RCVS with PRES after blood transfusion: a case report

Abstract

A 40-year-old housewife had severe anemia (hemoglobin 1.1 g/dl) because of menorrhagia for the past several years. She was admitted to the hospital, and a massive transfusion of packed red blood cells (2,800 ml) was performed. The hemoglobin level improved to 10.7 g/dl. Furthermore, she had undergone a surgery for uterine myoma, which may have caused menorrhagia. Two weeks after the transfusion, she suddenly experienced a severe headache and generalized tonic-clonic seizure. Magnetic resonance imaging (MRI) showed multifocal constriction of cerebral arteries on magnetic resonance angiography (MRA), and bilateral multiple high intense lesions were detected by T₂-weighted imaging. We diagnosed reversible cerebral vasoconstriction syndrome (RCVS) with posterior reversible encephalopathy syndrome (PRES). We treated the patient with a calcium channel blocker and anti-epileptic drugs; the symptoms and MRI findings improved immediately. The symptoms (headache and partial convulsions) and vascular constrictions on MRA worsened, but improved again once the dose of the calcium channel blocker and anti-epileptic drugs were increased. Five weeks after admission, the patient was discharged with no neurological deficits. Several cases of RCVS and PRES after blood transfusion have been reported. Although the mechanisms are unknown, blood transfusion for severe chronic anemia is one of the risk factors of RCVS and PRES. When performing a blood transfusion to severe chronic anemic patients, it is necessary to consider RCVS and PRES if the patient has severe headache, seizures, and other neurological symptoms.