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Breath-hold diving is a challenging activity that can lead to serious and dangerous complications, such as the "Taravana" syndrome. This syndrome is characterized by the onset of neurological symptoms after deep or repeated dives. The main clinical manifestations are cerebral, including stroke and cognitive impairment. The pathophysiology of Taravana syndrome is still widely debated, but the most accepted theory is that it is a specific form of decompression sickness. We have reviewed the main theories explaining the onset of Taravana syndrome and, through the description of a particularly illustrative case of a freediver using an underwater scooter, we have formulated a hypothesis according to which micro-bubbles formed directly in cerebral structures would be at the origin of this syndrome. MRI showed diffuse encephalopathy with vasogenic edema. Analysis of the radiological sequences did not suggest an ischemic or embolic mechanism. This finding is likely to be associated with the diagnosis of posterior reversible encephalopathy syndrome. The rapid ascent speeds associated with underwater scooter use could potentially result in the formation of nitrogen micro-bubbles in the capillaries of brain tissue. The emergence of scooters in freediving can be a hazard because of their ability to facilitate very rapid ascents. It is therefore essential to take preventive measures to ensure the safety of users of these devices. [ABSTRACT FROM AUTHOR]

Our case demonstrated unique cytomegalovirus (CMV) encephalitis post-haploidentical donor hematopoietic stem cell transplantation (HID-HSCT), with early findings on diffusion-weighted brain magnetic resonance imaging (MRI) in the absence of any neurologic symptoms. A 54-year-old Chinese man with acute lymphoblastic leukemia (Philadelphia chromosome-negative) underwent HID-HSCT. After HSCT, the patient developed CMV viremia and severe acute graft-versus-host disease. Recurrence of CMV viremia was observed. On day 129, brain MRI was performed to determine the cause for the intermittent fever. Diffusion-weighted imaging (DWI) revealed several bright spots in the cortex of the frontal lobes and anterior angle of the left lateral ventricle. Subsequently, he developed transplant-associated thrombotic microangiopathy, posterior reversible encephalopathy syndrome, and enlargement of lesions alongside the ventricular wall on a brain MRI series. Metagenomic next-generation sequencing (NGS) of the cerebrospinal fluid (CSF) led to the final diagnosis of CMV encephalitis. Although ganciclovir combined with foscarnet was administered, the patient’s consciousness deteriorated, followed by respiratory failure. The patient died on day 198. Additionally, we performed a systematic review to comprehensively analyze this disease. Regarding treatment, immunological therapies, including virus-specific T cells from a third donor and CMV-cytotoxic T lymphocytes, may be more effective. This case report and systematic review underscores the complexities of managing CMV ventriculoencephalitis in HSCT recipients and emphasizes the importance of early diagnosis by brain MRI and CSF polymerase chain reaction or NGS and ongoing research in improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome is a rare neurological syndrome that refers to reversible subcortical vasogenic brain edema disorder in patients with acute neurological symptoms. Case presentation: Whether there is a direct causal relationship between pancreatitis and posterior reversible encephalopathy syndrome needs further study. We here report a 39-year-old Chinese woman who was diagnosed with pancreatitis followed by vision disturbance. The patient was finally diagnosed with posterior reversible encephalopathy syndrome. On the basis of this rare case, we analyzed the causes of visual disturbance and proposed diagnostic ideas. Conclusions: For posterior reversible encephalopathy syndrome, early identification and treatment of the primary disease are particularly important. Imaging and clinical characteristics in posterior reversible encephalopathy syndrome are usually reversible. [ABSTRACT FROM AUTHOR]

Background: Despite promising outcomes of treatment with anti-programmed cell death (PD)-1/PD-ligand (L)1 agents in combination with platinum-doublet chemotherapy (PDC) in the first-line setting, a significant unmet medical need remains in patients with PD-L1-unselected non-small cell lung cancer (NSCLC). Methods: This multicenter, open-label, phase 1b study comprising dose-confirmation and dose-expansion parts investigated the combination of spartalizumab and various PDC regimens, with or without canakinumab, in treatment-naïve patients with PD-L1-unselected, metastatic NSCLC. The primary objectives were to determine maximum tolerated dose (MTD) and/or recommended dose for expansion (RDE) of spartalizumab, with or without canakinumab, in combination with PDC in the dose-confirmation part and antitumor activity of spartalizumab in the dose-expansion part. Results: The MTD/RDE of spartalizumab was 300 mg every 3 weeks (Q3W) when administered with either gemcitabine (1250 mg/m2)/cisplatin (75 mg/m2) (group A; no dose-limiting toxicities [DLTs]), pemetrexed (500 mg/m2)/cisplatin (group B; 2 DLTs: grade 2 posterior reversible encephalopathy syndrome and grade 4 hyponatremia), or paclitaxel (200 mg/m2)/carboplatin area under the curve 6 min*mg/mL (group C; 1 DLT: grade 4 neutropenic colitis). The RDE of canakinumab combined with spartalizumab and pemetrexed/cisplatin (group E; no DLTs) was 200 mg Q3W (no dose-expansion part was initiated). No new safety signals were identified. In groups A, B, C, and E, the overall response rates were 57.6%, 55.3%, 51.5%, and 57.1%, respectively. Group B compared with other groups had the longest median progression-free survival (10.4 months vs. 6.2–7.5 months), overall survival (29.7 months vs. 16.1–21.0 months), and duration of response (30.1 months vs. 6.0-8.2 months). Conclusions: The combination of spartalizumab and PDC, with or without canakinumab, was well tolerated across treatment groups. The antitumor activity across treatment groups was comparable with that of pembrolizumab and pemetrexed combination. Canakinumab did not appear to improve the antitumor activity when combined with spartalizumab, pemetrexed and cisplatin. Trial registration: The trial was registered in Clinicaltrials.gov with identifier no. NCT03064854. Date of Registration: 06 February 2017. Highlights: A significant unmet medical need still exists in patients with PD-L1-unselected NSCLC due to the limited efficacy of immune checkpoint inhibitors and the lack of a well-defined, effective treatment approach. Spartalizumab in combination with platinum doublet chemotherapy (PDC), with/without canakinumab, was well tolerated across treatment groups. Spartalizumab plus PDC, with/without canakinumab, showed the antitumor activity in this clinical setting. Addition of canakinumab did not appear to improve the antitumor activity of the combination of spartalizumab with pemetrexed plus cisplatin. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) in children has a propensity towards atypical features on magnetic resonance (MR) imaging, with limited literature on perfusion changes and clinicoradiological correlation. Objective: We aimed to comprehensively study MR imaging patterns of pediatric PRES, including cerebral blood flow variations on arterial spin labeling, and looked for any MR biomarkers of poor clinical outcome. Materials and methods: In this retrospective observational study conducted in a tertiary hospital setting, MR records over a 4-year period (May 2019 to May 2023) were systematically searched along with their clinical details. Patients with an age less than 18 years and a clinicoradiological constellation consistent with PRES were included. MR scans were analyzed by two neuroradiologists with 8 years' and 10 years' experience. Association was sought with poor clinical outcome (defined as modified Rankin Scale score at discharge of > 2). Results: A total of 45 patients (29 boys) were included in the study, with a mean age (± standard deviation) of 11.19 (± 4.53) years. On MR imaging, 95.6% of patients (n = 43) showed atypical features and/or atypical areas of involvement. The superior frontal sulcus (n = 18) was the most predominant MR pattern, and cerebellar involvement was not uncommon (n = 15). Unilateral involvement (n = 3), isolated central pattern (n = 1), and spinal cord involvement (PRES-SCI: n = 1) were also encountered. Brainstem involvement (n = 4) showed a characteristic "V-sign" of anterior medullary hyperintensity. Patchy restricted diffusion (46.6%), punctate hemorrhages (37.7%), and leptomeningeal contrast enhancement (36%) were not uncommon. Arterial spin labeling sequence (available in 24 patients) showed increased cerebral blood flow in the involved areas in 79.2% of patients. Univariate analysis showed a significant association of the presence of hemorrhage (P = 0.003), involvement of brainstem (P = 0.007), deep white matter (P = 0.008), and thalamus (P = 0.026) with poor clinical outcome. Multivariate regression analysis found that hemorrhage on MRI (P = 0.011, odds ratio 8) was an independent factor associated with poor clinical outcome. Conclusions: The conventionally described atypical features in PRES are common in children and therefore may no longer be considered exceptions. Raised perfusion on arterial spin labeling sequence was seen in the majority of cases. Hemorrhage on MRI was an independent predictor of poor clinical outcome in pediatric PRES. [ABSTRACT FROM AUTHOR]

Although toxicity from excessive exogenous vitamin D supplementation is rare, a range of symptoms can occur, most of which result from hypercalcemia. We report a novel case of posterior reversible encephalopathy syndrome (PRES) in a young child who required intensive care after presenting with hypercalcemia, hypertensive emergency, acute kidney injury, and hypercarbic respiratory failure, which ultimately were attributed to vitamin D toxicity (VDT). We report a young child who developed PRES in association with VDT. Our report informs pediatric outpatient, hospitalist, and intensivist providers about rare but lifethreatening complications from hypervitaminosis D, adds VDT to the differential diagnosis for children with similar presentations, and highlights the importance of vitamin supplementation safety guidance for families. [ABSTRACT FROM AUTHOR]

The article focuses on an 8-year-old girl diagnosed with atypical hemolytic uremic syndrome (aHUS) after presenting with non-bloody diarrhea, hemolytic anemia, and thrombocytopenia. Topics include her clinical presentation with elevated blood pressure and kidney involvement, the negative tests for shiga toxin and the normal ADAMTS-13 activity, and her subsequent treatment with plasma exchange and eculizumab, leading to improved kidney function and the cessation of dialysis.

This article discusses a case study of a 38-year-old female patient with refractory leukemia who received CAR-T cell therapy. The patient experienced complications, including immune effector cell–associated hemophagocytic lymphohistiocytosis–like syndrome and neurologic manifestations. The article explores the clinical manifestations of major complications, such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). The patient ultimately developed a sudden coma and was found to have a cerebellar hemorrhage. The article emphasizes the need for early involvement of neurointensivists in the evaluation and management of patients receiving CAR-T cell therapy. [Extracted from the article]

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological condition characterized by headaches, seizures, confusion, and visual impairment. It typically causes transient lesions in the posterior white matter in magnetic resonance imaging (MRI) of the brain. PRES induced by chemotherapy is uncommon in oncology but can be a significant neurological event. The exact cause of PRES remains unclear. This case report describes a 15-year-old female patient with acute lymphoblastic leukemia who developed PRES following chemotherapy with prednisolone (100 mg), vincristine (2 mg), and daunorubicin (40 mg) as per the modified Berlin-Frankfurt-Munster (95/2002) protocol. She developed headaches, partial seizures, and elevated blood pressure 1 day after starting chemotherapy. Brain MRI showed T2 and fluid-attenuated inversion recovery hyperintensities in the bilateral cerebral parenchyma, brainstem, and cerebellum. She was treated with levetiracetam (500 mg stat and then 1.5 g BD) for seizures, amlodipine (5 mg) for hypertension, and paracetamol (650 mg TDS) for headaches. Her symptoms improved and resolved within 2 days. The event was deemed possibly related to the chemotherapy drugs according to the World Health Organization-Uppsala Monitoring Centre causality assessment system. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare disease that is classified as a condition of diffuse cerebral artery constriction. RCVS can be complicated with transient neurological deficits, seizures, ischemic strokes, and hemorrhagic strokes. A thunder-clap headache, described as being the worst headache a patient can experience, is the predominant symptom in RCVS, which contributes to why RCVS is underdiagnosed as an ischemic stroke or migraine. Case Report: In this case study, we present a healthy 34-year-old Black woman who presented to the Emergency Department 3 times over a period of 4 days with concerns of severe headaches. In her first Emergency Department visit, she had a normal computed tomography scan of the brain. Her third Emergency Department visit resulted in hospitalization due to seizures, and a computed tomography brain scan done then showed acute intracranial hemorrhaging. The patient ultimately received a diagnosis of RCVS during her hospitalization. Conclusions: RCVS is the most notable mimicker of other similar-presenting vasculopathies, such as primary angiitis of the central nervous system and posterior reversible encephalopathy syndrome. It is important to note that thunder-clap headache, as well as complications such as intracranial hemorrhaging and seizures, can arise not just from other diseases but from RCVS as well; hence, an early diagnosis is critical to avoid complications, especially if initial imaging is negative. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition associated with a distinctive brain imaging pattern which typically occur in some complex clinical conditions. However, the leading offender to this condition remains not clear. Case presentation: We report a 6-year-old female with β-thalassemia major presenting with generalized tonic–clonic convulsions, repeated attacks of projectile vomiting, blurred vision, and altered conscious level after blood transfusion. The brain magnetic resonance imaging (MRI) FLAIR sequence revealed bilateral and symmetrical subcortical edema displaying high signal intensity. Follow-up MRI 1 month later showed complete resolution of the previously identified findings. The clinical presentation along with neuroimaging pattern as well as the reversible course indicated PRES as the most suitable diagnosis. Although PRES has been previously described in different clinical settings, this is a rare case of PRES recognized after blood transfusion in a child with β-thalassemia major. Conclusion: Acute neurological symptoms in children with thalassemia should raise high suspicion for PRES, especially after blood transfusion. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as other conditions, especially, among pregnant women with severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome in the puerperium. We hereby contribute to the literature this rare complication and hightlight the appropriate management of PRES. Presentation case: A pregnant woman (gravida 3, parity 2) had a normal antenatal course. However, she was diagnosed with severe preeclampsia and HELLP syndrome at 29 weeks and 5 days of gestation. Therefore, she was indicated for a medical termination of pregnancy following a patient's consent at our tertiary referral hospital. Severely, the patient developed rapidly with altered mental health in early puerperium. In result, PRES was diagnosed based on a brain magnetic resonance imaging (MRI) evidence with typical findings. After a strict multidisciplinary management, the clinical condition improved after 5 days of onset and recovered completely after a 4-month follow-up without any sequelae. Conclusion: In summary, despite its rarity, clinicians ought to be knowledgeable and raise an aware of PRES during pregnancy. Importantly, a brain imaging modalities should be taken into account among pregnant women with neurological symptoms subsequent to severe preeclampsia. In addition to early diagnosis, a timely appropriate treatment with multidisciplinary team is strongly indicated. Further studies with a large case series are required for this uncommon entity. [ABSTRACT FROM AUTHOR]

Objective: Challenging differential diagnosis Background: Pheochromocytoma, a rare catecholamine-secreting tumor, often presents with paroxysmal or sustained hypertension, tachycardia, headache, and diaphoresis. Timely diagnosis is essential to prevent adverse complications. Less common presentations include pheochromocytoma crisis, with severe neurological and cardiac complications. Case Report: We report a unique case of a 25-year-old woman who initially presented with pheochromocytoma-induced hypertensive encephalopathy and acute coronary syndrome. Echocardiography revealed takotsubo-like cardiomyopathy, and magnetic resonance imaging of the brain revealed posterior reversible encephalopathy syndrome. Initial treatment focused on controlling her blood pressure and supporting cardiac function. Due to her recovering from immediate crisis and absence of further symptoms, the patient refused further follow-up. However, she eventually experienced another episode of hypertensive crisis 2 years later. Subsequent investigations with 24-h urine tests revealed elevated vanillylmandelic acid levels (7.93 mg/24 h), normetanephrine (2638.72 µg/24 h), and nor-metanephrine to creatinine ratio (3546.67) and normal urine metanephrine levels (195.92 µg/24 h) and metanephrine to creatinine ratio (263.33). Contrast-enhanced computed tomography of the abdomen revealed a 4.3 x 3.1 x 4-cm mass in the right adrenal gland. A DOTATATE positron emission tomography scan revealed a 3.9 x 4.3 x 2.7-cm localized right adrenal pheochromocytoma. Biochemical testing and adrenal imaging revealed a previously undiagnosed pheochromocytoma. Following targeted medical therapy and right adrenalectomy, the patient achieved complete resolution of her hypertension and associated symptoms. Conclusions: Our case is a unique simultaneous presentation of posterior reversible encephalopathy syndrome and takotsubo- like cardiomyopathy, highlighting the importance to consider pheochromocytoma in acute neurological and cardiac presentations, even in the absence of typical symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Clear cell sarcoma (CCS) of soft tissue is a rare type of soft tissue sarcoma affecting usually lower extremities in young adults. The main challenges in the management of this disease include difficulties in diagnosis, aggressiveness of the cancer with rapid progression, and inadequate treatment, especially in small centers with few cases. Case Presentation: We present a case of a young woman diagnosed with CCS of soft tissue, stage IV. The patient benefited from a multidisciplinary approach including radiation therapy, surgery, chemotherapy, and targeted therapy with disease progression regardless of the therapeutic act. Despite all the efforts, the patient died from complications overlapping progression of the disease. Conclusion: The rarity of this sarcoma limits the amount of information available on the diagnosis and treatment process. The particularity of this case is the difficulty met in maintaining the disease under control using all the resources available due to lack of compliance of the patient in carrying out amputation at diagnosis, thus modifying the entire treatment algorithm. Targeted therapy showed promising results in the literature, however in our case resulted in an unexpected, rare adverse event aggravating the patient’s condition. In conclusion, patients with CCS should be referred to specialized centers for adequate multidisciplinary management and, if available, inclusion in clinical trials. New agents are needed to improve the survival of these patients. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is known as a transfusion‐related complication with typically favorable prognosis and no report fatalities. Pathological evaluation of PRES is also scarce. Case Report: An 88‐year‐old female with myelodysplastic syndromes (MDS) attended our hospital because of a compression fracture and chronic heart failure with chronic anemia. While her hemoglobin levels improved from 4.6 to 8.0 g/dL and the pleural effusions substantially decreased following six units of red blood cell transfusion and diuretic therapy, a gradual decline in cognitive function and speech reduction was noted. PRES was diagnosed by magnetic resonance imaging of the head. Despite treatment of intensive supportive care, the patient fell into a coma by the 20th day and passed away on the 22nd day. Although the pathophysiological link between blood‐transfusion‐related PRES and its impact on survival is not fully understood, autopsy findings confirmed the diagnosis of PRES and revealed multiple cerebral hemorrhages that were not detected in earlier imaging studies. Conclusion: This case highlights the importance of vigilant monitoring and management of PRES, especially in high‐risk populations such as elderly patients with multiple comorbidities or those with thrombocytopenia. Further studies are needed to elucidate the mechanisms of PRES in patients with hematologic diseases. [ABSTRACT FROM AUTHOR]

This document provides information on the approach to acute atraumatic vision loss in the emergency department. It emphasizes the importance of a thorough history and physical exam in diagnosing emergent vision-threatening emergencies. The document discusses various diagnostic methods, including point-of-care ultrasound, and highlights the importance of preserving and restoring vision. It also discusses the initial management and pharmacologic considerations for vision-threatening conditions, with a focus on prompt intervention and consultation with ophthalmologists. The document provides strategies for emergency management, medications for lowering intraocular pressure, and considerations for special populations. The goal is to preserve vision and prevent long-term visual impairment. [Extracted from the article]

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition associated with different etiologies, including antibiotic therapy. To date, most data regarding antibiotic-related PRES are limited to case reports and small case series. Here, we report a novel case description and provide a systematic review of the clinico-radiological characteristics and prognosis of available cases of PRES associated with antibiotic therapy. We performed a systematic literature search in PubMed and Scopus from inception to 10 January 2024, following PRISMA guidelines and a predefined protocol. The database search yielded 12 subjects (including our case). We described the case of a 55-year-old female patient with PRES occurring one day after administration of metronidazole and showing elevated serum neurofilament light chain protein levels and favorable outcome. In our systematic review, antibiotic-associated PRES was more frequent in female patients (83.3%). Metronidazole and fluoroquinolones were the most reported antibiotics (33.3% each). Clinical and radiological features were comparable to those of PRES due to other causes. Regarding the prognosis, about one third of the cases were admitted to the intensive care unit, but almost all subjects (90.0%) had a complete or almost complete clinical and radiological recovery after prompt cessation of the causative drug. Antibiotic-associated PRES appears to share most of the characteristics of classic PRES. Given the overall good prognosis of the disease, it is important to promptly diagnose antibiotic-associated PRES and discontinue the causative drug. [ABSTRACT FROM AUTHOR]

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a well-recognized serious complication of hematopoietic stem cell transplantation (HSCT). The understanding of TA-TMA pathophysiology has expanded in recent years. Dysregulation of the complement system is thought to cause endothelial injury and, consequently, microvascular thrombosis and tissue damage. TA-TMA can affect multiple organs, and each organ exhibits specific features of injury. Central nervous system (CNS) manifestations of TA-TMA include posterior reversible encephalopathy syndrome, seizures, and encephalopathy. The development of neurological dysfunction is associated with a significantly lower overall survival in patients with TA-TMA. However, there are currently no established histopathological or radiological criteria for the diagnosis of CNS TMA. Patients who receive total body irradiation (TBI), calcineurin inhibitors (CNI), and severe acute and chronic graft-versus-host disease (GVHD) are at a high risk of experiencing neurological complications related to TA-TMA and should be considered for directed TA-TMA therapy. However, the incidence and clinical manifestations of TA-TMA neurotoxicity remain unclear. Studies specifically examining the involvement of CNS in TMA syndromes are limited. In this review, we discuss clinical manifestations and imaging abnormalities in patients with nervous system involvement in TA-TMA. We summarize the mechanisms underlying TA-TMA and its neurological complications, including endothelial injury, evidence of complement activation, and treatment options for TA-TMA. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a disease rarely described in older adults. It is characterized by subacute onset of a set of clinical and radiological signs and a variety of neurological symptoms, such as headaches, seizures, and cognitive disorders. In the vast majority of patients, clinical presentation includes high blood pressure and hypertensive emergency. Magnetic resonance imaging (MRI) is the gold standard for diagnosing this condition using imaging findings. When the underlying cause is promptly recognized and treated, symptoms and imaging abnormalities may be completely reversible. The authors report the clinical case of an 87-year-old woman first admitted for treatment of community-acquired pneumonia. She returned to the emergency department 24 hours after discharge presenting with complex visual and neurological symptoms. An MRI scan showed lesions of bilateral occipital hypodensities, suggestive of vasogenic edema and compatible with PRES. Complete regression of brain lesions was observed after tight control of hypertension.

Cannabinoid use, particularly for recreational purposes, is increasing exponentially across all age groups, especially in younger populations, due to its perceived low risk and legalization. While cannabinoids may be largely considered as safe, there is mounting evidence of increased risk of systemic and neurological complications through their interaction with the poorly understood endocannabinoid receptor network within the central nervous system and other organ systems. Acute cannabinoid exposure can cause neuropsychiatric symptoms in addition to altering cerebral blood flow, leading to cerebrovascular complications such as ischemic stroke, subarachnoid hemorrhage, and reversible cerebral vasoconstriction syndrome (RCVS). Chronic use, particularly among adolescents, may be associated with increased risk of long-term cognitive deficits, schizophrenia, and other neuropsychiatric effects. Synthetic cannabinoids have increased potency, with reports of causing profound neurological complications including coma, seizures, posterior reversible encephalopathy syndrome, and RCVS. Despite increasing evidence, the quality of literature describing neurologic complications with cannabinoids remains limited to case series and retrospective cohort studies, with significant confounding factors such as concomitant use of other illicit drugs, limiting interpretation. In this review, we summarize the effect of cannabinoids on the neurologic system and associated neurological complications. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by cerebral blood flow dysregulation and the blood–brain barrier (BBB) disruption. While renal insufficiency has been considered a factor in BBB fragility, the relationship between renal insufficiency and the PRES lesions volume remains unclear. Methods: This observational study was performed retrospectively. PRES patients were categorized into two groups with renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 on the day of symptom occurrence. Lesion volume was measured using fluid-attenuated inversion recovery (FLAIR) imaging, and the brain was divided into nine regions. The volume of the parietal-occipital-temporal lobe was considered typical, while the other six regions were labeled as atypical. Results: The study included 200 patients, of whom 94 (47%) had renal insufficiency. Patients with renal insufficiency had a larger lesion volume (144.7 ± 125.2 cc) compared to those without renal insufficiency (110.5 ± 93.2 cc; p = 0.032); particularly in the atypical lesions volume (49.2 ± 65.0 vs. 29.2 ± 44.3 cc; p = 0.013). However, there was no difference in the reversibility of the lesions (35.2 ± 67.5 vs. 18.8 ± 33.4 cc; p = 0.129). Multiple regression analysis revealed that decreases in eGFR (β = -0.34, 95% CI -0.62-0.05, p = 0.020) were positively associated with total lesion volume. Conclusion: Our findings suggest that PRES patients with renal insufficiency experience more severe lesion volumes, likely due to the atypical brain regions involvement. The lesions involving atypical regions may have a similar pathophysiology to typical lesions, as the PRES lesions reversibility was found to be similar between individuals with and without renal insufficiency. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Patterns and utility of myelin oligodendrocyte glycoprotein (MOG) antibody testing in cerebrospinal fluid" published in the Journal of Neurology. The correction addresses errors in the original article, including misinformed information about CSF MOG antibody testing and a small error in reporting CSF MOG values. The corrections do not change the meaning, data, or interpretation of the results. The given text appears to be a table showing different neurological conditions and their corresponding number of cases. The conditions listed include primary psychiatric, movement disorder, peripheral nerve, neurosarcoidosis, CNS vasculitis, brain cancer/tumor, vision other, inflammatory brain disorder, idiopathic intracranial hypertension, seizure disorder, systemic lupus Erythematosus, PRES, normal, and other/unknown. The table also includes information about CSF MOG staining and immunotherapy timing for certain patients. The article discusses the use of various immunotherapies for the treatment of MOG antibody-associated disorders (MOGAD). It highlights the challenges in interpreting weakly positive titers as a reliable diagnostic tool for MOGAD. The study found that in their current research, 4 out of 5 cerebrospinal fluid (CSF) MOG staining results were weak, suggesting the need for further investigation into the diagnostic criteria for MOGAD. The authors provide valuable insights into the limitations and [Extracted from the article]

Key Clinical Message: Early screening and management of postpartum posterior reversible encephalopathy syndrome (PRES) can reduce hospital stay and complications. Obstetricians, gynecologists, ophthalmologists, and even general physicians should be aware of PRES since its presentation is variable. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Posterior Reversible Encephalopathy Syndrome, typically characterized by parieto‐occipital vasogenic edema, can present atypically, as a bilateral symmetrical vasogenic edema in the basal ganglia, featuring the called "lentiform fork sign." Prompt recognition of such variations is crucial for accurate diagnosis and tailored management, highlighting the complexity of this syndrome's manifestations. Posterior Reversible Encephalopathy Syndrome (PRES) manifests as transient neurological symptoms and cerebral edema, commonly associated with immunosuppressive drugs (ISDs) in transplant recipients. ISDs can lead to endothelial dysfunction and compromise the blood–brain barrier. Typically, PRES exhibits identifiable MRI patterns, often demonstrating vasogenic edema in the bilateral parieto‐occipital white matter. Identifying unique presentations, such as the recently observed "lentiform fork sign," commonly seen in uremic encephalopathy, emphasizes this syndrome's broad spectrum manifestations. A 19‐year‐old male, who underwent bilateral lung and liver transplantation, experienced a bilateral tonic–clonic seizure of unknown onset 47 days post‐surgery. MRI findings revealed an unconventional PRES pattern, featuring the "lentiform fork sign" as bilateral symmetrical vasogenic edema in the basal ganglia, surrounded by a hyperintense rim outlining the lentiform nucleus bilaterally. Subsequent management, including ISD modification and magnesium supplementation, resulted in clinical and neuroimaging resolution. An almost complete clinical and radiological resolution was achieved after 14 days. The occurrence of PRES in transplant recipients highlights the intricate interplay among ISDs, physiological factors, and cerebrovascular dynamics, potentially involving direct neurovascular endothelial toxicity and disruption of the blood–brain barrier. Neuroimaging plays a pivotal role in diagnosis. The distinctive "lentiform fork sign" was observed in this patient despite the absence of typical metabolic disturbances. Management strategies usually involve reducing hypertension, discontinuing ISDs, correcting electrolyte imbalances, and initiating antiseizure drugs if necessary. Identifying the presence of the "lentiform fork sign" alongside typical PRES edema in a patient lacking renal failure emphasizes that this manifestation is not solely indicative of uremic encephalopathy. Instead, it might represent the final common pathway resulting from alterations in the blood–brain barrier integrity within the deep white matter. Understanding such atypical imaging manifestations could significantly aid earlier and more precise diagnosis, influencing appropriate management decisions. [ABSTRACT FROM AUTHOR]

In this article, we describe a novel case of SARS‐CoV‐2‐associated‐hemophagocytic lymphohistiocytosis (HLH) complicated by posterior reversible encephalopathy syndrome (PRES). Initially diagnosed with multisystem inflammatory response in children (MIS‐C), the patient received a large corticosteroid dose days before the onset of neurological symptoms. After developing PRES, the patient was treated with antihypertensives, antiepileptics, dexamethasone, and anakinra, leading to neurologic normalization. We propose that given the challenging diagnostic picture of PRES developing in patients with HLH or MIS‐C, institutionalized standards for blood pressure management during corticosteroid induction may significantly improve outcomes in patients being treated for hyperinflammatory syndromes who develop neurological symptoms. [ABSTRACT FROM AUTHOR]

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This letter to the editor discusses a case of posterior reversible encephalopathy syndrome (PRES) in an elderly patient with advanced classical Hodgkin Lymphoma during frontline treatment with brentuximab vedotin plus AVD. The patient experienced adverse events during treatment and developed symptoms of PRES, which were confirmed through assessments and brain MRI scans. The patient's symptoms improved after discontinuing brentuximab vedotin and completing the remaining cycles of AVD. The authors suggest that the drug combination may have contributed to the development of PRES and emphasize the importance of clinicians being aware of this potential adverse event. Further research is needed to identify risk factors and preventive measures. [Extracted from the article]

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome, clinically present by impaired consciousness, headache, visual disturbances, and seizures, and radiologically brain edema. Cases of PRES induced by blood transfusion are rarely documented. We report this case to increase the awareness of treating physicians for the possible complications of rapid blood transfusion. A 29-year-old man presented with polytrauma and was in hemorrhagic shock. He was transfused with multiple transfusions. Later, he was found to have quadriplegia with minimal movement of fingers in the left hand. His computed tomography showed cerebral edema in multiple cerebral regions. We propose that the etiology in this case is that rapid blood transfusion induced acute rise in hemoglobin which led to PRES. The influences of blood transfusion on blood flow, blood viscosity, and endothelial dysfunction lead to blood-brain barrier dysfunction, which can result in PRES. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) is an autoimmune disorder characterized by demyelination of peripheral nerves. GBS-associated posterior reversible encephalopathy syndrome (PRES) is a rare and potentially life-threatening complication in the pediatric population. We aimed to report and analyze the clinical features, management, and outcomes of three cases of GBS-associated PRES in our setting in the light of the existing literature. Medical records of 75 pediatric patients with GBS were reviewed for autonomic changes and GBS-associated PRES. Thirty-one developed dysautonomia while three were identified to have PRES. Clinical, radiological, laboratory, and treatment data were collected and analyzed. All three patients were male and presented with symptoms of acute flaccid paralysis and respiratory distress requiring mechanical ventilation. All three patients experienced various complications, including hypertension, seizures, and hyponatremia, and were subsequently diagnosed with PRES. Multimodal intensive care resulted in patient improvement and discharge in an ambulatory state after an average of 104 days of care. GBS-associated PRES is a rare and potentially life-threatening complication that can occur in pediatric patients with GBS. Our findings suggest that early recognition, prompt intervention, and multimodal intensive care can improve patient outcomes. Further studies are needed to determine optimal treatment strategies for GBS-associated PRES. [ABSTRACT FROM AUTHOR]

Neuroblastoma is a common pediatric tumor arising from the post-ganglionic sympathetic nervous system and is associated with hypertension in 25% of cases. We describe an unusual case of labile, multi-drug resistant hypertension associated with chemotherapy administration for neuroblastoma and provide potential management strategies in this scenario. We report the case of a 4-year-old female with a history of headaches who presented with hypertensive emergency and evidence of end-organ damage, including posterior reversible encephalopathy syndrome, acute cerebral infarct, concentric left ventricular hypertrophy, and growth failure secondary to a large, abdominal catecholamine-secreting neuroblastoma, which compressed the kidney vasculature and inferior vena cava. She was classified as intermediate risk according to Children's Oncology Group criteria and underwent chemotherapy, complicated by labile hypertension, followed by surgical resection. Vigilance in monitoring and treatment of hypertension is recommended during chemotherapy for neuroblastoma due to the potential catecholamine release in the setting of tumor lysis. [ABSTRACT FROM AUTHOR]

Objectives: Posterior reversible encephalopathy syndrome (PRES) is a clinic radiological disorder characterized by headache, epileptic seizure, encephalopathy, visual impairment, and focal neurological deficits. Gestational hypertension, which is a significant risk factor for PRES, may cause significant morbidity and mortality among pregnant women. Design: Twenty-four patients with PRES caused by eclampsia who were admitted to our hospital in the last 5 years were included in this study. Participants/Materials, Setting, Methods: Blood pressure at admission, the number of regions with vasogenic edema in the brain, and recurrent seizures were noted. Patients were divided into three groups: mild, moderate, and severe. Results: Using Kruskal-Wallis and Pearson χ2 tests, there was no statistical significance between the groups in terms of cranial involvement (p = 0.471). However, binary logistic regression analysis showed that seizure recurrence increased in correlation with blood pressure (p = 0.04). Limitations: PRES is a rare syndrome associated with several etiologies. In our study, only patients with PRES due to eclampsia were included. Therefore, the number of included patients was limited (24 participants). Conclusion: PRES may occur in eclamptic patients with mild, moderate, or severe blood pressure values. Evaluation by magnetic resonance imaging is needed to confirm the diagnosis. Early and rapid treatment is essential for reducing morbidity and mortality among pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: Tacrolimus-associated neurotoxicity (TAN) manifests with wide clinical spectrum, ranging from mild tremors to severe encephalopathy. The isolated involvement of the brainstem is a rarely documented presentation of TAN, and its clinical and diagnostic characteristics are unclear. Methods: We report two cases of brainstem-isolated TAN (bi-TAN). Moreover, we performed a systematic review of the literature on bi-TAN and extracted data concerning demographics, clinical characteristics, radiological features, and management. The systematic literature search followed PRISMA guidelines and a pre-defined protocol. Results: Eleven patients, including our two, were identified (mean age: 41.3 years, ± 18.8; five males, 45%). Speech disturbance was the most common clinical presentation (45%). The mean latency from Tacrolimus initiation to bi-TAN onset was 26 days (± 30.8). Tacrolimus serum level tested above the reference range in three patients (mean: 26.83 ± 5.48). Brain MRI showed T2-FLAIR hyperintensities; three showed restricted diffusion on ADC maps. Neurological symptoms resolved completely in seven patients (63%) after Tacrolimus withdrawal or dose reduction. Conclusions: Our findings suggest that bi-TAN could represent a brainstem variant of posterior reversible encephalopathy syndrome. Recognition of bi-TAN as a potential cause of isolated brainstem lesions is crucial to disentangle the diagnostic work-up and ensure prompt withdrawal or reduction of the offending agent. [ABSTRACT FROM AUTHOR]

Constitutional mismatch repair deficiency (CMMRD) is a rare childhood cancer predisposition syndrome that results from biallelic germline mutations in one of the four MMR genes, MLH1, MSH2, MSH6, or PMS2. This syndrome is characterized by a broad spectrum of early-onset malignancies, including hematologic malignancies, colorectal malignancies, brain tumors, and other malignancies. It is common to have more than one malignancy in an individual diagnosed with CMMRD. In addition to malignancies, primary immunodeficiency in the form of low or absent immunoglobulin levels can also be seen in CMMRD. Congenital abnormalities such as agenesis of the corpus callosum (ACC), cavernous hemangioma, and other non-neoplastic diseases can also be linked to it. In this case report, we discussed the case of a girl born out of consanguineous marriage initially identified as having T-cell acute lymphoblastic lymphoma and later found to have selective immunoglobulin A (IgA) deficiency. Her younger sibling with a pontine cavernous hemangioma was also diagnosed with lymphoma. The girl exhibited brain lesions on magnetic resonance imaging (MRI), which were initially diagnosed as posterior reversible encephalopathy syndrome (PRES) related changes; however, one of the lesions persisted and remained stable over a period of 2 years and more in favor of diffuse glioma. The younger sibling also showed a solitary lesion in the brain. Based on the clinical and radiological findings, a diagnosis of CMMRD was suspected. Next-generation sequence (NGS) analysis of her blood sample was done. The results showed a homozygous mutation in the MSH6 gene was diagnostic of CMMRD. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 51-year-old woman who presented to the emergency department with a sudden, severe headache. Topics include her medical history, examination findings, and diagnostic imaging results. The patient's history, examination, and imaging were consistent with a subarachnoid hemorrhage.

This document is a collection of abstracts from the European Journal of Neurology, covering a wide range of topics related to neurology and neurological disorders. The abstracts provide brief overviews of various research studies, case reports, and presentations, highlighting the objectives and findings of each. The topics covered include stroke, epilepsy, multiple sclerosis, Parkinson's disease, and various other neurological conditions. The abstracts come from researchers around the world, showcasing the global nature of neurology research. [Extracted from the article]

This letter describes a case of glial fibrillary acidic protein astrocytopathy (GFAP-A), an autoimmune disease that affects the central nervous system. The patient presented with symptoms such as headache, confusion, and seizure, and was diagnosed with GFAP-A based on the presence of GFAP antibodies in the cerebrospinal fluid and serum. The imaging findings showed linear enhancement in the white matter, which is a characteristic feature of GFAP-A. Additionally, the patient exhibited diffusion restriction on diffusion-weighted imaging (DWI), which is a rare finding in GFAP-A. The patient responded well to treatment with intravenous immunoglobulin (IVIg) and corticosteroids. The diffusion restriction on DWI could be attributed to either inflammation caused by GFAP-A or complications associated with IVIg therapy. Overall, this case highlights the unique presentation of GFAP-A and the potential complications of treatment. [Extracted from the article]

This article discusses a case study of a patient with intravascular large B-cell lymphoma (IVLBCL) who developed reversible cerebral vasoconstriction syndrome (RCVS) after receiving immunochemotherapy. IVLBCL is a rare subtype of large B-cell lymphoma that can present with neurological symptoms. The patient experienced sudden blindness and was diagnosed with RCVS based on neurological symptoms and imaging findings. The article explores the potential triggers and pathogenesis of RCVS in IVLBCL patients and highlights the importance of considering RCVS as a differential diagnosis in these cases. Treatment with nimodipine and continuation of immunochemotherapy resulted in the resolution of symptoms and improvement in vision. [Extracted from the article]

The article discusses a case study of a 33-year-old male with Hashimoto's Thyroiditis who presented with acute cerebral infarction and reversible posterior encephalopathy syndrome. The patient had a history of hyperthyroidism and diabetes, and imaging showed brain abnormalities consistent with both conditions. Treatment included antiplatelet therapy, glycemic control, and thyroid regulation, leading to gradual improvement. The case highlights the importance of early recognition and intervention in patients with neurological deficits and thyroid dysfunction. [Extracted from the article]

Iodine-based contrast media (ICM) are commonly used in medical imaging to enhance visibility during CT scans and angiographic procedures. However, their use may be linked to a rare adverse reaction called Iodine-based contrast medium-induced Posterior Reversible Encephalopathy Syndrome (PRES). PRES is a reversible neurological condition characterized by brain swelling. There is also overlap between PRES and Contrast-Induced Encephalopathy (CIE), another rare adverse reaction to ICM. The pathophysiology of both conditions involves disruption of the blood-brain barrier and impaired cerebral autoregulation. It is important for healthcare professionals to be vigilant in identifying symptoms and to conduct comprehensive medical histories for patients at risk. Further research is needed to understand the mechanisms and risk factors associated with these conditions. [Extracted from the article]

Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular dysregulation. To our knowledge, we present the first case of lenalidomide‐induced PRES in English. A 59‐year‐old woman with history of multiple myeloma status post stem cell transplant and induction triple therapy 6 months ago with partial remission and subsequent high‐dose melphalan 1 month ago presented with progressive vision loss for 1 week. Her systolic blood pressure was >180 mmHg, and neurological examination demonstrated decreased vision bilaterally. Brain MRI revealed significant T2 hyperintensity restricted to temporal and occipital lobes and left occipital parenchymal hemorrhage and diffuse leptomeningeal enhancement. She had a witnessed generalized tonic–clonic seizure and EEG that captured an electrographic seizure originating from the occipital lobe. Her vision improved rapidly after discontinuing the lenalidomide. She was discharged to rehab with a normal neurological examination. We report the first English case of presumed lenalidomide induced PRES in a patient undergoing multiple myeloma treatment. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) may cause ischaemic stroke and intracranial haemorrhage. The aim of our study was to assess the frequency of the afore‐mentioned outcomes. Methods: We performed a PROSPERO‐registered (CRD42022355704) systematic review and meta‐analysis accessing PubMed until 7 November 2022. The inclusion criteria were: (1) original publication, (2) adult patients (≥18 years), (3) enrolling patients with PRES and/or RCVS, (4) English language and (5) outcome information. Outcomes were frequency of (1) ischaemic stroke and (2) intracranial haemorrhage, divided into subarachnoid haemorrhage (SAH) and intraparenchymal haemorrhage (IPH). The Cochrane Risk of Bias tool was used. Results: We identified 848 studies and included 48 relevant studies after reviewing titles, abstracts and full text. We found 11 studies on RCVS (unselected patients), reporting on 2746 patients. Among the patients analysed, 15.9% (95% CI 9.6%–23.4%) had ischaemic stroke and 22.1% (95% CI 10%–39.6%) had intracranial haemorrhage. A further 20.3% (95% CI 11.2%–31.2%) had SAH and 6.7% (95% CI 3.6%–10.7%) had IPH. Furthermore, we found 28 studies on PRES (unselected patients), reporting on 1385 patients. Among the patients analysed, 11.2% (95% CI 7.9%–15%) had ischaemic stroke and 16.1% (95% CI 12.3%–20.3%) had intracranial haemorrhage. Further, 7% (95% CI 4.7%–9.9%) had SAH and 9.7% (95% CI 5.4%–15%) had IPH. Conclusions: Intracranial haemorrhage and ischaemic stroke are common outcomes in PRES and RCVS. The frequency reported in the individual studies varied considerably. [ABSTRACT FROM AUTHOR]

Tacrolimus, a calcineurin inhibitor, is an immunosuppressant used globally to prevent rejection after organ transplantation. Although it significantly improves outcomes for solid organ transplant patients, it is associated with various side effects such as nephrotoxicity and neurotoxicity. Tacrolimus-induced neurotoxicity is frequently encountered in clinical practice and can present with a variety of symptoms that may occur even at therapeutic levels. Although tacrolimus-induced neurotoxicity is well documented, there is limited literature available on pharmacologic management. Twenty-eight case reports of tacrolimus-induced neurotoxicity were identified and analyzed in addition to other literature including reviews, retrospective studies, and animal model studies. The severity of cases of tacrolimus-induced neurotoxicity reported ranged from mild symptoms that could be managed with symptomatic treatment to conditions such as posterior reversible encephalopathy syndrome and chronic inflammatory demyelinating polyradiculoneuropathy that may require more immediate intervention. This information was utilized in addition to clinical experience to compile potential management options for prevention and treatment of neurotoxic adverse events. This review is limited by the utilization of primarily retrospective studies and case reports. The available literature on the subject is largely narrative and there are no guidelines on treatment of tacrolimus-induced neurotoxicity at the time of this research. This comprehensive review may guide further studies to investigate the pathophysiology of tacrolimus-induced neurotoxicity and to define patient-specific strategies for mitigation or minimization of neurotoxicity. This is especially important given that management of tacrolimus-induced neurotoxicity can include changes to immunosuppression that can result in an increased risk of rejection. [ABSTRACT FROM AUTHOR]

This letter published in the Journal of Neurology discusses a case of posterior reversible encephalopathy syndrome (PRES) in a multiple sclerosis (MS) patient treated with interferonβ1a (INFβ1a). PRES is a clinical syndrome characterized by various symptoms and can be caused by different factors, including certain medications. The case described in the letter involved a 34-year-old woman with MS who developed PRES along with malignant hypertension. The patient's condition improved after discontinuing INF therapy and receiving antihypertensive treatment. The letter also discusses the relationship between PRES and immune-modulatory drugs used to treat MS. [Extracted from the article]

This article discusses a rare case of a 10-year-old girl with posterior reversible encephalopathy syndrome (PRES) and associated periodic lateralized epileptiform discharges (PLEDs). PRES is a neurological disorder characterized by sudden onset of symptoms such as headache, altered consciousness, seizures, and visual impairments. The underlying cause of PRES is typically endothelial dysfunction triggered by various factors. Electroencephalography (EEG) plays a crucial role in evaluating encephalopathy and identifying nonconvulsive status epilepticus in patients with PRES. The article provides a comprehensive review of the existing literature on PRES-associated PLEDs. [Extracted from the article]

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare acute or subacute clinicoradiologic disorder. Systemic lupus erythematosus (SLE) is associated with irreversibility, recurrence, and poor prognosis of PRES. Delayed treatment of PRES in SLE can lead to significant neurological deficits and mortality. Objective: To collect case series of SLE patients with PRES treated in Nongkhai Hospital between 2012 and 2023 and compare with other studies. Materials and Methods: The medical records of SLE patients with PRES were reviewed and collected. The following information were obtained, gender, occupation, age at SLE diagnosis, age of onset, duration of disease, comorbid or risks, SLE disease activity, glucocorticoids, and immunosuppressants administered before or at diagnosis, clinical presentations, laboratory data, neuroimaging, treatments, complications, length of stay, and outcomes. Results: Six hundred eleven patients with SLE were identified. Five patients developed PRES. All patients received prednisone with a mean dose of 26.0 (SD 10.4) mg/day before the onset of PRES. Seizures were displayed by all patients. The mean systolic blood pressure was 163.4 (SD 6.3) mmHg. The occipital lobe was the most common brain lesion. Lupus nephritis was observed in all patients. Three of five patients needed intubation and were admitted for closed monitoring in the intensive care unit (ICU). The most common complications during admission were infections, especially sepsis. All patients recovered completely. Conclusion: The present study suggested that SLE patients with hypertension presenting with seizures and high systolic blood pressure along with a history of moderate to high dose steroids and/or immunosuppressants should always be suspected of PRES. Meanwhile, computerized tomography (CT) and/or magnetic resonance imaging (MRI) brain are the most important tools to establish an early diagnosis. Individualized treatment should be based on clinical presentations, and disease activity evaluation, especially lupus nephritis. Accordingly, sepsis prevention, and ICU admission in severe cases are crucial for a favorable outcome. [ABSTRACT FROM AUTHOR]

This study describes the profile of children diagnosed with posterior reversible encephalopathy syndrome (PRES) in the pediatric hematology oncology unit and highlights the clinical features of PRES in immunosuppressed children. This retrospective study included 10 children diagnosed with PRES with a mean age of 6.8 years. Acute lymphoblastic leukemia was the most common primary diagnosis followed by post-hematopoietic stem cell transplant patients. Most cases of PRES occurred within one month of treatment initiation. Hypertension was noted in all at the time of diagnosis. Neuroimaging revealed bilateral lesions with parietal and occipital lobe involvement being the most common. All patients received corticosteroids as part of treatment for primary diagnosis. Controlling blood pressure was critical in managing PRES. Consideration of PRES as a clinical possibility in pediatric hematology oncology unit in children presenting with symptoms such as headache, seizures, and visual disturbances will aid in early diagnosis after ruling out other causes of these symptoms. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of delayed post-ischemic leukoencephalopathy (DPIL) associated with infective endocarditis. DPIL is a complication that can occur after successful recanalization of a cerebral artery occlusion and can cause aphasia, dementia, and motor impairment. The article presents a case study of a 65-year-old patient who experienced DPIL following mechanical thrombectomy. The patient's symptoms improved initially but worsened over time, and MRI revealed expanding leukoencephalopathy. The article discusses the possible mechanisms underlying DPIL and suggests that careful monitoring and follow-up MRI are necessary after successful recanalization. Treatment approaches for DPIL are still being investigated. [Extracted from the article]