title: Posterior reversible encephalopathy and cerebral vasoconstriction in a patient with hemolytic uremic syndrome.
abstract: BACKGROUND
  We report a patient with hemolytic uremic syndrome who presented with radiological manifestations suggestive of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome.
  
  
  METHODS
  A 13-year-old girl presented with fever and bloody diarrhea and progressed to develop hemolytic uremic syndrome. She subsequently developed encephalopathy, aphasia, and right-sided weakness.
  
  
  RESULTS
  Brain magnetic resonance imaging showed presence of vasogenic edema in the left frontal lobe, in addition to T2 and fluid-attenuated inversion recovery changes in white matter bilaterally, compatible with posterior reversible encephalopathy syndrome. Magnetic resonance angiography showed beading of the cerebral vessels. Neurological deficits reversed 8 days after symptom onset, with resolution of the beading pattern on follow-up magnetic resonance angiography after 3 weeks, suggesting reversible cerebral vasoconstriction syndrome.
  
  
  CONCLUSIONS
  Both posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome may represent manifestations of similar underlying pathophysiologic mechanisms. Recognition of the co-existence of these processes in patients with hemolytic uremic syndrome may aid in judicious management of these patients and avoidance of inappropriate therapeutic interventions.
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan. Electronic address: ragarwal@dmc.org.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
authors.forename: Cresha
authors.initials: C
authors.lastname: Davis
authors.affiliation: Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
authors.forename: Deniz
authors.initials: D
authors.lastname: Altinok
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
authors.forename: Fatema J
authors.initials: FJ
authors.lastname: Serajee
mesh_terms: D000293:Adolescent; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology
keywords: PRES; RCVS; hemolytic-uremic syndrome; vasospasm