Ictal Asystole in a patient with posterior reversible encephalopathy syndrome (pres) and seizures: A Case Report

BACKGROUND Ictal asystole is rare, seen in less than 1% of patients with epilepsy, and typically seen in patients with temporal or frontal lobe seizures, rarely in occipital lobe seizures, and has never been described in a patient with PRES . PRES is a clinical-radiologic diagnosis in which there is a breakdown of the blood brain barrier caused by abrupt changes of blood pressure, or cytokines causing endothelial damage and this creates brain edema. The typical neurological symptoms of PRES include encephalopathy (50-80%), seizure (60-75%), headache (50%), and visual disturbance (35%). Brain imaging in PRES usually reveals vasogenic edema in the bilateral parietal-occipital regions, and may include the frontal, temporal, basal ganglia, brainstem or cerebellum. Most patients with PRES have a favorable outcome but mortality can be as high as 3-6%, persistent neurological sequela in 10-20% of patients, and recurrent PRES in 5-10%.https://jdc.jefferson.edu/neurologyposters/1000/thumbnail.jp