MRI-proven Posterior Reversible Encephalopathy Syndrome in Diaysis Patients with Initial Diagnosis of Hypertensive Encephalopathy

초록

Sudden attack of seizure is very striking presentation in dialysis patients. The posterior reversible encephalopathy syndrome (PRES) is a recently proposed to be a clinically and radiologically defined syndrome characterized by seizures, headaches, visual disturbances. On magnetic resonance imaging (MRI) studies, vasogenic edema has been reported in a relatively symmetrical pattern, typically in the posterior area of the brain. Total 9 patients on dialysis were collected, the patients on HD are six and the other three patients are treated on PD. Seven out of nine patients who had seizure-like events in the emergency center. Six patients complained of severe headache with nausea, one female patient suffered from a visual blindness for one week. Their serum electrolyte, osmolarity and glucose levels were within normal range. MRI showed bilateral, subcortical and whitematter lesions in the parietal and occipital lobes generating low signal on T1-weighted images and high signal on T2-weighted images, with a high apparent diffusion coefficient and no contrast enhancement. All the patients had severely elevated blood pressure (BP) over 200/120 mmHg. After intensive BP control with the IV anti-hypertensives under 160/100 mmHg, seizures well subsided with the anti-convulsant for a few days. Follow-up MRI within one month did not reveal any other defects. But one HD patient died of multi-organ failure in the ICU despite of supportive care.