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, 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 suggestive of posterior reversible encephalopathy syndrome (PRES). This study also demonstrates multiple T2W/FLAIR hyperintense variable-sized foci, mainly subcortical cerebral bilaterally, which could be related to changes seen on the previous study or new changes.
The condition clinically exhibited marked progressive improvement in the next few days and was planned for follow-up. Meanwhile, the likely diagnosis is diabetic ketoacidosi- induced ketoacidosis-induced posterior reversible encephalopathy syndrome.
-<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 <a title="Diabetic ketoacidosis" href="/articles/diabetic-ketoacidosis">diabetic ketoacidosis</a>-associated ischaemia or <a title="Extrapontine myelinolysis" href="/articles/extrapontine-myelinolysis-1">extrapontine myelinolysis</a>, or an intervening event of <a title="Hypoglycaemia" href="/articles/hypoglycaemia">hypoglycaemia</a>, 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 suggestive of <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome</a>. This study also demonstrates multiple T2W/FLAIR hyperintense variable-sized foci, mainly subcortical cerebral bilaterally, which could be related to changes seen on the previous study 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 ketoacidosi- induced posterior <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">reversible encephalopathy syndrome</a>.</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 <a href="/articles/diabetic-ketoacidosis">diabetic ketoacidosis</a>-associated ischaemia, <a href="/articles/extrapontine-myelinolysis-1">extrapontine myelinolysis</a>, or an intervening event of <a href="/articles/hypoglycaemia">hypoglycaemia</a>, 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 suggestive of <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome (PRES)</a>. This study also demonstrates multiple T2W/FLAIR hyperintense variable-sized foci, mainly subcortical cerebral bilaterally, which could be related to changes seen on the previous study 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 <a title="Posterior reversible encephalopathy syndrome" href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome</a>.</p>
Updates to Freetext Attributes
The patient was extubated and later on developed vision loss, tonic-clonic convulsions, and quadriparesis after about a week. Another MRI and MRV study was done.
Unable to process the form. Check for errors and try again.