Disulfiram
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Posterior reversible encephalopathy syndrome: case report A 55-year-old man developed posterior reversible encephalopathy syndrome (PRES) during treatment with disulfiram for chronic alcohol abuse. The man, who had been diagnosed with chronic alcohol abuse, started receiving disulfiram 500 mg/day [route not stated]. Three days after initiation of disulfiram, he was found unconscious and was thus hospitalised. He exhibited tonic-clonic seizure during transportation to the hospital. Upon admission, the BP was 144/92mm Hg and temperature was 38ºC. Neurological examination revealed right hemiparesis and global aphasia. Brain CT-scan revealed bilateral subcortical parieto-occipital hypodensities. The blood test was negative for alcohol and other unspecified drugs. Lumber puncture showed slightly elevated proteins. Based on the clinical presentation, disulfiram-related PRES was determined. The man’s therapy with disulfiram was therefore discontinued, and benzodiazepines (antiepileptics) and thiamine were initiated. A brain MRI revealed extensive bilateral subcortical occipital T2 hyperintensities with extension to parieto-frontal areas. A diagnosis of PRES was thus confirmed. After the initiation of anti-epileptics, he remained free of seizures for the remaining period of hospitalisation, and fully recovered from the deficits. Tests for infectious and autoimmune diseases were found to be negative. Hence, disulfiram-related PRES was considered. Three weeks after admission, a repeat brain MRI revealed almost complete regression of the hyperintensities. Hierro F, et al. Posterior reversible encephalopathy syndrome after exposure to dissulfiram. European Journal of Neurology 27 (Suppl. 1): 748 (plus poster) abstr. EPO1352, 803498479 May 2020. Available from: URL: https://www.ean.org/fileadmin/user_upload/ean/congress-2020/Present/Abstracts/00_EAN_Journal_2020_Book.pdf [abstract]
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Reactions 29 Aug 2020 No. 1819
