Transient Blindness Due to Posterior Reversible Encephalopathy Syndrome Following Ephedra Overdose

Fouad J. Moawad, MD; Joshua D. Hartzell, MD; Timothy J. Biega, MD; Christopher J. Lettieri, MD


South Med J. 2006;99(5):511-514. 

In This Article

Abstract and Introduction


Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is most often associated with hypertensive emergencies and is characterized by seizures, mental status changes and visual disturbances. We report a case of a previously healthy young man who developed multiorgan failure and transient cortical blindness following ingestion of a performance-enhancing ephedra-based supplement. Neuroimaging findings confirmed the clinical suspicion of PRES. Radiographic abnormalities and neurologic dysfunction subsequently resolved with correction of his systolic blood pressure. This case emphasizes the need for prompt treatment and consideration of toxic ingestions in patients presenting with hypertension-related end-organ dysfunction.


The amphetamine-like properties of ephedra have been linked with several adverse effects, including seizure, myocardial infarction and hepatotoxicity.[1,2] Even at recommended doses, this agent can result in an abrupt rise of systemic blood pressure with resultant end-organ dysfunction.[1] Posterior reversible encephalopathy syndrome (PRES) is an uncommon manifestation of hypertensive emergencies that classically presents with seizures, mental status changes and visual impairment.3 We present a case of transient cortical blindness secondary to PRES following ingestion of the ephedra-based weight-loss supplements, Stacker 3 and Ripped Fuel Extreme.


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