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POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME SECONDARY TO PERITONITIS
  1. Odai Jumma
  1. University of Dohuk

    Abstract

    Introduction Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical and radiological diagnosis characterised by headache, confusion, visual disturbance and cerebral oedema involving the posterior region of brain. The associations between the PRES and pre–eclampsia and eclampsia, hypertension, autoimmune disease, chemotherapy and bone marrow transplantation are well recognised. However the development of PRES in septic surgical patients is less well documented.

    Case Presentation We report the case of a 49 year old woman with a background of depression and Raynaud's disease who developed prolonged sepsis following two emergency laparotomies for peritonitis, secondary to traumatic recto–vaginal tears. Six weeks after admission, she developed sudden onset bilateral visual loss, intermittent headaches and multiple generalised seizures. MRI brain axial and Coronal views (Figures 1 and 2) respectively showed multifocal hyperintensity T2–lesions in the cortical and subcortical parietooccipital regions. The diagnosis of PRES was made based on clinical and radiological findings. Following treatment of her sepsis, recovery from the surgical wounds and initiatin of an antiepileptic treatment, the patient transferred to neurorehabilitation unit.

    Conclusion PRES is rarely encountered in septic surgical patients. Early identification of the characteristic clinical and radiological features are keys to the diagnosis.

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