Researchers from Vietnam reported the rare case of a patient with myasthenia gravis (MG) who developed posterior reversible encephalopathy syndrome.
“Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of posterior reversible encephalopathy syndrome,” wrote Pham Dang Hai, MD, from the Medical Intensive Care Unit at 108 Military Central Hospital in Hanoi and colleagues.
Read more about the pathophysiology of MG
The study is published in Radiology Case Reports.
“Early recognition and management of posterior reversible encephalopathy syndrome as a cause of encephalopathy in patients with septicemia and myasthenia gravis is necessary to prevent secondary complications in this condition,” they added.
The case was that of a 22-year-old male who presented to the emergency department with a 2-week history of drooping eyelids, double vision, paralysis in the arms and legs, dyspnea, and respiratory distress. He underwent tracheal intubation and was transferred to 108 Military Central Hospital.
He was diagnosed with MG and sepsis caused by pneumonia. He had several generalized convulsions lasting 3 to 5 minutes followed by loss of consciousness.
He underwent cranial magnetic resonance imaging, which revealed lesions within the subcortical white matter of the temporal, parietal, and bilateral occipital lobes.
He was treated with 600 mg of daily valproic acid, which led to an improvement in his symptoms 1 week later, after which he was discharged from the hospital.
Posterior reversible encephalopathy syndrome is a rare neurological disease characterized by headaches, vision problems, seizures, impaired consciousness, and vasogenic cerebral edema. The condition is usually associated with other conditions such as high blood pressure, pre-eclampsia, some autoimmune diseases, and certain immunosuppressive agents. Symptoms can develop quickly and be severe or life-threatening, but they are highly treatable. Diagnosing the condition is therefore of great importance to prevent the development of secondary complications.
Hai PD, Duc VA, Hung VQ, Thang NVV. Posterior reversible encephalopathy syndrome following septicemia in patient with myasthenia gravis. Radiol Case Rep. Published online February 8, 2023. doi:10.1016/j.radcr.2023.01.050