Health Boards
Tue-18-10-2011, 11:31 AM
Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is a syndrome characterised by headache, confusion, seizures and visual loss. It may occur due to a number of causes, predominantly malignant hypertension, eclampsia and some medical treatments. On magnetic resonance imaging (MRI) of the brain, areas of edema (swelling) are seen. The symptoms tend to resolve after a period of time, although visual changes sometimes remain. It was first described in 1996.
The first case of RPLS in a 65-year-old woman who underwent Stelara therapy for psoriasis. Approximately 21/2 years after the patient began Stelara therapy, she experienced an acute onset of confusion, headache, nausea, vomiting, and seizures. Computed tomographic scans and magnetic resonance images of her head revealed characteristic findings, including white matter abnormalities consistent with edema in the absence of infarction. There was no evidence of vasospasm, thrombosis, or infection. Cerebrospinal fluid tests were negative for the JC virus. The patient improved clinically and was discharged 6 days after she presented to the emergency department. She made a full neurologic recovery, with a reversal of the radiologic findings.
Reversible posterior leukoencephalopathy syndrome is an increasingly recognized neurologic disorder that has been reported with the use of systemic and biologic agents to treat moderate to severe psoriasis. Although the relationship between RPLS and Stelara therapy remains unclear, this case emphasizes the need for dermatologists to recognize the syndrome's signs and symptoms and to refer patients promptly for evaluation and appropriate treatment if the clinical features of RPLS are suspected.
Source: archderm.ama-assn.org
The first case of RPLS in a 65-year-old woman who underwent Stelara therapy for psoriasis. Approximately 21/2 years after the patient began Stelara therapy, she experienced an acute onset of confusion, headache, nausea, vomiting, and seizures. Computed tomographic scans and magnetic resonance images of her head revealed characteristic findings, including white matter abnormalities consistent with edema in the absence of infarction. There was no evidence of vasospasm, thrombosis, or infection. Cerebrospinal fluid tests were negative for the JC virus. The patient improved clinically and was discharged 6 days after she presented to the emergency department. She made a full neurologic recovery, with a reversal of the radiologic findings.
Reversible posterior leukoencephalopathy syndrome is an increasingly recognized neurologic disorder that has been reported with the use of systemic and biologic agents to treat moderate to severe psoriasis. Although the relationship between RPLS and Stelara therapy remains unclear, this case emphasizes the need for dermatologists to recognize the syndrome's signs and symptoms and to refer patients promptly for evaluation and appropriate treatment if the clinical features of RPLS are suspected.
Source: archderm.ama-assn.org