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Extra resources for The Neurologist Issue. Volume 17(2), pgs. 67-123
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Platelet function during and after thrombolytic therapy for acute myocardial infarction with reteplase, alteplase, or streptokinase. Circulation. 1999;100:1858–1864. 17. Nordt TK, Moser M, Kohler B, et al. Augmented platelet aggregation as predictor of reocclusion after thrombolysis in acute myocardial infarction. Thromb Haemost. 1998;80:881–886. 18. Pezzini A, Del Zotto E, Archetti S, et al. Plasma homocysteine concentration, C677 T MTHFR genotype, and 844ins68bp CBS genotype in young adults with spontaneous cervical artery dissection and atherothrombotic stroke.
To our knowledge, this is the first reported case of phentermine use associated with PRES. Case Report: A 35-year-old woman taking phentermine for weight loss presented with altered mental status and 2 witnessed generalized seizures. She was found to have large bilateral parieto-occipital hemorrhages. The radiographic imaging was consistent with PRES with hemorrhagic conversion. After treatment with anti-epileptic medication, normalization of blood pressure, and discontinuation of phentermine, the patient improved clinically.
A serum pregnancy test, factor V Leiden mutation assay, and prothrombin 20210 mutation assay were negative. Doppler evaluation of both lower extremities showed no evidence of deep venous thrombosis. The patient was treated with intravenous heparin as a bridge to oral warfarin therapy. The vaginal ring was removed. She was maintained on levetiracetam for seizure prophylaxis and had no further clinical seizures. The patient completed 11 days of inpatient rehabilitation. At discharge, she had marked improvement with mild residual weakness involving the left upper extremity and was ambulating independently.