TY - JOUR
T1 - Posterior Reversible Encephalopathy Syndrome Secondary to Hypertensive Encephalopathy Brought on by a MAO Inhibitor
T2 - A Case Report
AU - Strother, Robert
AU - Wong, Hailon
AU - Miller, Nathaniel E.
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - 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.
AB - 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.
KW - MAO inhibitor
KW - encephalopathy
KW - hypertension
KW - medication effect
KW - mental status change
KW - primary care
UR - http://www.scopus.com/inward/record.url?scp=85071717909&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071717909&partnerID=8YFLogxK
U2 - 10.1177/2150132719869539
DO - 10.1177/2150132719869539
M3 - Article
C2 - 31423884
AN - SCOPUS:85071717909
SN - 2150-1319
VL - 10
JO - Journal of Primary Care and Community Health
JF - Journal of Primary Care and Community Health
ER -