Posterior reversible encephalopathy syndrome.

3. Information on permissions/orders of reprints in rheumatology and related fields. Silverman featuring research articles on clinical subjects from scientists working is a monthly international serial edited by Earl D. We read with interest the article by Varaprasad, et al 1 in which the authors studied 13 patients with systemic lupus erythematosus (SLE) and posterior reversible encephalopathy syndrome (PRES) presenting clinical and magnetic resonance imaging (MRI) features. All patients were female, ranging in age from 14 to 37 years. The duration of SLE ranged from 1.5 to 36 months. Eleven patients had seizures, 10 had headaches, 7 had loss of consciousness and vomiting, 3 had transient vision loss, and each presented paraparesis and left hemiplegia. All patients showed both early stages of SLE and hypertension. Eight patients were receiving corticos-teroids and 4 were taking monthly cyclophosphamide. In 2007, we described the first case of PRES associated with SLE and thrombotic thrombocytopenic purpura 2. In that case, the neurologic symptoms , the characteristic MR images, and the prompt full response to treatment enabled the diagnosis (Figure 1). After that, we followed 2 other patients with PRES. Of the 3 total cases, 1 had SLE, another presented with SLE and thrombotic thrombocytopenic purpura, and the third with postinfection glomerulonephritis. Two were women and all ages ranged from 15 to 31 years. The duration of SLE was 1 month and 108 months, respectively, and SLE was active in both patients (SLE Disease Activity Index of 28 and 12). Similar to Varaprasad's series, all our patients presented with headaches, hypertension, renal involvement, and seizures; 1 patient had loss of consciousness and hemiplegia. Although some authors do not specify the duration of SLE in their reports, others describe the diagnosis of PRES in patients with SLE between 1 and 20 years' duration 3,4,5. Most patients showed active lupus, with nephritis being the most common accompaniment. Renal failure and severe hypertension are known risk factors for the development of PRES 6. The occurrence of PRES in nor-motensives and treatment-naive patients may explain that the endothelial dysfunction due to disease activity plays an important pathogenetic role 7. On the MR images, lesions may be observed in detail. They are hypointense on T1 and hyperintense on T2 images, with greater sensitivity of the fluid-attenuated inversion recovery and of the apparent diffusion coefficient map. They are typically bilateral and symmetrical and they follow the calcarine and paramedian occipital lobe …