Journal of Pediatric Neurosciences
: 2019  |  Volume : 14  |  Issue : 3  |  Page : 137--139

Porphyria: An uncommon cause of posterior reversible encephalopathy syndrome

Vinay Agarwal1, Namit Singhal2 
1 Chief Neurologist, Agarwal Neurology Clinic, Agra, Uttar Pradesh, India
2 Director neurosciences, S S Hospital, Agra, Uttar Pradesh, India

Correspondence Address:
Dr. Namit Singhal
Director neurosciences, S S Hospital, Hari Parwat, Agra 282002, Uttar pradesh.

Acute intermittent porphyria (AIP) is rare and the diagnosis is often delayed. It usually presents with abdominal symptoms, behavioural changes, seizures, tachycardia, and hypertension. MRI findings are usually normal or few contrast enhancing lesions may be present. Rarely , reversible vasogenic edema is seen on MRI as T2 weighted and FLAIR hyper intensity without diffusion restriction suggestive of posterior reversible encephalopathy syndrome (PRES). Review of literature suggests that there are only few case reports of AIP associated with PRES. Because diffusion-weighted MRI is normal, the lesions are likely caused by reversible vasogenic edema and transient breakdown of the blood-brain barrier. Treatment of porphyria consists of a high carbohydrate diet supplemented with the use of intravenous glucose and haematin infusions during acute attacks. Management of seizures with commonly used anti-epileptics including phenytoin, valproic acid, carbamazepine and barbiturates can worsen symptoms or precipitate acute attacks because of their enzyme inducing activity. Levetiracetam is the preferred choice these cases. Porphyria is an important differential diagnosis in patients with unexplained abdominal pain along with neuro-psychiatric manifestations. This case report adds to a handful of cases worldwide associating AIP with radiological findings of PRES.

How to cite this article:
Agarwal V, Singhal N. Porphyria: An uncommon cause of posterior reversible encephalopathy syndrome.J Pediatr Neurosci 2019;14:137-139

How to cite this URL:
Agarwal V, Singhal N. Porphyria: An uncommon cause of posterior reversible encephalopathy syndrome. J Pediatr Neurosci [serial online] 2019 [cited 2020 Jun 4 ];14:137-139
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