title: Elucidating the mechanism of posterior reversible encephalopathy syndrome: a case of transient blindness after central venous catheterization.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by reversible symptoms including headache, visual disturbances, focal neurological deficits, altered mentation, and seizures. It has been associated with circumstances that may affect the cerebrovascular system, such as hypertension, eclampsia, and immunosuppression with calcineurin inhibitors. The underlying etiology of PRES has remained unclear; however, cerebrovascular autoregulatory dysfunction, hyperperfusion, and endothelial activation have been implicated.
  
  
  METHODS
  We describe a case of a young patient with lung transplant, who presented with headache, acute binocular blindness, and seizure immediately after infusion of saline through a peripherally inserted central catheter line, which inadvertently terminated cephalad in the left internal jugular vein, near the jugular foramen. Subsequent brain magnetic resonance imaging revealed vasogenic edematous lesions in a pattern consistent with PRES--a diagnosis supported by his constellation of symptoms, history of lung transplantation on tacrolimus immunosuppression, and relative hypertension.
  
  
  CONCLUSIONS
  This is the first reported case describing the development of PRES after the insertion of a peripherally inserted central catheter line. The development of PRES in a typical high-risk patient immediately after cerebral venous outflow obstruction implicates the role of the cerebral venous system and provides potential insight into the mechanism of this disorder that remains of unclear pathogenesis.
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, CA, USA. NealRao@mednet.ucla.edu
authors.forename: Neal M
authors.initials: NM
authors.lastname: Rao
authors.forename: Radoslav
authors.initials: R
authors.lastname: Raychev
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000328:Adult; D001766:Blindness / Q000209:etiology*; D001921:Brain / Q000473:pathology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006261:Headache / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D007165:Immunosuppression Therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology*; D012640:Seizures / Q000150:complications; D016559:Tacrolimus / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D016559:Tacrolimus