后部可逆性脑病综合征(PRES)是先兆子痫/子痫患者的神经血管序列,实体器官/骨髓移植,恶性高血压.PRES发生的机制尚未确定。据推测,它可能与内皮细胞功能障碍或导致血脑屏障受损的损伤有关。临床表现各不相同,但与颅内压升高的症状相似,比如头痛,视觉变化,局灶性神经功能缺损,癫痫发作,和改变精神状态。虽然病理学提示可逆性,并不总是发生严重的缺血性损伤。我们介绍了一名来急诊室有药物滥用史的患者,并在尿毒理学筛查中对甲基苯丙胺和可卡因呈阳性。在美国,近年来,多物质的使用更为普遍。此外,文献强调了当这些药物联合使用时对血压的累加效应。我们的病人精神状态改变了,高血压,并精确定位瞳孔。在她逗留的过程中,患者的心理状态缓慢改善,并且能够间歇性地遵循命令。我们认为,这是第一个记录在案的与PRES相关的多物质滥用案件。我们假设PRES的机制是由于几种已知引起短暂性高血压发作的非法药物的增殖作用以及它们破坏血脑屏障必需的结构蛋白的能力。
Posterior reversible encephalopathy syndrome (PRES) is a neurovascular sequence noted in patients with preeclampsia/eclampsia, solid-organ/bone marrow transplantation, and malignant hypertension. The mechanism in which PRES occurs has not yet been determined. It has been hypothesized that it may be related to endothelial cell dysfunction or injury leading to the compromise of the blood-brain barrier. The clinical presentations vary but are similar to symptoms of increased intracranial pressure, such as headache, visual changes, focal neurological deficits, seizures, and altered mental status. Although the pathology suggests reversibility, that is not always the
case in which severe ischemic damage has occurred. We present a patient who came to the emergency room with a history of substance abuse and tested positive on a urinary toxicology screen for methamphetamine and cocaine. In the US, polysubstance use has been more prevalent in recent years. Furthermore, literature has highlighted the additive effects on one\'s blood pressure when such drugs are combined. Our patient presented with altered mental status, hypertension, and pinpoint pupils. Over the course of her stay, the patient\'s mentation slowly improved and was able to follow commands intermittently. We believe that this is the first documented
case of polysubstance abuse in correlation to PRES. We hypothesize that the mechanism of PRES resulted from the multiplicative effect of several illicit drugs known to cause transient hypertensive episodes and their ability to disrupt the structural proteins imperative for the blood-brain barrier.