Abstract Details

Title A Case of Posterior Reversible Encephalopathy Syndrome Associated with HIV

Topic Infections/AIDS/Prion Disease

Presentation(s) P04 - (-)

Poster/Presentation
Number 008

Objective

Background BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic diagnosis characterized by headache, altered mental status, seizures and visual disturbance. It is most commonly associated with hypertension and the theory of failed autoregulation of the brain. Normally in hypertension, with intact autoregulation, the cerebral vessels constrict to maintain a constant state of perfusion. In PRES, it is believed that autoregulation fails; the blood vessels don't constrict appropriately in the face of hypertension and the brain is hyperperfused with resulting cerebral edema evident as hyperintensity on MRI. We report a case of a patient with PRES and HIV who was normotensive and without other risk factors for PRES.

Design/Methods DESIGN/METHODS: A 56 year old woman presented with altered mental status and visual field defect. She had a past medical history of HIV with a CD4 count of 438 and was on highly active anti-retroviral therapy (HAART). She was normotensive and workup of CNS infection including lumbar puncture with measurement of titers for crypotococcus, tuberculosis, cytomegalovirus, herpes simplex virus, JC virus among others was all negative.

Results RESULTS: MRI of the brain with and without contrast revealed abnormal hyperintensity on T2 and FLAIR of the bilateral cerebral hemispheres, primarily in the occipital lobes consistent with PRES.

Conclusions CONCLUSIONS: HIV is associated with endothelial dysfunction as evidenced by intravascular, transmural and perivascular CD4 and CD8 T cells. This endothelial dysfunction is sufficient to cause PRES.

Authors/Disclosures
Leslie Wilbanks, MD (Community Care Network Neurology) PRESENTER	No disclosure on file
Ghazala Hayat, MBBS, FAAN (Saint Louis University)	Dr. Hayat has received personal compensation in the range of $500-$4,999 for serving as a Consultant for kabafusion. Dr. Hayat has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for csl. Dr. Hayat has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for alexion. Dr. Hayat has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for MTPA. Dr. Hayat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for alexion. Dr. Hayat has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for kabafusion.
Olga Ciccarelli, MD, PhD, FRCP (UCL Institute of Neurology)	Prof. Ciccarelli has received personal compensation in the range of $0-$499 for serving as a Consultant for Lundebeck. Prof. Ciccarelli has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Prof. Ciccarelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Prof. Ciccarelli has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. Prof. Ciccarelli has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEUROLOGY Journal.

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