title: Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report.
abstract: The posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visual disturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the case of a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergency department for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headache for two hours. His physical examination was remarkable for a blood pressure of 190/100 mmHg and tenderness in epigastrium. His analytical results revealed emphasis on amylase 193 U/L and lipase 934 U/L. During the observation in the emergency department,he presented a generalized tonic-clonic seizure. Abdominal ultrasonography was performed and suggestive of pancreatitis withoutgallstones signals. Head computed tomography showed subarachnoid haemorrhage and a small right frontal cortical haemorrhage. The brain magnetic resonance imaging done one week after admission showed areas of a bilateral and symmetrical T2 / FLAIR hyperintensities in the subcortical white matter of the parietal and superior frontal regions, suggesting a diagnosis of posterior reversible encephalopathy syndrome. Abdominal computed tomography (10 days after admission) demonstrated a thickened pancreas in connection with inflammation and two small hypodense foci in the anterior part of the pancreas body, translating small foci of necrosis. The investigation of a thrombophilic defect revealed a heterozygous G20210A prothrombin gene mutation. The patient was discharged without neurological sequelae and asymptomatic. The follow-up brain magnetic resonance imaging confirmed the reversal of the lesions, confirming the diagnosis.
authors.affiliation: Serviço de Gastrenterologia. Hospital Central do Funchal. Funchal. Portugal.
authors.forename: Vítor
authors.initials: V
authors.lastname: Magno Pereira
authors.affiliation: Serviço de Medicina Interna. Hospital Central do Funchal. Funchal. Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Marote Correia
authors.affiliation: Serviço de Neurorradiologia. Hospital Central do Funchal. Funchal. Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Rodrigues
authors.affiliation: Serviço de Gastrenterologia. Hospital Central do Funchal. Funchal. Portugal.
authors.forename: Gorete
authors.initials: G
authors.lastname: Serrão Faria
mesh_terms: D000208:Acute Disease; D000328:Adult; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications*