Features Of Posterior Reversible Encephalopathy Syndrome Research Articles

Exploring the Spectrum: An Original Observational Study of Posterior Reversible Encephalopathy Syndrome from Tertiary Center in Kerala

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a disorder of subcortical vasogenic edema causing reversible neurologic dysfunction which includes headache, altered sensorium, seizures, and visual disturbances. It is a relatively rare disease with a myriad of nonspecific symptoms with similar presentations to that seen in other diseases such as stroke and cortical venous thrombosis. Hence, accurate diagnosis is needed for early detection to guide the management of such patients. This is a single-center retrospective study from June 2022 to May 2024 to identify the demographic profile, etiologies, imaging features, and prognosis of patients diagnosed with PRES. Materials and Methods: Diagnosis of PRES was made on the basis of clinical history, neurological examination, and magnetic resonance imaging brain after ruling out other possible differential diagnoses. The patients who satisfied Fugate et al. criteria were included in the study. The data were collected from the hospital database. Patients with alternate diagnoses were excluded from the study. Results: There were 22 patients diagnosed with PRES. There were 20 (91%) females among the cohort. Eighteen (82%) patients had headache. Fourteen (64%) patients had seizures all of which were generalized tonic–clonic seizures. All had positive imaging findings with 2 patients having leptomeningeal enhancement in the presence of normal cerebrospinal fluid findings. Blood pressure (BP) was normal in 5 (22%) patients. Most of the patients were postpartum without a prior history of hypertension or preeclampsia. Conclusion: PRES is a reversible entity with the imaging findings primarily involving the posterior part of the brain. It can also involve anterior circulation and spinal cord. Normotensive PRES is possible and should not be overlooked if the patient has all features of PRES but has normal BP. It has a female predilection with the most vulnerable state being immediate postpartum. Although recurrence is possible, PRES does not require long-term medications. Complicated PRES presents with SAH and intracranial hemorrhage.

Different Clinicoradiological Characteristics of Posterior Reversible Encephalopathy Syndrome in Pediatric Oncology and Post-Bone Marrow Transplantation Cases: A Retrospective Study.

Posterior reversible encephalopathy syndrome (PRES) is receiving increasing recognition in pediatrics. However, comparisons between PRES in pediatric oncology and post-bone marrow transplantation (BMT) are lacking. Therefore, we aimed to describe the risk factors and clinical and radiological features of PRES and investigate the differences between PRES in pediatric oncology and post-BMT. The PRES data of 13 patients from our center were combined with those of 217 cases from the PubMed, Scopus, and Web of Science databases. The patients were divided into either an oncology or a post-BMT group. We included 230 patients in the analysis, 26.1% of whom belonged to the post-BMT group. Oncology patients developed PRES at a younger age (p = 0.010) and were more likely to develop encephalopathy (p = 0.004). Systemic hypertension (S-HTN) preceding PRES occurred in 43.5% (66/154) of patients. Post-BMT patients were more likely to have S-HTN (p = 0.003). Cyclosporine levels were detected in 37 patients; 40.5% had supra-therapeutic levels. The radiological findings were atypical in 74.3% of patients, and delayed repeated imaging increased the occurrence of resolution (p = 0.004). Sixteen (7%) patients developed PRES recurrence after a median of 8 weeks, with the between-group difference being non-significant. Oncology patients were more likely to develop chronic epilepsy, while BMT patients were more likely to develop rare neurologic abnormalities (p < 0.001). In conclusion, atypical clinical presentation and imaging findings should not hinder the diagnosis of PRES. S-HTN is a risk factor, particularly in post-BMT patients. Supra-therapeutic levels of cyclosporine and previous exposure to immunosuppression did not increase the risk of recurrence.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in Late Onset Postpartum Eclampsia- A Retrospective Study

Background: Reversible posterior leukoencephalopathy syndrome (RPLS) or Posterior reversible encephalopathy syndrome (PRES) is a unique clinicoradiologic entity characterized by acute onset headache, seizures, blindness and altered mental state associated with reversible vasogenic edema of the brain. It is a major complication of eclampsia, but data on clinicoradiological features of PRES in late-onset postpartum eclampsia are scarce. The objective is to analyze the clinicoradiologic features and outcome in a cohort of late postpartum eclampsia patients with PRES. Subjects and Methods: Eighteen patients of late postpartum eclampsia with clinical as well as neuroimaging features consistent with PRES were included in this retrospective study. All had undergone magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) and apparent diffusion coefficient(ADC) mapping. Data on age, antepartum history, peak systolic and diastolic blood pressures, clinical features, time to neuroimaging, location of lesions on brain imaging and presence of associated ischemia or hemorrhage in MRI were collected and analyzed. Results: The mean age was 25.72 3.23 years. The average duration between labor and clinical symptoms was 8.5 days. 13/18 patients (72.2%) had elevated blood pressure at admission. Mean systolic and diastolic blood pressures were 143.88 (120-180) and 93.88 (80-100) mm Hg respectively. Headache was the presenting feature in 16 patients. The parieto-occipital regions were the most frequently involved followed by the cerebellum (7/18) and frontal lobe (4/18). Atypical regions were not involved. Clinical recovery had been noted in all. Conclusion: PRES associated with late postpartum eclampsia, an entity of limited awareness can present without antecedent preeclampsia. Radiological changes are the key to early diagnosis.

Predictors of posterior reversible encephalopathy syndrome in women with hypertension in pregnancy: A prospective observational study.

Posterior reversible encephalopathy syndrome (PRES) is a clinical neuro-radiologic abnormality associated with eclampsia and is diagnosed with magnetic resonance imaging (MRI). However, MRI scans to detect PRES may be difficult to obtain routinely. Thus, it would be useful to see whether standard demographic, clinical and laboratory parameters are predictive of PRES. Prospective observational cohort study. Prediction of PRES with standard parameters. 30 hypertensive pregnant women were enrolled. Brain MRI scans were performed after delivery till 7 days post-partum. Area under curves (AUC)s for clinical and laboratory parameters were generated for PRES prediction. A total of 8 women (5 with eclampsia and 3 with preeclampsia with features of severity) had PRES features in MRI. The most specific parameters for predicting PRES were age (<24 years), platelet count (<0.69 lacs/mm3), serum ALT (>129 IU/L) and AST (>55 IU/L), total bilirubin (>1.3 mg/dl), low hemoglobin (<8.7 g/dl) and presence of seizures. The most sensitive predicting parameters were serum uric acid > 5.2 mg/dl, systolic blood pressure (SBP) > 164 mm Hg, diastolic blood pressure > 100 mmHg and serum creatinine > 0.8 mg/dl. The best AUCs > 70% and good Youden indices were obtained for age < 24 years, SBP > 164 mm Hg, total bilirubin > 1.3 mg/dl, AST > 55 IU/L, hemoglobin < 8.7 mg/dl and uric acid > 5.2 mg/dl. In women with preeclampsia, younger age, raised SBP, elevated serum total bilirubin, uric acid and AST and low hemoglobin best predict PRES.

MRI Features of Posterior Reversible Encephalopathy Syndrome

Background and Purpose: Posterior Reversible Encephalopathy Syndrome (PRES) represents a clinico-radiological constellation of neurological symptoms and radiological features. The syndrome tends radiologically to be present with certain features and patterns. Our aim in this study is to investigate the PRES radiological features by which it does present in our community and to correlate the findings clinically. Methods: The MR images obtained for the 17 patients included in the study were analyzed for the PRES features and patterns. Fluid Attenuation Inversion Recovery (FLAIR) sequence was the mainly used sequence for assessment. Diffusion images with their apparent diffusion coefficient maps, T2* images, and Angiography were also utilized for further assessment and characterization. Results: Most of the cases demonstrated a bilateral involvement (94%). The regional distribution supra-tentorially included parietal and occipital affection in 94%, frontal lobe affection in 76%, and a temporal lobe affection in 71%. Infra-tentorial involvement was noted in 41% of the cases. Pattern percentages were slightly different from those available in the literature with the Holo-hemispheric Watershed pattern being the most common (35%). Conclusion: The originally described PRES features are present in the majority of the studied cases. The identified PRES patterns may reflect underlying clinical or pathological correlations, and hence can vary across communities.

Posterior reversible encephalopathy syndrome in postpartum woman: a case report

Posterior reversible encephalopathy syndrome (PRES) also known as reversible posterior leukoencephalopathy syndrome (RPLS) is a neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. PRES has been accompanied by a number of medical conditions such as hypertensive encephalopathy, preeclampsia, eclampsia, acute or chronic renal diseases, hemolytic uremic syndrome, use of cytotoxic and immunosuppressant drugs, blood transfusion, and electrolyte disturbances1. Clinical and radiological features of PRES include headache, encephalopathy, seizures, cortical visual changes, and parieto-occipital white matter edema visualized on neuroimaging modalities. An association between eclampsia and PRES was first described by Hinchey et al in 19962. Low magnesium levels can augment PRES(3). The diagnosis is typically made clinically, with supportive findings on magnetic resonance imaging of the brain. The treatment of PRES depends on the underlying cause. Prompt recognition and treatment are crucial to avoid the permanent damage leading to sequelae and even mortality. Many cases resolve within 1–2 weeks of controlling the blood pressure and eliminating the inciting factor. PRES may recur in about 5-10% of cases3. In this case report, we present a pre-eclamptic pregnant woman presented with acute loss of vision and elevated blood pleasure due to PRES without seizures after delivery (which is an uncommon complication of preeclampsia.)

Posterior reversible encephalopathy syndrome due to targeted agents: vemurafinib among suspects!

Posterior reversible encephalopathy syndrome features reversible cortical neurologic dysfunction and characteristic findings on brain imaging studies. This syndrome can be caused by several agents including traditional chemotherapy and immunosuppressive drugs. Targeted therapies such as agents binding vascular endothelial growth factor/VEGFR, CD20 and cytotoxic T-cell lymphocyte antigen 4 (CTLA-4) antigens are also among the culprits. Vemurafenib is a BRAF gene inhibitor that has not been previously linked with posterior reversible encephalopathy syndrome. We report herein the first such case and believe that further studies confirming this association are warranted. We further review the existing posterior reversible encephalopathy syndrome cases associated with targeted therapies in the scientific literature.