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VOLUME 21 , ISSUE 7 ( 2017 ) > List of Articles

SHORT COMMUNICATION

Clinical Features and Outcomes of Patients with Posterior Reversible Encephalopathy Syndrome

M. K. Renuka, A. S. Arunkumar

Keywords : critically ill, eclampsia, posterior reversible encephalopathy syndrome,Clinical features

Citation Information : Renuka MK, Arunkumar AS. Clinical Features and Outcomes of Patients with Posterior Reversible Encephalopathy Syndrome. Indian J Crit Care Med 2017; 21 (7):453-456.

DOI: 10.4103/ijccm.IJCCM_79_17

License: CC BY-ND 3.0

Published Online: 00-07-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims: The aim of this study was to study the clinical features and outcomes of patients with posterior reversible encephalopathy syndrome (PRES) admitted to the Intensive Care Unit (ICU). Subjects and Methods: All adult patients admitted to our ICU with acute onset neurologic symptoms with focal vasogenic edema on magnetic resonance imaging (MRI) were included in the study. Data were collected on demography, coexisting illness, admission severity of illness, neurological symptoms, blood pressure, treatment initiated, and MRI findings. Outcome data collected included mortality, ICU average length of stay (ALOS), number of ventilator days, and neurological disability at discharge assessed by modified Rankin scale (MRS). Results: Fourteen patients were admitted with PRES. Thirteen patients were female, and their mean age was 31.5 ± 8.3 years. Etiology of PRES included eclampsia (64.2%), lupus nephritis (21.4%), CKD (7.1%), and hypertension (n = 1 [7.1%]). The most common presenting symptom was seizure (92.8%), followed by visual disturbance (42.8%), headache (42.8%), encephalopathy (14.2%), and status epilepticus (14.2%). The Glasgow coma scale on admission was 12.3 ± 2.9. High blood pressure was seen in 12 patients 85.7%; their mean systolic and diastolic pressures were 173 ± 10.2 and 110 ± 8.6 mmHg, respectively. MRI showed that parieto-occipital region was most commonly involved (92.8%), followed by frontal lobe (42.8%). ICU ALOS was 4.35 ± 2.4 days and mean ventilator days was 1.7 ± 2.0 days. One patient (1/14 [7.4%]) died of multiorgan failure and 13 patients were discharged with no residual neurological deficit (MRS, 0). Conclusions: PRES is a potentially reversible disorder with prompt recognition and control of blood pressure.


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  1. 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.
  2. Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: Clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 2015;14:914-25.
  3. Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol 2006;27:2179-90.
  4. Furukawa M, Terae S, Chu BC, Kaneko K, Kamada H, Miyasaka K. MRI in seven cases of tacrolimus (FK-506) encephalopathy: Utility of FLAIR and diffusion-weighted imaging. Neuroradiology 2001;43:615-21.
  5. Kur JK, Esdaile JM. Posterior reversible encephalopathy syndrome – An underrecognized manifestation of systemic lupus erythematosus. J Rheumatol 2006;33:2178-83.
  6. 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.
  7. Gatla N, Annapureddy N, Sequeira W, Jolly M. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus. J Clin Rheumatol 2013;19:334-40.
  8. Ni J, Zhou LX, Hao HL, Liu Q, Yao M, Li ML, et al. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: A retrospective series of 24 patients. J Neuroimaging 2011;21:219-24.
  9. Ergün T, Lakadamyali H, Yilmaz A. Recurrent posterior reversible encephalopathy syndrome in a hypertensive patient with end-stage renal disease. Diagn Interv Radiol 2008;14:182-5.
  10. Li R, Mitchell P, Dowling R, Yan B. Is hypertension predictive of clinical recurrence in posterior reversible encephalopathy syndrome? J Clin Neurosci 2013;20:248-52.
  11. Sweany JM, Bartynski WS, Boardman JF. “Recurrent” posterior reversible encephalopathy syndrome: Report of 3 cases – PRES can strike twice! J Comput Assist Tomogr 2007;31:148-56.
  12. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65:205-10.
  13. Legriel S, Schraub O, Azoulay E, Hantson P, Magalhaes E, Coquet I, et al. Determinants of recovery from severe posterior reversible encephalopathy syndrome. PLoS One 2012;7:e44534.
  14. Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: The retrospective Berlin PRES study. J Neurol 2012;259:155-64.
  15. Postma IR, Bouma A, Ankersmit IF, Zeeman GG. Neurocognitive functioning following preeclampsia and eclampsia: A long-term follow-up study. Am J Obstet Gynecol 2014;211:37.e1-9.
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