Ictal Asystole in a patient with posterior reversible encephalopathy syndrome (pres) and seizures: A Case Report
Joanna Suski, MD; Reginald T. Ho, MD; and Maromi Nei, MD
- Ictal asystole is rare, seen in less than 1% of patients with epilepsy, and typically seen in patients with temporal or frontal lobe seizures, rarely in occipital lobe seizures, and has never been described in a patient with PRES .
- PRES is a clinical-radiologic diagnosis in which there is a breakdown of the blood brain barrier caused by abrupt changes of blood pressure, or cytokines causing endothelial damage and this creates brain edema.
- The typical neurological symptoms of PRES include encephalopathy (50-80%), seizure (60-75%), headache (50%), and visual disturbance (35%).
- Brain imaging in PRES usually reveals vasogenic edema in the bilateral parietal-occipital regions, and may include the frontal, temporal, basal ganglia, brainstem or cerebellum.
- Most patients with PRES have a favorable outcome but mortality can be as high as 3-6%, persistent neurological sequela in 10-20% of patients, and recurrent PRES in 5-10%.