Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 93636

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : OD17 - OD19 Full Version

Hypertension Secondary to COVID-19 Leading to Posterior Reversible Encephalopathy Syndrome in a 13-year-old Male


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56337.16512
Saranya Sai Satya Nelabhotla, Pradnya Diggikar, Prashant Gopal

1. Resident, Department of General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India. 2. Professor, Department of General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India. 3. Resident, Department of General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.

Correspondence Address :
Dr. Prashant Gopal,
Resident, Department of General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
E-mail: drprashantgopal@gmail.com

Abstract

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological condition defined by white matter vasogenic oedema predominantly affecting the posterior occipital and parietal lobes. A 13-year-old male presented with complaints of fever for four days. Upon evaluation, he turned out positive for COVID-19 with a Computed Tomography (CT) severity score of 5/25. Three days post admission (day 7 of illness), patient developed sudden onset of painless, diminution of vision in both eyes followed by two episodes of generalised tonic clonic seizures. Examination revealed a blood pressure of 180/110 mmHg. Characteristic Magnetic Resonance Imaging (MRI) findings led to a diagnosis of PRES. Patient was treated with antiepileptics, antihypertensives and intravenous mannitol and made a complete recovery. Early identification, treatment of symptomatology and correction of the underlying cause are all key aspects of management.

Keywords

Anticonvulsive agents, Coronavirus disease-2019, Convulsive generalised seizure disorder, Reversible cortical blindness, Vasogenic cerebral oedema

Case Report

A13-year-old male with no significant medical history presented with complaints of fever for four days. Fever was continuous, high grade and relieved on taking over the counter medications. There was no history of cold, cough, breathlessness, palpitations, chest pain, pain in abdomen, headache or burning micturition. Patient was not vaccinated against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). His father and maternal uncle were both diagnosed with COVID-19 infection seven days earlier.

General examination revealed a Blood Pressure (BP) of 130/80 mmHg, Heart Rate of 96 beats per minute (bpm), respiratory rate of 16 cycles/minute, oxygen saturation of 97% at room air. All peripheral pulses were normal. Systemic examination revealed no abnormalities. Laboratory investigations revealed raised inflammatory markers and negative fever profile (Table/Fig 1).

Test for COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was positive. Patient was started on tab. paracetamol 500 mg and intravenous fluids. Steroids and antivirals were not started due to the mild nature of the disease. High-Resolution Computed Tomography (HRCT) thorax revealed bilateral peripheral basal consolidations with a Computed Tomography (CT) severity score of 5/25.

Patient was continued on symptomatic treatment and three days post admission, patient complained of painless sudden onset diminution of vision in both eyes associated with headache which was occipital and throbbing in nature. Patient was conscious, oriented and obeying commands. There was complete loss of vision in both eyes with no perception of light and projection of rays bilaterally. Ocular and fundus examination was normal. Pupil examination revealed normal accommodation and light reflexes. Intraocular pressure was normal. Examination revealed a BP reading of 180/110 mmHg. Two hours later, patient developed two episodes of generalised tonic clonic seizures.Patient was unaware of these episodes and postictal confusion lasted for a few minutes with no bowel or bladder involvement. Kernig’s and Brudzinski’s were negative. Neurological examination revealed bilateral extensor plantar response. Cranial nerves, motor, sensory and deep tendon reflexes examination were normal.

An initial differential diagnosis of ischaemic stroke, cerebral haemorrhage, Cerebral Venous Sinus Thrombosis (CVST) and Posterior Reversible Encephalopathy Syndrome (PRES) was considered due to the abrupt onset of headache and bilateral vision loss with elevated blood pressure.

Cerebrospinal fluid analysis was normal. Neuroimaging {Magnetic Resonance Imaging (MRI) of brain with angiography and venography-plain and contrast} revealed T2-weighted Fluid Attenuated Inversion Recovery (T2/FLAIR) hyperintensities and corresponding T1WI hypointensities involving the cortical and subcortical white matter of bilateral parietal, occipital lobes and bilateral cerebellar hemispheres indicating vasogenic oedema suggestive of PRES (Table/Fig 2).

Creatine kinase-MB (CK-MB) (112 IU/L) and cardiac Troponin-I (44 IU/L) were elevated. Electrocardiography (ECG) and 2D-echocardiography were normal. Plasma renin activity, aldosterone levels and plasma free nor metanephrine levels were normal. Renal artery doppler showed no abnormalities.

Based on the above findings, a diagnosis of PRES was made. A normal Cerebrospinal Fluid (CSF) picture and lack of an identifiable cause of hypertension led us to conclude that PRES was secondary to hypertension associated with COVID-19. Patient was started on injection mannitol, antiepileptics (inj levetiracetam 1 gm i.v. stat followed by 500 mg i.v. q12hr) and antihypertensives (tab. amlodipine 5 mg PO q12hr, tab. telmisartan 40 mg PO q24hr) anda target blood pressure of 130/80 mmHg was maintained. His vision started to improve on day 4 of admission and completely recovered by day five post admission. A contrast enhanced F-18 Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) scan was done which showed mild to moderate hypometabolism in the region of the left sensorimotor cortex and mild hypometabolism in the left precuneus. Rest of the scan was normal.

Inj. mannitol (100 mL i.v. q8hr for 3 days followed by 100 mL i.v. q12hr for 1 day followed by 100 mL IV q24hr for 1 day) and antihypertensives (tab. telmisartan 40 mg q24hr for 5 days, tab. amlodipine 5 mg q12hr for 4 days followed by tab. amlodipine 5 mg q24hr for 5 days) were tapered and stopped by day 11 of admission. Patient was kept under observation for a total of 14 days at the end of which his BP was 130/80 mmHg. Visual acuity was 6/6 at the time of discharge. Patient was asymptomatic on follow-up three months postdischarge.

Discussion

Posterior reversible encephalopathy syndrome is a clinico-radiological condition defined by white matter vasogenic oedema predominantly affecting the posterior occipital and parietal lobes. Hinchey J et al., originally described PRES in 1996 (1). Seizures, loss of consciousness, headaches, visual problems, nausea/vomiting and focal neurological abnormalities are characteristics of this condition (2). It has been reported in individuals ranging from 4-90 years, with the majority of cases affecting young to middle-aged adults (3).

Hypertension, preeclampsia/eclampsia, infections, renal dysfunction, autoimmune diseases such as systemic lupus erythematosus, systemic sclerosis, tumour lysis syndrome, Guillain-Barr syndrome, Acquired Immunodeficiency Syndrome (AIDS), thrombotic thrombocytopenic purpura, and immunosuppressive agents are among the most common causes of PRES, all of which cause cerebral vasogenic oedema, which appears to be the key pathogenic mechanism (4). Stroke, meningoencephalitis, demyelinating diseases of the brain, and cerebral venous sinus thrombosis are all possible differential diagnoses (5).

Magnetic resonance imaging is the preferred imaging modality, which primarily shows bilateral subcortical hyperintense white matter regions, predominantly involving the parietal and occipital lobes. Hyperintensity on diffusion sequences with an elevated Apparent Diffusion Coefficient (ADC) is typically seen on MRI, indicating vasogenic oedema. In contrast, cytotoxic oedema caused by ischaemia is hyperintense and has low diffusion coefficient. The use of magnetic resonance angiography and venography helps rule out alternative diagnoses {Cerebral Venous Sinus Thrombosis (CVST) or stroke} (6).

Although the exact pathogenesis of PRES is unclear, it is thought to be due to rapid increase in blood pressure resulting in dysfunction of the autoregulatory mechanisms of cerebral blood vessels leading to vascular leakage and oedema. It is also suggested that the rapid rise in blood pressure could damage the blood-brain barrier, which explains involvement of the posterior circulation in PRES since it lacks sympathetic tone. However, in patients of PRES associated with other conditions like organ transplants, renal disease, and the use of immunosuppressive drugs with normal blood pressure, there may be certain endogenous or exogenous toxins that cause endothelial damages and vasogenicoedema (7).

Some cases of COVID-19 with PRES may develop macrophage activation syndrome (MAS) with fever and increased levels of tumour Necrosis Factor-alpha (TNF-α). TNF-α increases vascular permeability and upregulates vascular endothelial growth factor in the presence of hypoxemia causing endothelial injury and oedema (8).

The majority of PRES cases however, are associated with hypertension. In a study of six cases of PRES in COVID-19 patients by Colombo A et al., it was reported that CSF-PCR for SARS-CoV-2 genome was negative in all cases and that blood pressure fluctuations were the most relevant factor in PRES pathogenesis (9). In a study of 15 COVID-19 patients with PRES by Hinchey J et al., 12 patients had abrupt increases in blood pressure (1).

Characteristic imaging findings and reversibility of symptoms were diagnostic of PRES. Since, other causes of hypertension were ruled out, and evidence of hypertension associated with COVID-19 is documented, the cause of PRES was determined to be due to hypertension secondary to COVID-19 infection. Elevated cardiac markers with normal electrocardiography and 2D-echocardiography were suggestive of myocardial injury.

The pathophysiology and consequences of COVID-19 are still poorly understood. COVID-19 patients without prior hypertension showed a rise in blood pressure during hospitalisation, and majority of the patients had higher systolic blood pressure. In a study of 190 COVID-19 patients, 8.42% patients had a rise in blood pressure during hospitalisation (10). Another study on153 confirmed COVID-19 patients showed new onset hypertension in 18 patients (11).

The binding of SARS-CoV-2 to Angiotensin-Converting Enzyme 2 (ACE2), which inhibits angiotensin II breakdown and leads to increased blood pressure, is one possible mechanism. Another theory is that excessive Renin-Angiotensin-Aldosterone system (RAS) activation promotes inflammatory response and cytokine storm, which stimulates the Nicotinamide Adenine Dinucleotide Phosphate/Nicotinamide Adenine Dinucleotide Phosphate Hydrogen reduced form (NADP/NADPH) oxidase system and causes cell contraction and vasoconstriction (10).

Angiotensin II has been shown to have direct or indirect effects on cardiomyocytes, some of which were linked to proinflammatory and prohypertrophic responses. Increased Angiotensin II activity could lead to cardiac inflammation, oxidative stress, and myocyte death, especially when the balance between ACE and ACE2 was altered in COVID-19 patients. This hypothesis explains why COVID-19 patient’s blood pressure may rise in parallel with mild cardiac injury (12). Studies have suggested that SARS-CoV-2 binds to ACE2 receptors, which are abundant in myocytes andcan result in direct injury to cardiomyocytes (13). Though the exact mechanism is still unknown, it is becoming evident that RAS plays a major role in hypertension and COVID-19 infection.

Conclusion

Early identification, treatment of symptomatology, and correction of the underlying cause are all important aspects of PRES management. As the term implies, proper treatment is expected to result in a complete recovery. However, there have been reports of long-term complications and fatalities. Recurrence of symptoms has been observed in a few cases.

References

1.
Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494-500. [crossref] [PubMed]
2.
Kumari DS, Arumilli MNLN, Reddy LSK, Reddy DN, Motor R. Acute intermittent porphyria presenting with posterior reversible encephalopathy syndrome: A rare cause of abdominal pain and seizures. Indian J Crit Care Med. 2020;24(8):724-26. [crossref] [PubMed]
3.
Legriel S, Pico F, Azoulay E. Understanding Posterior Reversible Encephalopathy Syndrome. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2011. Annual Update in Intensive Care and Emergency Medicine. vol 1. Berlin, Heidelberg: Springer; 2011. https://doi.org/10.1007/978-3-642-18081-1_56. [crossref]
4.
Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: Fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29(6):1036-42. [crossref] [PubMed]
5.
Admane SS, Yelne TS, Giri PJ. A case of posterior reversible encephalopathy syndrome mimicking stroke. Indian J Crit Care Med. 2020;24(9):877-78. [crossref] [PubMed]
6.
Hugonnet E, da Ines D, Boby H, Claise B, Petitcolin V, Lannareix V, et al. Posterior reversible encephalopathy syndrome (PRES): Features on CT and MR imaging. Diagnostic and Interventional Imaging. 2013;94(1):45-52. [crossref] [PubMed]
7.
Alnass AJ, Alamer RA, Alamri HH, Alharthi AA, Assad MA, Sedran MK, et al. Posterior reversible encephalopathy syndrome: A rare complication in COVID-19. Cureus. 2021;13(10):e18426. [crossref] [PubMed]
8.
Arslan G, Besci T, Karaca Ö, AylanGelen S. Posterior reversible encephalopathy syndrome related to COVID-19 in a child. Pediatrics International. 2022;64(1):e14908. [crossref]
9.
Colombo A, Martinelli Boneschi F, Beretta S, Bresolin N, Versino M, Lorusso L, et al. Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy. eNeurologicalSci. 2021;22:100306. [crossref] [PubMed]
10.
Chen G, Li X, Gong Z, Xia H, Wang Y, Wang X, et al. Hypertension as a sequela in patients of SARS-CoV-2 infection. PLoS ONE. 2021;16(4):e0250815. [crossref] [PubMed]
11.
Akpek M. Does COVID-19 cause hypertension? Angiology. 2022;73(7):682-87. [crossref] [PubMed]
12.
Forrester SJ, Booz GW, Sigmund CD, Coffman TM, Kawai T, Rizzo V, et al. Angiotensin II signal transduction: An update on mechanisms of physiology and pathophysiology. Physiological Reviews. 2018;98(3):1627-738. [crossref] [PubMed]
13.
Khan S, Rasool ST, Ahmed SI. Role of cardiac biomarkers in COVID-19: What recent investigations tell us? Current Problems in Cardiology. 2021;46(10):100842. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/56337.16512

Date of Submission: Mar 13, 2022
Date of Peer Review: Apr 05, 2022
Date of Acceptance: Apr 11, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 23, 2022
• Manual Googling: Apr 15, 2022
• iThenticate Software: May 28, 2022 (25%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com