DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161209

Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings: a study from tertiary care hospital

Amrut Mahabalshetti, Preetam B. Patil, Dhananjaya M.

Abstract


Background: Posterior reversible encephalopathy syndrome (PRES) is a syndrome with neuroimaging findings of reversible vasogenic subcortical edema without infraction. It is potentially reversible clinico-neuro-radiological syndrome featured by clinical symptoms of headache, altered mental status and seizures, visual perception defects in collaboration with radiological findings of posterior cerebral edema appearing as hypodense area on MRI and can also involve the brain stem, cerebellum and other cerebral areas. To identify the clinical associations and radiologic findings of posterior reversible encephalopathy syndrome (PRES).

Methods: One hundred twenty patients were included in the study. Demographic data, clinical history, blood pressure measurements, laboratory investigations, predisposing condition and neuroimaging were assessed. The primary etiology of PRES was determined for each case on the basis of the diagnosis of the attending clinician/s.

Results: Out of the one hundred twenty retrospectively identified cases, 98 were females and 22 were males. Mean age of the patients at presentation was 28.94 years. The most common clinical presentation was seizures, seen in 94 patients (78.3%). The most common location was the parieto-occipital 69 (57.5%), followed by temporal lobe 19 (15.8%), frontal lobe 14 (11.6%) and basal ganglia 08 (6.6%).

Conclusions: PRES is an under diagnosed condition, needs high degree of suspicion for diagnosis. In this study females are commonly affected, and most of them were in postpartum period and had good prognosis.

 


Keywords


Posterior reversible encephalopathy, Vasogenic edema, Preeclampsia

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References


Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494-500.

Kozak OS, Wijdicks EF, Manno EM, Miley JT, Rabinstein AA. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology. 2007;69:894-7.

Ishikura K, Ikeda M, Hamasaki Y, Hataya H, Nishimura G, Hiramoto R, et al. Nephrotic state as a risk factor for developing posterior reversible encephalopathy syndrome in paediatric patients with nephrotic syndrome. Nephrol Dial Transplant. 2008;23:2531-6.

Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007;131:1949-62.

Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356:411-7.

Cipolla MJ. Cerebrovascular function in pregnancy and eclampsia. Hypertension. 2007;50:14-24.

Kontos HA, Wei EP, Navari RM, Levasseur JE, Rosenblum WI, Patterson JL Jr. Responses of cerebral arteries and arterioles to acute hypotension and hypertension. Am J Physiol. 1978;234:H371-83.

Lim MH, Kim DW, Cho HS, Lee HJ, Kim HJ, Park KJ, et al. Isolated cerebellar reversible leuko-encephalopathy syndrome in a patient with end stage renal disease. Intern Med. 2008;47:43-5.

Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B. Hypertensive encephalopathy: findings on CT, MR imaging and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159(2):379-83.

Lee VH, Wijdicks EFM, Manno EM, Rabinstein AA. Clinical spectrum of Reversible posterior leukoencephalopathy syndrome. Arch neurol. 2008;65(2):205-10.

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85:427-32.

Patil VC, Agrwal V, Rajput A, Garg R, Krhirsagar K, Chaudhari V. Clinical profile and outcome of Posterior reversible encephalopathy syndrome (PRES). Ann Trop Med Public Health. 2015;8:105-12.

Cho HJ, Lee HJ. Posterior reversible encephalopathy syndrome in early postpartum woman. Hong Kong J Emerg Med. 2012;19;58-61.

Raroque HG Jr, Orrison WW, Rosenberg GA. Neurologic involvement in toxaemia of pregnancy: reversible MRI lesions. Neurology. 1990;40(1):167-9.

Mc Kinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. Am J Roentgenol. 2007;189:904-12.