title: Expanding the spectrum of subacute diencephalic angioencephalopathy.
abstract: We present a patient with subacute diencephalic angioencephalopathy (SDAE), a poorly understood syndrome of progressive confusion, disorientation, and dementia that rapidly deteriorates to severe encephalopathy and death. This is the seventh and most thoroughly investigated report of this exceedingly rare diagnosis to date, and we present the first evidence of a potential sentinel syndrome that may allow for earlier diagnosis and therapeutic intervention. We also review the relevant literature, and highlight new evidence that suggests that SDAE and the related disorder, subacute brainstem angioencephalopathy (SBAE), represent severe and terminal variants of posterior reversible encephalopathy syndrome (PRES). Taken together, we suggest a new understanding of SDAE/SBAE and PRES as a spectrum of hypertension-associated non-inflammatory vascular encephalopathies that are mediated by a loss of venous autoregulation, marked by cytotoxic edema, and that ultimately produce subacute-to-acute diencephalic, brainstem, and posterior fossa injuries with devastating neurologic consequences.
authors: Department of Neurologic Surgery, Mayo Clinic, 200 First Street Southeast, Rochester, MN 55905, USA.
authors: Christopher S
authors: CS
authors: Graffeo
authors: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors: Elliot T
authors: ET
authors: Dawson
authors: Department of Neurologic Surgery, Mayo Clinic, 200 First Street Southeast, Rochester, MN 55905, USA.
authors: Meghan E
authors: ME
authors: Murphy
authors: Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA.
authors: David F
authors: DF
authors: Black
authors: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
authors: Joseph E
authors: JE
authors: Parisi
authors: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors: Brian A
authors: BA
authors: Crum
authors: Department of Neurologic Surgery, Mayo Clinic, 200 First Street Southeast, Rochester, MN 55905, USA. Electronic address: Meyer.Fredric@Mayo.edu.
authors: Fredric B
authors: FB
authors: Meyer
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis
keywords: Encephalopathy; Posterior reversible encephalopathy syndrome; Rare diseases; Subacute diencephalic angioencephalopathy; Vasculopathy