A 53-year-old woman was admitted to our hospital with
headache and convulsion. Advanced
anemia with a Hb level of 3.5 g/dl had been detected about a month earlier, and it had been treated by
iron administration to achieve a Hb level of 8.9 g/dl. The patient developed
status epilepticus on admission. The blood pressure was elevated, and brain diffusion weighted imaging and fluid attenuated inversion recovery imaging revealed high intensity areas in the bilateral posterior and parietal lobes, right frontal lobe, and right basal ganglia. The cerebrospinal fluid
protein was elevated. The convulsions settled after continuous infusion of
thiamylal under
mechanical ventilation. Subsequently, the patient became conscious, and the brain MRI abnormalities gradually disappeared. While a number of factors such as
hypertension, medication and others have been reported as causes of
posterior reversible encephalopathy syndrome (PRES), comparatively rapid
anemia correction could also possibly precipitate PRES as like as this case. Thus
anemia correction needs to be undertaken carefully.