Dados do Trabalho

Título

Posterior reversible encephalopathy syndrome after chronic obstructive pulmonary disease : a case report

RESUMO

Apresentação. ERS, male, 61 years old, born in Itacoatiara, Amazonas. He entered the emergency department on January 20, 2022 being immediatelly intubated and sedated. His family tells a history of chronic obstructive pulmonary disease (COPD) with exacerbation in the last 2 weeks causing respiratory failure due to community-acquired pneumonia. He had systemic arterial hypertension and heart failure. Somatoscopy showed normal color, hydrated, anicteric, acyanotic, and afebrile. Physical examination revealed edema of the lower limbs and the respiratory system showed diffusely abolished breath sounds, with no other complaints. On January 27, the patient had a seizure being medicated with phenytoin and, later, escalated with an association of valproate, phenobarbital and clonazepam. On this same day, a cranial tomography (CT) was performed, which showed hypodense lesions in the posterior fossa, in addition to partial emptying of the sella turcica, which correlated with intracranial hypertension. In view of the clinical findings and the imaging exam, posterior reversible encephalopathy syndrome (PRES) due to COPD was observed and in the same period the patient complicated with a subarachnoid hemorrhage which was reabsorbed later. Lastly Patient evolved to death due to cardiac arrest due to the lack of possibility of long-term treatment. Discussão. PRES is a neurotoxic event which results a fluid extravasation marked often by the presence of vasogenic edema in the parieto-occipital region in CT or magnetic resonance imaging (RMI) with clinical features like altered mental status, headache, seizures and vision loss. This syndrome is due mainly from secondary chronic diseases such as hypertension. In addition, it may be complicated by subarachnoid hemorrhage which, despite its not fully understood mechanism, progresses in most cases with bleeding reabsorption within a few days. Finally, due to the reversible behavior of PRES, improvement in the condition generally occurs after controlling the underlying disease. Comentários finais. In this case, we present a curious and rare manifestation of PRES correlated with COPD exacerbation. In patient care, all possible measures to be used in the service were adopted, however, some limitations can be mentioned, such as the lack of long-term therapeutic possibilities, which culminated in the patient's death. In this context, further discussions on future advances and research in the field are necessary.

Palavras Chave

Chronic obstructive pulmonary disease; Seizure;Posterior reversible encephalopathy syndrome