PD) developed headache and dizziness with truncal ataxia and ataxic gait. Severe hypertension (systolic blood pressure/diastolic pressure: 193/83 mm Hg) and lower extremity edema were present, and his PD efficiency (weekly KT/V: 1.49) was inadequate. Magnetic resonance imaging revealed diffuse hyperintensities in the brain stem and bilateral cerebellar hemispheres on fluid-attenuated inversion recovery and apparent diffusion coefficient mapping imaging. Based on these findings, the patient was diagnosed with posterior reversible encephalopathy syndrome due to hypertension and uremia. He was treated with antihypertensive agents, and we changed the PD prescription to improve PD efficiency. Thereafter, his symptoms gradually improved, and abnormal findings on brain magnetic resonance imaging disappeared in accordance with lowering blood pressure.

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References

  1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.

    Article  CAS  PubMed  Google Scholar 

  2. Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol. 2012;259:155–64.

    Article  CAS  PubMed  Google Scholar 

  3. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85:427–432.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Moreiras-Plaza M, Fernandez-Fleming F, Azkarate-Ramirez N, Najera-de la Garza W, Martin-Baez I, Hernansanz-Perez M. Peritoneal dialysis: a factor of risk or protection for posterior reversible encephalopathy syndrome? review of the literature. Nefrologia. 2018;38:136–40.

    Article  PubMed  Google Scholar 

  5. Graham BR, Pylypchuk GB. Posterior reversible encephalopathy syndrome in an adult patient undergoing peritoneal dialysis: a case report and literature review. BMC Nephrol. 2014;15:10.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kitamura M, Furusu A, Hirose M, Nishino T, Obata Y, Uramatsu T, Kohno S. A case of reversible posterior leukoencephalopathy syndrome in a patient on peritoneal dialysis. Clin Exp Nephrol. 2010;14:633–6.

    Article  PubMed  Google Scholar 

  7. Girisgen I, Tosun A, Sonmez F, Ozsunar Y. Recurrent and atypical posterior reversible encephalopathy syndrome in a child with peritoneal dialysis. Turk J Pediatr. 2010;52:416–9.

    PubMed  Google Scholar 

  8. Ogawa A, Sugiyama H, Nakayama K, Morinaga H, Akagi S, Makino H. Reversible posterior leukoencephalopathy syndrome in a young adult patient receiving peritoneal dialysis. Perit Dial Int. 2012;32:587–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. Am J Neuroradiol. 2002;23:1038–48.

    PubMed  Google Scholar 

  10. Roth C, Ferbert A. The posterior reversible encephalopathy syndrome: what’s certain, what’s new? Pract Neurol. 2011;11:136–44.

    Article  CAS  PubMed  Google Scholar 

  11. Ni J, Zhou LX, Hao HL, Liu Q, Yao M, Li ML, Peng B, Cui LY. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: a retrospective series of 24 patients. J Neuroimaging. 2011;21:219–24.

    Article  PubMed  Google Scholar 

  12. Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017;264:1608–16.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, Holman BL. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. Am J Roentgenol. 1992;159:379–83.

    Article  CAS  Google Scholar 

  14. Nakayama M, Kawaguchi Y. Multicenter survey on hydration status and control of blood pressure in Japanese CAPD patients. Perit Dial Int. 2002;22:411–4.

    PubMed  Google Scholar 

  15. Rodriguez-Carmona A, Perez-Fontan M, Garca-Naveiro R, Villaverde P, Peteiro J. Compared time profiles of ultrafiltration, sodium removal, and renal function in incident CAPD and automated peritoneal dialysis patients. Am J Kidney Dis. 2004;44:132–45.

    Article  PubMed  Google Scholar 

  16. Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. Am J Neuroradiol. 2006;27:2179–90.

    CAS  PubMed  Google Scholar 

  17. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65:205–10.

    PubMed  Google Scholar 

  18. Krane NK. Intracranial pressure measurement in a patient undergoing hemodialysis and peritoneal dialysis. Am J Kidney Dis. 1989;13:336–9.

    Article  CAS  PubMed  Google Scholar 

  19. Murakami M, Hamasaki T, Kimura S, Maruyama D, Kakita K. Clinical features and management of intracranial hemorrhage in patients undergoing maintenance dialysis therapy. Neurologia medico-chirurgica. 2004;44:225–232 (discussion 33).

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan

    Shohei Kaneko, Keiji Hirai, Saori Minato, Katsunori Yanai, Yuko Mutsuyoshi, Hiroki Ishii, Taisuke Kitano, Mitsutoshi Shindo, Akinori Aomatsu, Haruhisa Miyazawa, Kiyonori Ito, Yuichirou Ueda, Taro Hoshino, Susumu Ookawara & Yoshiyuki Morishita

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  1. Shohei Kaneko
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  2. Keiji Hirai
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  3. Saori Minato
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  4. Katsunori Yanai
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  5. Yuko Mutsuyoshi
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  13. Taro Hoshino
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  15. Yoshiyuki Morishita
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Corresponding author

Correspondence to Keiji Hirai.

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The authors have declared that no conflict of interest exists.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the patient described in this case report.

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Kaneko, S., Hirai, K., Minato, S. et al. A case of posterior reversible encephalopathy syndrome in a patient undergoing automated peritoneal dialysis. CEN Case Rep 8, 178–182 (2019). https://doi.org/10.1007/s13730-019-00389-1

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  • DOI: https://doi.org/10.1007/s13730-019-00389-1

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