Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by headache, encephalopathy, visual disturbances, and seizures associated with reversible vasogenic edema on neuroimaging. We herein present three cases of PRES due to sepsis that developed after liver transplantation. Case 1; A 28-year-old female received a liver transplantation for fulminant hepatitis. She subsequently developed a sudden onset visual disorder about 5 weeks after the operation. She had received an immunosuppressive medication on schedule according to the standard protocol. A brain magnetic resonance imaging (MRI) study revealed high signal intensity areas on T2-weighted images (T2WI), fluid-attenuated inversion recovery (FLAIR) images, and diffusion-weighted images (DWI) at the bilateral occipital lobe, parietal lobe, cerebellum, brainstem, and low signal intensity areas on T1WI at the same areas. Follow-up noncontrast brain CT forty-five days after the operation showed a high density area in the left occipital lobe. A follow-up of brain MRI on FLAIR and T2WI at seventy-six days after the operation showed a residual high intensity area in the left occipital lobe, but no cerebral edema. She recovered following conservative therapy, except for hemianopsia in the right eye field. Case 2; A 5-year-old female liver transplant recipient for liver cirrhosis after congenital biliary atresia experienced a sudden onset seizure within a few seconds recovery about 4 weeks after operation. Brain MRI on T2WI, FLAIR, and DWI showed high signal intensities in the bilateral parieto-occipital regions, and on T1WI, low signal intensities in the same areas. She recovered with no sequelae. Case 3; A 19-old-male liver transplant recipient for fulminant hepatitis had a sudden onset generalized convulsive seizure 5 days after surgery. He experienced a full recovery with no sequelae. MRI is the most sensitive imaging technique for diagnosing PRES. When patients are diagnosed to have PRES, they also tend to have sepsis. Therefore, PRES may have occurred in association with septic conditions in these patients. Attention should therefore be paid by intensivists and emergency medicine teams to ensuring that a patient does not have PRES.
