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Case Reports
. 2016 Jul;31(6):415-9.
doi: 10.1177/0885066615623465. Epub 2016 Jan 5.

Assessment of Noninvasive Regional Brain Oximetry in Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome

David Y Chung  1 , Jan Claassen  2 , Sachin Agarwal  2 , J Michael Schmidt  2 , Stephan A Mayer  3
Affiliations
Case Reports

Assessment of Noninvasive Regional Brain Oximetry in Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome

David Y Chung et al. J Intensive Care Med. 2016 Jul.

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) leads to small- and large-vessel circulatory dysfunction. While aggressive lowering of elevated blood pressure is the usual treatment for PRES, excessive blood pressure reduction may lead to ischemia or infarction, particularly when PRES is accompanied by reversible cerebral vasoconstriction syndrome (RCVS). Regional cerebral oximetry using near-infrared spectroscopy is a noninvasive modality that is commonly used intraoperatively and in intensive care settings to monitor regional cerebral oxygenation (rSO2) and may be useful in guiding treatment in select cases of PRES and RCVS.

Results: We report a case of a patient with PRES complicated by infarction and RCVS where the optimal blood pressure management was unclear. A decision was made to decrease blood pressure which resulted in an improved neurological examination and increase in rSO2 from 40% to 55% in at-risk brain. Infarcted brain as determined by diffusion-weighted magnetic resonance imaging and computed tomography perfusion imaging showed no change in rSO2 during the same time period. Furthermore, there was a qualitative change in the rSO2-mean arterial pressure (MAP) relationship, suggesting an alteration in cerebrovascular autoregulation as a result of lowering blood pressure.

Conclusions: Regional cerebral oximetry can provide valuable diagnostic feedback in complicated cases of PRES and RCVS.

Keywords: brain injury; brain ischemia; hemodynamic monitoring; neurocritical care.

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Conflict of interest statement

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Magnetic resonance imaging (MRI) and computed tomography (CT) perfusion images of patient after her clinical decompensation on hospital day 17 and 22, respectively. There is an apparent diffusion coefficient (ADC) correlate to the diffusion-weighted imaging (DWI) signal (ADC map not shown). Low axial images on the left. High axial images on the right.
Figure 2
Figure 2
Conventional cerebral angiography on hospital day 18. A follow-up angiogram on hospital day 24 was largely unchanged.
Figure 3
Figure 3
Time course of arterial blood pressure and regional cerebral oxygenation (rSO2). The gap in blood pressure data represents the time at the first cerebral angiogram. The red bars, A and B, indicate the time range from which the data for Figure 4A and B were obtained. The upper and lower bounds of gray area represent systolic and diastolic blood pressure. The black line represents MAP.
Figure 4
Figure 4
Left frontal regional cerebral oxygenation (rSO2) versus MAP (A) before and (B) after clinical improvement. rSO2 in integer values. Red lines are linear regressions.
See this image and copyright information in PMC

References

    1. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494–500. - PubMed
    1. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29(6):1036–1042. - PMC - PubMed
    1. Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146(1):34–44. - PubMed
    1. Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol. 2011;68(8):1005–1012. - PubMed
    1. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008;29(6):1043–1049. - PMC - PubMed

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