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Posterior Reversible Encephalopathy Syndrome In Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports Bérenger Largeau, David Boels, Caroline Victorri-Vigneau, Clara Cohen, Charlotte Salmon Gandonnière, Stephan Ehrmann To cite this version: Bérenger Largeau, David Boels, Caroline Victorri-Vigneau, Clara Cohen, Charlotte Salmon Gan- donnière, et al.. Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Sys- tematic Review of Published Case Reports. Frontiers in Neurology, Frontiers, 2020, 10, pp.1420. 10.3389/fneur.2019.01420. hal-02526571 HAL Id: hal-02526571 https://hal.archives-ouvertes.fr/hal-02526571 Submitted on 31 Mar 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. SYSTEMATIC REVIEW published: 12 February 2020 doi: 10.3389/fneur.2019.01420 Posterior Reversible Encephalopathy Syndrome in Clinical Toxicology: A Systematic Review of Published Case Reports Bérenger Largeau 1*†, David Boels 2†, Caroline Victorri-Vigneau 3†, Clara Cohen 4†, Charlotte Salmon Gandonnière 5† and Stephan Ehrmann 6† 1 2 Edited by: CHU de Nantes, Service de Pharmacologie Clinique—Centre Régional de Pharmacovigilance, Nantes, France, CHU de Nantes, Service de Pharmacologie Clinique—Unité de Toxicologie Clinique et Toxicosurveillance Médicamenteuse, Nantes, Bo Gao, France, 3 Université de Nantes, Université de Tours, INSERM, Methods in Patients-Centered Outcomes and Health Research Affiliated Hospital of Guizhou Medical (SPHERE)—UMR 1246, CHU de Nantes, Service de Pharmacologie Clinique—Centre d’Évaluation et d’Information sur la University, China Pharmacodépendance et d’Addictovigilance, Nantes, France, 4 Université de Tours, CHRU de Tours, Service de Reviewed by: Neuroradiologie Diagnostique et Interventionnelle, Tours, France, 5 CHRU de Tours, Service de Médecine Intensive Andrea Bink, Réanimation, CIC 1415, réseau CRICS-TRIGGERSEP, Tours, France, 6 Université de Tours, INSERM, Centre d’Étude des University Hospital Zürich, Switzerland Pathologies Respiratoires (CEPR)—UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC 1415, Mehmet Akif Topçuoglu, Réseau CRICS-TRIGGERSEP, Tours, France Hacettepe University, Turkey *Correspondence: Bérenger Largeau Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and [email protected] radiological entity characterized by a typical brain edema. Although several case reports †ORCID: have described PRES in a context of poisoning, to our knowledge, a comprehensive Bérenger Largeau assessment has not been performed. The aim of this systematic review was to raise orcid.org/0000-0002-6824-7283 awareness on poisoning-specific PRES features and to encourage consistent and David Boels orcid.org/0000-0001-5599-9593 detailed reporting of substance abuse–and drug overdose–associated PRES. Caroline Victorri-Vigneau orcid.org/0000-0002-3745-2532 Methods: Medline/PubMed, Web of Science, and PsycINFO were screened through Clara Cohen May 31, 2019, to systematically identify case reports and case series describing PRES orcid.org/0000-0002-8200-2784 associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical Charlotte Salmon Gandonnière orcid.org/0000-0001-7675-9564 substances) in accidental context, intentional overdose, and substance abuse. The Stephan Ehrmann methodological quality of eligible case reports/series was assessed. Patients and orcid.org/0000-0001-6221-4467 exposure characteristics were recorded; relevant toxicological, radiological, and clinical Specialty section: data were extracted. This article was submitted to Results: Forty-one case reports and one case series reporting 42 unique cases were Applied Neuroimaging, a section of the journal included. The median time to PRES onset from the start of exposure was 3 days Frontiers in Neurology (IQR 2–10). Acute high blood pressure, visual disturbance, and seizure were reported Received: 06 July 2019 in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness Accepted: 30 December 2019 Published: 12 February 2020 disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. Citation: One-third of patients had at least one risk factor for PRES such as chronic hypertension Largeau B, Boels D, (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the Victorri-Vigneau C, Cohen C, Salmon combination of classical parieto-occipital edema with another anatomical region (e.g., Gandonnière C and Ehrmann S (2020) Posterior Reversible Encephalopathy frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% Syndrome in Clinical Toxicology: A of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction Systematic Review of Published Case Reports. Front. Neurol. 10:1420. and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. doi: 10.3389/fneur.2019.01420 Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance Frontiers in Neurology | www.frontiersin.org 1 February 2020 | Volume 10 | Article 1420 Largeau et al. PRES in Clinical Toxicology imaging. The median time required to hospital discharge was 14 days (IQR 7–18). Mortality and neurological recurrence rate were null. Conclusions: Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored. Keywords: leukoencephalopathy syndrome, hypertensive encephalopathy, blood–brain barrier, substance abuse, alcohol, poisoning INTRODUCTION In order to investigate the occurrence of PRES in poisoned patients, the authors systematically reviewed the scientific Posterior reversible encephalopathy syndrome (PRES) is a rare literature of case reports and case series concerning PRES radiological and clinical entity characterized by a typical brain associated with poisoning (i.e., alcohol, drugs, illicit drugs, edema and various symptoms such as high blood pressure natural toxins, chemical substances) in accidental context, (75–80%), encephalopathy (50–80%), headache (50%), visual intentional overdose, and substance abuse. The authors did not disturbances (33%), focal neurological deficits (10–15%), include cases of calcineurin inhibitor overexposure, which has seizures (60–75%), and status epilepticus (5–15%) (1). Kidney already been covered (6). The purpose of this study is to raise injury is highly prevalent during PRES (up to 55%), and awareness of the features of PRES in poisoned patients and more than half of patients have chronic hypertension (1). encourage consistent and detailed reporting of PRES in a context PRES can occur in a number of complex clinical conditions, of overdose and substance abuse. classically dichotomized into iatrogenic (e.g., antineoplastic therapy, calcineurin inhibitors) and PRES-associated medical conditions (e.g., eclampsia, sepsis, autoimmune disorders), METHODS requiring mechanical ventilation for 3–7 days in 35–40% of A systematic review was conducted in accordance with the patients (2). Although there is currently no unified diagnostic Preferred Reporting Items for Systematic reviews and Meta- algorithm, neuroimaging usually yields bilateral cortical– Analyses (PRISMA) guidelines (7). subcortical vasogenic edema according to three anatomic patterns: dominant parieto-occipital involvement, variant atypical PRES, and combination of different patterns. Variant Eligibility Criteria atypical PRES gathers superior frontal sulcus, holohemispheric All language case reports and cases series were eligible if they watershed, cerebellum, basal ganglia, brainstem, and spinal concerned human subjects and included full-text. Records were cord involvements (3, 4). The atypical or combined patterns screened if they were explicitly labeled as PRES based on are more common than the typical PRES with isolated head MRI (magnetic resonance imaging) or CT (computed parieto-occipital involvement. tomography) scans. Case reports were included if PRES occurred The pathophysiology of PRES is still debated through in temporal connection with poisoning (i.e., alcohol, drugs, hypoperfusion and hyperperfusion theories. Impaired cerebral illicit drugs, chemical substances, natural toxins) in accidental autoregulation responsible for disruption of the blood– context, intentional overdose, or substance abuse and/or a causal brain barrier (BBB) is one of the two main hypotheses, relationship was assumed by the authors of the report. the other one being endothelial dysfunction (5). A recent review suggests that arginine vasopressin (AVP) axis Data Sources, Search Strategy, and Data stimulation could precipitate PRES development through Extraction an increase in AVP secretion or AVP receptor density. A search using Medline/PubMed,
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