Serotonin Syndrome Presenting as a Posterior Reversible Encephalopathy Syndrome
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a...
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| Veröffentlicht in: | Case reports in neurology Jg. 12; H. 1; S. 63 - 68 |
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01.01.2020
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| Abstract | Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient’s neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage. |
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| AbstractList | Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient's neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage. Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient's neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage.Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient's neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage. |
| Author | Zand, Ramin Malik, Muhammad Taimur Majeed, Mohammad Faraz |
| AuthorAffiliation | Geisinger Health System, Danville, Pennsylvania, USA |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32231545$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1056/NEJM199602223340803 10.1152/ajpheart.00377.2013 10.2214/ajr.159.2.1632361 10.4065/mcp.2009.0590 10.1016/S1474-4422(15)00111-8 10.1038/jcbfm.2014.256 10.1007/s11523-011-0201-x 10.3174/ajnr.A0549 10.1016/j.mehy.2014.02.022 10.1056/NEJMra041867 10.1186/s40064-015-0883-0 10.1093/qjmed/hcr139 10.1093/qjmed/hcg109 10.1002/ana.410330215 10.7461/jcen.2015.17.3.239 10.1097/00005344-200006000-00004 |
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| Keywords | Venlafaxine Adverse reactions Cerebral vasoconstriction Serotonin syndrome Posterior reversible encephalopathy syndrome |
| Language | English |
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| References | Ungvari Z, Pacher P, Koller A. Serotonin reuptake inhibitor fluoxetine decreases arteriolar myogenic tone by reducing smooth muscle [Ca2+]i. J Cardiovasc Pharmacol. 2000Jun;35(6):849–54. 10.1097/00005344-200006000-00004108367170160-2446 Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin M, Lamy C, Mas J, Caplan L. A reversible posterior leukoencephalopathy syndrome.199610.1056/NEJM199602223340803 Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015Sep;14(9):914–25. 10.1016/S1474-4422(15)00111-8261849851474-4422 Tlemsani C, Mir O, Boudou-Rouquette P, Huillard O, Maley K, Ropert S, et al.. Posterior reversible encephalopathy syndrome induced by anti-VEGF agents. Target Oncol. 2011Dec;6(4):253–8. 10.1007/s11523-011-0201-x220902601776-2596 Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al.. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992Aug;159(2):379–83. 10.2214/ajr.159.2.163236116323610361-803X Springo Z, Toth P, Tarantini S, Ashpole NM, Tucsek Z, Sonntag WE, et al.. Aging impairs myogenic adaptation to pulsatile pressure in mouse cerebral arteries. J Cereb Blood Flow Metab. 2015Mar;35(4):527–30. 10.1038/jcbfm.2014.256256052920271-678X Toth P, Csiszar A, Tucsek Z, Sosnowska D, Gautam T, Koller A, et al.. Role of 20-HETE, TRPC channels, and BKCa in dysregulation of pressure-induced Ca2+ signaling and myogenic constriction of cerebral arteries in aged hypertensive mice. Am J Physiol Heart Circ Physiol. 2013a Dec;305(12):H1698–708. 10.1152/ajpheart.00377.2013240974250363-6135 Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010May;85(5):427–32. 10.4065/mcp.2009.0590204358350025-6196 Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol. 1993Feb;33(2):222–5. 10.1002/ana.41033021584348860364-5134 Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005Mar;352(11):1112–20. 10.1056/NEJMra041867157846640028-4793 Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003Sep;96(9):635–42. 10.1093/qjmed/hcg109129257181460-2725 Marra A, Vargas M, Striano P, Del Guercio L, Buonanno P, Servillo G. Posterior reversible encephalopathy syndrome: the endothelial hypotheses. Med Hypotheses. 2014May;82(5):619–22. 10.1016/j.mehy.2014.02.022246137350306-9877 Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007Aug;28(7):1320–7. 10.3174/ajnr.A0549176985350195-6108 Edvardsson B. Venlafaxine as single therapy associated with hypertensive encephalopathy. Springerplus. 2015Feb;4(1):97. 10.1186/s40064-015-0883-0257633072193-1801 Seet RC, Rabinstein AA. Clinical features and outcomes of posterior reversible encephalopathy syndrome following bevacizumab treatment. QJM. 2012Jan;105(1):69–75. 10.1093/qjmed/hcr139218653141460-2725 Kur JK, Esdaile JM. Posterior reversible encephalopathy syndrome—an underrecognized manifestation of systemic lupus erythematosus. J Rheumatol. 2006Nov;33(11):2178–83.169609250315-162X Lee WJ, Yeon JY, Jo KI, Kim JS, Hong SC. Reversible Cerebral Vasoconstriction Syndrome and Posterior Reversible Encephalopathy Syndrome Presenting with Deep Intracerebral Hemorrhage in Young Women. J Cerebrovasc Endovasc Neurosurg. 2015Sep;17(3):239–45. 10.7461/jcen.2015.17.3.239265232592234-8565 ref13 ref12 ref15 ref14 ref11 ref10 ref2 ref1 ref16 ref8 ref7 ref9 ref4 ref3 ref6 ref5 |
| References_xml | – reference: Edvardsson B. Venlafaxine as single therapy associated with hypertensive encephalopathy. Springerplus. 2015Feb;4(1):97. 10.1186/s40064-015-0883-0257633072193-1801 – reference: Ungvari Z, Pacher P, Koller A. Serotonin reuptake inhibitor fluoxetine decreases arteriolar myogenic tone by reducing smooth muscle [Ca2+]i. J Cardiovasc Pharmacol. 2000Jun;35(6):849–54. 10.1097/00005344-200006000-00004108367170160-2446 – reference: Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol. 1993Feb;33(2):222–5. 10.1002/ana.41033021584348860364-5134 – reference: Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005Mar;352(11):1112–20. 10.1056/NEJMra041867157846640028-4793 – reference: Springo Z, Toth P, Tarantini S, Ashpole NM, Tucsek Z, Sonntag WE, et al.. Aging impairs myogenic adaptation to pulsatile pressure in mouse cerebral arteries. J Cereb Blood Flow Metab. 2015Mar;35(4):527–30. 10.1038/jcbfm.2014.256256052920271-678X – reference: Lee WJ, Yeon JY, Jo KI, Kim JS, Hong SC. Reversible Cerebral Vasoconstriction Syndrome and Posterior Reversible Encephalopathy Syndrome Presenting with Deep Intracerebral Hemorrhage in Young Women. J Cerebrovasc Endovasc Neurosurg. 2015Sep;17(3):239–45. 10.7461/jcen.2015.17.3.239265232592234-8565 – reference: Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003Sep;96(9):635–42. 10.1093/qjmed/hcg109129257181460-2725 – reference: Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010May;85(5):427–32. 10.4065/mcp.2009.0590204358350025-6196 – reference: Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015Sep;14(9):914–25. 10.1016/S1474-4422(15)00111-8261849851474-4422 – reference: Marra A, Vargas M, Striano P, Del Guercio L, Buonanno P, Servillo G. Posterior reversible encephalopathy syndrome: the endothelial hypotheses. Med Hypotheses. 2014May;82(5):619–22. 10.1016/j.mehy.2014.02.022246137350306-9877 – reference: Toth P, Csiszar A, Tucsek Z, Sosnowska D, Gautam T, Koller A, et al.. Role of 20-HETE, TRPC channels, and BKCa in dysregulation of pressure-induced Ca2+ signaling and myogenic constriction of cerebral arteries in aged hypertensive mice. Am J Physiol Heart Circ Physiol. 2013a Dec;305(12):H1698–708. 10.1152/ajpheart.00377.2013240974250363-6135 – reference: Seet RC, Rabinstein AA. Clinical features and outcomes of posterior reversible encephalopathy syndrome following bevacizumab treatment. QJM. 2012Jan;105(1):69–75. 10.1093/qjmed/hcr139218653141460-2725 – reference: Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin M, Lamy C, Mas J, Caplan L. A reversible posterior leukoencephalopathy syndrome.199610.1056/NEJM199602223340803 – reference: Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al.. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992Aug;159(2):379–83. 10.2214/ajr.159.2.163236116323610361-803X – reference: Kur JK, Esdaile JM. Posterior reversible encephalopathy syndrome—an underrecognized manifestation of systemic lupus erythematosus. J Rheumatol. 2006Nov;33(11):2178–83.169609250315-162X – reference: Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007Aug;28(7):1320–7. 10.3174/ajnr.A0549176985350195-6108 – reference: Tlemsani C, Mir O, Boudou-Rouquette P, Huillard O, Maley K, Ropert S, et al.. Posterior reversible encephalopathy syndrome induced by anti-VEGF agents. Target Oncol. 2011Dec;6(4):253–8. 10.1007/s11523-011-0201-x220902601776-2596 – ident: ref3 doi: 10.1056/NEJM199602223340803 – ident: ref13 doi: 10.1152/ajpheart.00377.2013 – ident: ref2 doi: 10.2214/ajr.159.2.1632361 – ident: ref8 doi: 10.4065/mcp.2009.0590 – ident: ref1 doi: 10.1016/S1474-4422(15)00111-8 – ident: ref14 doi: 10.1038/jcbfm.2014.256 – ident: ref10 doi: 10.1007/s11523-011-0201-x – ident: ref12 doi: 10.3174/ajnr.A0549 – ident: ref11 doi: 10.1016/j.mehy.2014.02.022 – ident: ref5 doi: 10.1056/NEJMra041867 – ident: ref7 doi: 10.1186/s40064-015-0883-0 – ident: ref9 doi: 10.1093/qjmed/hcr139 – ident: ref6 doi: 10.1093/qjmed/hcg109 – ident: ref4 doi: 10.1002/ana.410330215 – ident: ref16 doi: 10.7461/jcen.2015.17.3.239 – ident: ref15 doi: 10.1097/00005344-200006000-00004 |
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| SubjectTerms | adverse reactions Antibiotics Antidepressants Blood pressure Case reports cerebral vasoconstriction Convulsions & seizures Eclampsia Emergency medical care Headaches Hypertension Lupus Magnetic resonance imaging Pathogenesis posterior reversible encephalopathy syndrome Serotonin serotonin syndrome Single Case – General Neurology Single Case − General Neurology venlafaxine |
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| Title | Serotonin Syndrome Presenting as a Posterior Reversible Encephalopathy Syndrome |
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