title: An unusual cause of altered mental status: the importance of monitoring a patient's blood pressure.
abstract: A 73-year-old man presented to the emergency room for acute onset altered mental status. The initial work-up yielded no definitive cause. An MRI demonstrated lesions in the bilateral posterior occipital lobes (not noted on an earlier MRI obtained from an outside institution) that were suggestive of posterior reversible encephalopathy syndrome (PRES). He had a history of Parkinson's disease complicated by autonomic instability (wide blood pressure fluctuations) that was medically controlled in the outpatient setting. During the early course of his hospitalisation, he again displayed wide blood pressure fluctuations. After his blood pressure stabilised, his mental status eventually improved to baseline. A repeat MRI obtained demonstrated near-complete resolution of the previously noted lesions and confirmed the diagnosis of PRES.
authors.affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Mathew
authors.affiliation: University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koo
authors.affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Irina R
authors.initials: IR
authors.lastname: Crook
authors.affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Jahanmir
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D013129:Spinal Puncture
references.citation: Arch Intern Med. 1995 Mar 13;155(5):461-5
references.pmid: 7864702
references.citation: Clin Neurol Neurosurg. 1997 Aug;99(3):222-6
references.pmid: 9350407
references.citation: J Child Neurol. 1999 May;14(5):277-81
references.pmid: 10342593
references.citation: AJNR Am J Neuroradiol. 2001 Jun-Jul;22(6):1068-70
references.pmid: 11415899
references.citation: AJNR Am J Neuroradiol. 2002 Jun-Jul;23(6):1038-48
references.pmid: 12063238
references.citation: Clin Geriatr Med. 2007 Nov;23(4):823-32, vi-vii
references.pmid: 17923340
references.citation: AJR Am J Roentgenol. 1992 Aug;159(2):379-83
references.pmid: 1632361
references.citation: J Am Geriatr Soc. 1992 Aug;40(8):829-38
references.pmid: 1634729
references.citation: Lancet Neurol. 2012 Oct;11(10):906-17
references.pmid: 22995694
references.citation: N Engl J Med. 1996 Feb 22;334(8):494-500
references.pmid: 8559202
references.citation: J Neuroimaging. 2004 Apr;14(2):89-96
references.pmid: 15095552
references.citation: Lancet Infect Dis. 2011 Feb;11(2):80-1
references.pmid: 21272787