Carbamazepine
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Carbamazepine Posterior reversible encephalopathy syndrome secondary to hypertensive crisis: case report
An 81-year-old man developed posterior reversible encephalopathy syndrome (PRES) secondary to hypertensive crisis during treatment with carbamazepine for left occipital neuralgia. The man presented to the emergency department with an altered mental status that had developed during the previous several hours. One day prior to the presentation, he had visited the outpatient neurology clinic with a 1-week history of left occipital neuralgia, and had been started on oral carbamazepine 200mg twice daily. He had a 9-year history of hypertension, which was well controlled with candesartan-cilexetil [candesartan], bisoprolol and torasemide [torsemide]. He had no history of recent medication that might affect his mental status. He had a stuporous mental status and BP of 213/85mm Hg (BP indicating hypertensive crisis). Routine blood tests revealed no abnormalities. An MRI of the brain showed bilateral posterior-predominant hyperintensities in T2-weighted fluid-attenuated inversion recovery imaging, with no diffusion restriction in diffusion-weighted imaging. Carbamazepine level was within the therapeutic range (9.0 µg/mL). The man’s therapy with carbamazepine was stopped considering the possibility of its adverse effects. He was initiated on antihypertensives [specific drug not stated], after which his BP gradually decreased. His BP normalised on day 5 without the need of antihypertensive medications. On day 7, he was oriented and able to walk without assistance. A brain MRI performed on day 13 showed that the vasogenic oedema had almost completely resolved, a finding consistent with PRES. On day 14, he was discharged after his symptoms had fully resolved. Kim R, et al. Posterior reversible encephalopathy syndrome related to carbamazepine-induced hypertension. Journal of Clinical Neurology 16: 502-504, No. 3, Jul 2020. Available from: URL: http://doi.org/10.3988/jcn.2020.16.3.502 803502513
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Reactions 26 Sep 2020 No. 1823
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