Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: a case report

Abstract

Introduction: Posterior reversible encephalopathy syndrome is a clinical and radiological entity. The most accepted theory of posterior reversible encephalopathy syndrome is a loss of autoregulation in cerebral blood flow with a subsequent increase in vascular permeability and leakage of blood plasma and erythrocytes, producing vasogenic edema. In infection-associated posterior reversible encephalopathy syndrome, a clinical pattern consistent with systemic inflammatory response syndrome develops. Parainfluenza virus has not been reported in the medical literature to be associated with posterior reversible encephalopathy syndrome.

Case presentation: We report herein the case of a 54-year-old Caucasian woman with posterior reversible encephalopathy syndrome associated with parainfluenza virus infection who presented with generalized headache, blurring of vision, new-onset seizure and flu-like symptoms.

Conclusion: Infection-associated posterior reversible encephalopathy syndrome as well as hypertension-associated posterior reversible encephalopathy syndrome favor the contribution of endothelial dysfunction to the pathophysiology of this clinicoradiological syndrome. In view of the reversible nature of this clinical entity, it is important that all physicians are well aware of posterior reversible encephalopathy syndrome in patients presenting with headache and seizure activity. A detailed clinical assessment leading to the recognition of precipitant factors in posterior reversible encephalopathy syndrome is paramount.

Figure 1

Computed tomographic image showing findings in the brain of a patient with posterior reversible encephalopathy syndrome. Subtle evidence of a possible acute abnormality in the right occipital lobe (arrow) in addition to an unusual pattern of calcification in the cerebral hemispheres.

Figure 2

MRI findings in the brain of a patient with posterior reversible encephalopathy syndrome. Multifocal, T2-weighted, hyperintense lesions are present within the parasagittal posterior parietal lobe, both cerebellar hemispheres, and the occipital lobes bilaterally (arrows).