IMAGES IN MEDICINE
Posterior reversible encephalopathy syndrome in SLE nephritis
1 BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
2 Division of Nephrology, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
Correspondence to:
Dr R Sinha, British Columbia Children’s Hospital, Division of Nephrology, 4480, Oak Street, Vancouver, BC, V6H 3V4, Canada; rajivsinha_in@yahoo.com
Accepted 19 September 2007
| The first 150 words of the full text of this article appear below. |
A 16-year-old girl with systemic lupus erythematosus (SLE) nephritis was started on pulse methylprednisolone and monthly cyclophosphamide infusion. She was already on antihypertensive for border line hypertension (130/80–140/90 mm Hg). On day 4 of treatment she suddenly started complaining of headache and subtle neurological symptoms including disorientation, blurred vision and motor apraxia. This was followed by a brief episode of generalised fit. Apart from being in post-ictal aura her gross neurological examination including fundoscopy was unremarkable. Her blood pressure around this episode was 150/80–160/90 mm Hg. Serum electrolytes and calcium were within normal range.
Urgent neuroimaging was arranged. Axial fluid-attenuated inversion recovery (FLAIR) (fig 1) and turbo spin echo T2 weighted images were acquired followed by diffusion weighted sequence. Both imaging techniques showed areas of increased signal intensity which was primarily on the left parietal and occipital region. Diffusion weighted image (DWI) and apparent diffusion coefficient (ADC) map
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