Author Of 1 Presentation
P0744 - Posterior Reversible Encephalopathy Syndrome Complicating Plasmapheresis In Neuromyelitis Optica (ID 1248)
Abstract
Background
Patients with Neuromyelitis Optica Spectrum Disorder (NMOSD) have a predisposition to developing posterior reversible encephalopathy syndrome (PRES) due to the Aquaporin 4 channelopathy characteristic of the disease. PRES occurs with therapies that cause rapid fluid shifts or rapid changes in blood pressure such as plasmapheresis (PLEX).
Objectives
To report a case of posterior reversible encephalopathy syndrome in a patient receiving plasmapheresis as a therapy for neuromyelitis optica (NMO) exacerbation. The objective of this case report is to increase awareness of this unusual but described complication of plasmapheresis in patients with NMOSD.
Methods
A 57-year-old, right-handed woman with a past medical history of breast cancer diagnosed in 2016 who underwent radiation and lumpectomy with maintenance hormonal therapy was diagnosed with NMOSD in March 2020 as she had a first episode of right optic neuritis with positive serum aquaporin 4 antibodies. She had an NMO exacerbation in April 2020 manifested as left hemiparesis due to a long segment, contrast-enhancing cervical spine lesion. She was started on plasmapheresis and after the first session, she developed a right focal seizure with impaired awareness, encephalopathy, and right hemiparesis.
Results
Magnetic resonance imaging (MRI) of the brain revealed fluid-attenuated inversion recovery (FLAIR) hyperintensities with contrast enhancement in the bilateral frontal and parietal cortex with small areas of diffusion restriction in the left occipital lobe, the patient also had diffuse increase FLAIR hyperintensity in the corona radiata bilaterally and in the bilateral cerebellar hemispheres. Repeat cervical spine MRI demonstrated improvement in contrast enhancement of the cervical spine lesion. Her blood pressure ranged from 110 over 70 to 130 over 80 millimeters of mercury and she did not have significant fluctuations in blood pressure readings. The patient was started on a single agent antiepileptic with resolution of the seizures and encephalopathy although right hemiparesis persisted, she completed 5 sessions of PLEX and was discharged with plans to start eculizumab as an outpatient.
Conclusions
Our case suggests that posterior reversible encephalopathy syndrome is a possible complication of plasmapheresis in patients with NMOSD.
Presenter Of 1 Presentation
P0744 - Posterior Reversible Encephalopathy Syndrome Complicating Plasmapheresis In Neuromyelitis Optica (ID 1248)
Abstract
Background
Patients with Neuromyelitis Optica Spectrum Disorder (NMOSD) have a predisposition to developing posterior reversible encephalopathy syndrome (PRES) due to the Aquaporin 4 channelopathy characteristic of the disease. PRES occurs with therapies that cause rapid fluid shifts or rapid changes in blood pressure such as plasmapheresis (PLEX).
Objectives
To report a case of posterior reversible encephalopathy syndrome in a patient receiving plasmapheresis as a therapy for neuromyelitis optica (NMO) exacerbation. The objective of this case report is to increase awareness of this unusual but described complication of plasmapheresis in patients with NMOSD.
Methods
A 57-year-old, right-handed woman with a past medical history of breast cancer diagnosed in 2016 who underwent radiation and lumpectomy with maintenance hormonal therapy was diagnosed with NMOSD in March 2020 as she had a first episode of right optic neuritis with positive serum aquaporin 4 antibodies. She had an NMO exacerbation in April 2020 manifested as left hemiparesis due to a long segment, contrast-enhancing cervical spine lesion. She was started on plasmapheresis and after the first session, she developed a right focal seizure with impaired awareness, encephalopathy, and right hemiparesis.
Results
Magnetic resonance imaging (MRI) of the brain revealed fluid-attenuated inversion recovery (FLAIR) hyperintensities with contrast enhancement in the bilateral frontal and parietal cortex with small areas of diffusion restriction in the left occipital lobe, the patient also had diffuse increase FLAIR hyperintensity in the corona radiata bilaterally and in the bilateral cerebellar hemispheres. Repeat cervical spine MRI demonstrated improvement in contrast enhancement of the cervical spine lesion. Her blood pressure ranged from 110 over 70 to 130 over 80 millimeters of mercury and she did not have significant fluctuations in blood pressure readings. The patient was started on a single agent antiepileptic with resolution of the seizures and encephalopathy although right hemiparesis persisted, she completed 5 sessions of PLEX and was discharged with plans to start eculizumab as an outpatient.
Conclusions
Our case suggests that posterior reversible encephalopathy syndrome is a possible complication of plasmapheresis in patients with NMOSD.