Diabetic ketoacidosis-induced posterior reversible encephalopathy syndrome (PRES)
Updates to Case Attributes
The patient presented with neurological deficits and was found to have hypernatraemia and diabetic ketoacidosis, with urinary tract infection.
The brain CT scan showed no definite features of brain pathology.
The first MRI study was suggestive of early changes of diabetic ketoacidosis-associated ischaemia or extrapontine myelinolysis, or an intervening event of hypoglycaemia, which could be reversible changes.
After about a week, the patient developed new neurological deficits, including vision loss, tonic-clonic convulsions, and quadriparesis.
Another MRI and an MRV study revealed vasogenic oedema mainly involving the posterior cerebral hemispheres (areas of almost symmetrical posterior vascular territories) without restricted diffusion or venous sinus thrombosis, typical and likely suggestive of posterior reversible encephalopathy syndrome. This study also demonstrates multiple T2W/FLAIR sequences hyperintense variable-sized foci, mainly subcortical cerebral bilaterally, which could be related to previous study changes or new changes.
The condition clinically exhibited marked progressive improvement in the next few days and was planned for follow-up.
Meanwhile Meanwhile, the likely diagnosis is diabetic ketoacidosis induced posterior reversible encephalopathy syndrome.
-<p>The patient presented with neurological deficits and was found to have hypernatraemia and <a title="Diabetic ketoacidosis" href="/articles/diabetic-ketoacidosis">diabetic ketoacidosis</a>, with <a title="Urinary tract infection" href="/articles/urinary-tract-infection">urinary tract infection</a>.</p><p>The brain CT scan showed no definite features of brain pathology.</p><p>The first MRI study was suggestive of early changes of diabetic ketoacidosis-associated ischaemia or extrapontine myelinolysis, or an intervening event of hypoglycaemia, which could be reversible changes.</p><p>After about a week, the patient developed new neurological deficits, including vision loss, tonic-clonic convulsions, and quadriparesis.</p><p>Another MRI and an MRV study revealed vasogenic oedema mainly involving the posterior cerebral hemispheres (areas of almost symmetrical posterior vascular territories) without restricted diffusion or <a title="Dural venous sinus thrombosis" href="/articles/dural-venous-sinus-thrombosis">venous sinus thrombosis</a>, typical and likely suggestive of <a title="Posterior reversible encephalopathy syndrome" href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome</a>. This study also demonstrates multiple T2W/FLAIR sequences hyperintense variable-sized foci, mainly subcortical cerebral bilaterally, which could be related to previous study changes or new changes.</p><p>The condition clinically exhibited marked progressive improvement in the next few days and was planned for follow-up. </p><p>Meanwhile, the likely diagnosis is diabetic ketoacidosis induced posterior <a title="Posterior reversible encephalopathy syndrome" href="/articles/posterior-reversible-encephalopathy-syndrome-1">reversible encephalopathy syndrome</a>.</p><p> </p>- +<p>The patient presented with neurological deficits and was found to have hypernatraemia and <a href="/articles/diabetic-ketoacidosis">diabetic ketoacidosis</a>, with <a href="/articles/urinary-tract-infection">urinary tract infection</a>.</p><p>The brain CT scan showed no definite features of brain pathology.</p><p>The first MRI study was suggestive of early changes of diabetic ketoacidosis-associated ischaemia or extrapontine myelinolysis, or an intervening event of hypoglycaemia, which could be reversible changes.</p><p>After about a week, the patient developed new neurological deficits, including vision loss, tonic-clonic convulsions, and quadriparesis.</p><p>Another MRI and an MRV study revealed vasogenic oedema mainly involving the posterior cerebral hemispheres (areas of almost symmetrical posterior vascular territories) without restricted diffusion or <a href="/articles/dural-venous-sinus-thrombosis">venous sinus thrombosis</a>, typical and likely suggestive of <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome</a>. This study also demonstrates multiple T2W/FLAIR sequences hyperintense variable-sized foci, mainly subcortical cerebral bilaterally, which could be related to previous study changes or new changes.</p><p>The condition clinically exhibited marked progressive improvement in the next few days and was planned for follow-up. Meanwhile, the likely diagnosis is diabetic ketoacidosis induced posterior <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">reversible encephalopathy syndrome</a>.</p>
Tags changed:
- dka
- diabetes
- endocine
Systems changed:
- Paediatrics
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