Compare and contrast the clinical manifestations, aetiology, treatment and complications of posterior reversible encephalopathy syndrome (PRES) with herpes simplex virus (HSV) encephalitis
PRES |
HSV encephalitis |
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Clinical manifestations (4 marks) |
The symptoms of PRES evolve rapidly over hours to days Hypertension is frequent but not invariable. The hypertensive crisis may precede the neurologic syndrome by 24 hours or longer. The clinical syndrome of PRES is characterized by
Rarely patients can have symptoms referable to the upper cervical spinal cord (limb weakness, bladder dysfunction), along with one or more of the symptoms above. |
Focal neurologic findings are usually acute - <1 week in duration - and include
The majority of patients will have one of the above symptoms plus fever |
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Aetiology (1 mark) |
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HSV |
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Management (3 marks) |
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IV acyclovir |
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Complications (2 marks) |
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-Behavioural abnormalities |
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-death |
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- cognitive impairment |
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-seizures |
Though the college must be commended for their lucid tabulated answer, the inclusion of "death" in the complications deserves a raised eyebrow (because surely that can't have attracted a grade if the trainees wrote it). Also, just putting "HSV" under the "aetiology" heading would have probably attracted comments like "insufficient knowledge and detail"
Anyway, the specific information regarding HSV encephalitis is derived from by Bradshaw & Ventakesan (2016) for HSV, and Walter Bartynski (Part 1 or Part 2, 2008) for PRES.
HSV encephalitis | PRES |
Pathophysiology / aetiology | |
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Clinical manifestations | |
Historical features and symptoms
Features on examination
CSF biochemistry
Radiology/neurophysiology
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Historical features and symptoms
Features on examination
CSF biochemistry (Ellis, 2019)
Radiology/neurophysiology
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Treatment | |
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Complications | |
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Hypertensive complications (Fischer et al, 2017)
Persistent neurological sequelae are rare Persisting epilepsy may occur |
Staykov, Dimitre, and Stefan Schwab. "Posterior reversible encephalopathy syndrome." Journal of Intensive Care Medicine 27.1 (2012): 11-24.
Bartynski, W. S. "Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features." American Journal of Neuroradiology 29.6 (2008): 1036-1042.
Bartynski, W. S. "Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema." American Journal of Neuroradiology 29.6 (2008): 1043-1049.
Bradshaw, Michael J., and Arun Venkatesan. "Herpes simplex virus-1 encephalitis in adults: pathophysiology, diagnosis, and management." Neurotherapeutics 13.3 (2016): 493-508.
Sili, Uluhan, et al. "Herpes simplex virus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients." Journal of Clinical Virology 60.2 (2014): 112-118.
Ellis, Colin A., et al. "Cerebrospinal fluid in posterior reversible encephalopathy syndrome: implications of elevated protein and pleocytosis." The Neurohospitalist 9.2 (2019): 58-64.