Predictors of poor outcome in patients with posterior reversible encephalopathy syndrome

Purpose Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes. Methods We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge. Results We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR=4.3; 95% CI: 1.4-36.3; p=0.047) and mRS (OR=3.6; 95% CI: 1.2-10.7; p=0.019). Conclusions Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes.

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“…[18] One recent study reported mRS data, and found that 36% had a mRS score of 3–6, whereas 45% patients in our cohort had the same. [29]…”

Section: Discussionmentioning

confidence: 99%

“…However, these and other studies on this topic have been hampered by limited scope of inclusion criteria and non- standardized measures of clinical outcome. [13, 20, 16, 15, 17, 24–29…”

Section: Introductionmentioning

confidence: 99%

Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome

et al. 2017

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“…In a recent retrospective chart review, the authors found that pre-existing diabetes mellitus and corpus callosum involvement of PRES-associated lesions were strong predictors of poor outcome 55. Although the presence and degree of elevated blood pressure have been shown in many studies, these do not correlate with either the clinical outcome or MRI severity or grading of vasogenic oedema 3 7 10 56.…”

Section: Prognosismentioning

confidence: 99%

Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years?

Gao

Lyu

Lerner

et al. 2017

J Neurol Neurosurg Psychiatry

111

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Over two decades have passed since posterior reversible encephalopathy syndrome (PRES) was first described in 1996. It has becoming increasingly recognised because of improved and more readily available imaging modality. The exact pathophysiological mechanism is not completely understood and remains controversial at present. Precise diagnosis is essential to guide prompt, proper management. Our ability of differentiating it from other acute neurological disorders is likely to improve as we learnt more about the spectrum of this entity in the last 20 years. We emphasise the importance of recognising its diagnostic criteria and biomarker, which would be of great relevance to either outcome evaluation or study design. PRES has a favourable prognosis generally, but neurological sequelae and even fatalities can occur, especially in severe forms that might cause substantial morbidity and even mortality, particularly when the syndrome is complicated by intracranial haemorrhage or brain infarction. In this review, the pathophysiology, approach to diagnosis, some controversies as to the prognosis, as well as the future research direction of PRES are described.

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“…Its clinical impact can be devastating and occasionally fatal [1]. Of described cases, it is estimated that greater than one third of patients will never regain baseline neurologic function [2]. Currently there are not any well-established treatment options for PRES [3].…”

Section: Introductionmentioning

confidence: 99%

An unusual presentation of a rare disease: posterior reversible encephalopathy syndrome following abdominal sepsis

et al. 2016

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Posterior reversible encephalopathy syndrome (PRES) is an unusual disease of unknown incidence and cause. There are a wide range of associated, predisposing medical causes to include pregnancy, renal failure, immunosuppressive medication administration and hypertension. The diagnosis is made following the radiographic identification of characteristic vasogenic edema in the setting of neurologic impairment. A significant portion of patients will have long-term, if not permanent, sequelae of the disease. We present a patient who developed PRES following a hemicolectomy that was complicated by an anastomotic leak. She went on to a complete recovery following surgical treatment of the leak and supportive care.

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Predictors of poor outcome in patients with posterior reversible encephalopathy syndrome

Abstract: Large prospective studies incorporating serial blood glucose values and advanced imaging studies are required to validate these findings.

Cited by 38 publications

References 20 publications

Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome

Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome

Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years?

An unusual presentation of a rare disease: posterior reversible encephalopathy syndrome following abdominal sepsis

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