Case Report
Transient Blindness Due to Posterior Reversible Encephalopathy Syndrome Following Ephedra Overdose
Abstract
Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is most often associated with hypertensive emergencies and is characterized by seizures, mental status changes and visual disturbances. We report a case of a previously healthy young man who developed multiorgan failure and transient cortical blindness following ingestion of a performance-enhancing ephedra-based supplement. Neuroimaging findings confirmed the clinical suspicion of PRES. Radiographic abnormalities and neurologic dysfunction subsequently resolved with correction of his systolic blood pressure. This case emphasizes the need for prompt treatment and consideration of toxic ingestions in patients presenting with hypertension-related end-organ dysfunction.This content is limited to qualifying members.
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References
1. Miller SC. Safety concerns regarding ephedrine-type alkaloid-containing dietary supplements. Mil Med2004;169:87–93.
2. Stevens T, Qadri A, Zein NN. Two patients with acute liver injury associated with use of the herbal weight-loss supplement Hydroxycut. Ann Intern Med 2005;142:477–478.
3. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494–500.
4. Daly PA, Krieger DR, Dulloo AG, et al. Ephedrine, caffeine and aspirin: safety and efficacy for treatment of human obesity. Int J Obes Relat Metab Disord 1993;17(suppl 1):S73–S78.
5. U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition.
6. Bent S, Tiedt TN, Odden MC, et al. The relative safety of ephedra compared with other herbal products. Ann Intern Med 2003;138:468–471.
7. Jarosz JM, Howlett DC, Cox TC. Cyclosporine-related reversible posterior leukoencephalopathy: MRI.Neuroradiology 1997;39:711–715.
8. Hauser RA, Lacey DM, Knight MR. Hypertensive encephalopathy: magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol 1988;45:1078–1083.
9. Bakshi R, Bates VE, Mechtler LL, et al. Occipital lobe seizures as the major clinical manifestation of reversible posterior leukoencephalopathy syndrome: magnetic resonance imaging findings. Epilepsia1998;39:295–299.
10. Casey SO, Sampaio RC, Michel E, et al. posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 2000;21:1199–1206.
11. Ozcakar ZB, Ekim M, Fitoz S, et al. Hypertension induced reversible posterior leukoencephalopathy syndrome: a report of two cases. Eur J Pediatr 2004;163:728–730.
12. Lacaille F, Hertz-Pannier L, Nassogne MC, et al. Magnetic resonance imaging for the diagnosis of acute leukoencephalopathy in children treated with tacrolimus. Neuropediatrics 2004;35:130–133.
13. Miyazaki Y, Tajima Y, Sudo K, et al. Hodgkin's disease-related central nervous system angiopathy presenting as reversible posterior leukoencephalopathy. Intern Med 2004;43:1005–1007.
14. Primavera A, Audenino D, Mavilio N, et al. Reversible posterior leucoencephalopathy syndrome in systemic lupus and vasculitis. Ann Rheum Dis 2001;60:534–537.
15. Delanty N, Vaughan C, Frucht S, et al. Erythropoietin-associated hypertensive posterior leukoencephalopathy. Neurology 1997;49:686–689.
