Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Aug;95(33):e4556.
doi: 10.1097/MD.0000000000004556.

Duloxetine-related posterior reversible encephalopathy syndrome: A case report

Nathalie Zappella  1 , François Perier, Fernando Pico, Catherine Palette, Alexandre Muret, Sybille Merceron, Andrei Girbovan, Fabien Marquion, Stephane Legriel
Affiliations
Case Reports

Duloxetine-related posterior reversible encephalopathy syndrome: A case report

Nathalie Zappella et al. Medicine (Baltimore). 2016 Aug.

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) has well-established links with several drugs. Whether a link also exists with serotonin-norepinephrine reuptake inhibitor such as duloxetine is unclear.

Methods: We report on a patient who developed PRES with a coma and myoclonus related to hypertensive encephalopathy a few days after starting duloxetine treatment. Magnetic resonance imaging was performed and catecholamine metabolites assayed.

Results: The patient achieved a full recovery after aggressive antihypertensive therapy and intravenous anticonvulsant therapy.

Conclusions: The clinical history, blood and urinary catecholamine and serotonin levels, and response to treatment strongly suggest that PRES was induced by duloxetine. Duloxetine should be added to the list of causes of PRES.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Cerebral imaging in a patient with duloxetine-related PRES. (Panels A and B) No abnormalities 5 days before the onset of PRES. (Panels C and D) FLAIR sequence showing bilateral high-signal foci in the occipital, parietal, and temporal lobes (white arrows). (Panels E and F) FLAIR follow-up sequence showing complete resolution of the abnormalities. FLAIR = fluid-attenuated inversion recovery, PRES = posterior reversible encephalopathy syndrome.
Figure 2
Figure 2
Arterial blood pressure and Glasgow Coma Scale score from the onset of PRES to ICU discharge, according to key PRES management landmarks. ICU = intensive care unit, PRES = posterior reversible encephalopathy syndrome.
See this image and copyright information in PMC

References

    1. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334:494–500. - PubMed
    1. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol 2008; 29:1036–1042. - PMC - PubMed
    1. Schwartz RB. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334:1743.author reply 1746. - PubMed
    1. Legriel S, Pico F, Azoulay E. Vincent J-L. Understanding posterior reversible encephalopathy syndrome. Annual Update in Intensive Care and Emergency Medicine 2011. Vol 1. Berlin, Heidelberg: Springer; 2011. 631–653.
    1. Schwartz RB, Bravo SM, Klufas RA, et al. Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. Am J Roentgenol 1995; 165:627–631. - PubMed

Publication types

MeSH terms

Substances