John ES, Sedhom R, Dalal I, Sharma R. Posterior reversible encephalopathy syndrome in alcoholic hepatitis: Hepatic encephalopathy a common theme. World J Gastroenterol 2017; 23(2): 373-376 [PMID: 28127211 DOI: 10.3748/wjg.v23.i2.373]
Corresponding Author of This Article
Elizabeth S John, MD, Department of Medicine, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB 492, New Brunswick, NJ 08901, United States. elizabethjohn17@gmail.com
Research Domain of This Article
Allergy
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 14, 2017; 23(2): 373-376 Published online Jan 14, 2017. doi: 10.3748/wjg.v23.i2.373
Posterior reversible encephalopathy syndrome in alcoholic hepatitis: Hepatic encephalopathy a common theme
Elizabeth S John, Ramy Sedhom, Ishita Dalal, Ranita Sharma
Elizabeth S John, Ramy Sedhom, Ishita Dalal, Ranita Sharma, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
Author contributions: All authors took care of the patient medically; John ES drafted the report; Sedhom R, Dalal I and Sharma R made critical appraisals of the report.
Informed consent statement: Informed consent was acquired from the patient.
Conflict-of-interest statement: None of the authors have any financial disclosures or conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elizabeth S John, MD, Department of Medicine, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB 492, New Brunswick, NJ 08901, United States. elizabethjohn17@gmail.com
Telephone: +1-973-5926116
Received: July 22, 2016 Peer-review started: July 25, 2016 First decision: August 22, 2016 Revised: September 6, 2016 Accepted: October 10, 2016 Article in press: October 10, 2016 Published online: January 14, 2017 Processing time: 174 Days and 7.8 Hours
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiologic diagnosis that has become more widely recognized and reported over the past few decades. As such, there are a number of known risk factors that contribute to the development of this syndrome, including volatile blood pressures, renal failure, cytotoxic drugs, autoimmune disorders, pre-eclampsia, and eclampsia. This report documents the first reported case of PRES in a patient with severe alcoholic hepatitis with hepatic encephalopathy and delves into a molecular pathophysiology of the syndrome.
Core tip: Posterior reversible encephalopathy syndrome (PRES) has been described in a number of settings, but not in the setting of severe alcoholic hepatitis, as is presented in this case report. There are clear molecular relationships between ammonia, which is detoxified to glutamine in the brain, causing astrocytic swelling, cerebral edema, and vasogenic edema. This vasogenic edema is a pivotal component of PRES and accounts for one of the major hypotheses of the syndrome. Thus, though a clear connection between hyperammonemia and PRES has never been documented, there is a theoretical relationship.
