Clinical Features and Outcomes of Patients with Posterior Reversible Encephalopathy Syndrome

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.

Keywords: Clinical features; critically ill; eclampsia; posterior reversible encephalopathy syndrome.

Figure 1

Clinical presentation of posterior reversible encephalopathy syndrome

Figure 2

(A1-3) Axial T2-weighted image and coronal T2-FLAIR showing hyperintensities of bilateral basal ganglia, parietal, occipital, and left temporal lobe. Diffusion-weighted images showing no restricted diffusion (patient with eclampsia). (B1-3) Axial T2-FLAIR showing hyperintensities involving bilateral frontal, parietal, temporal, and occipital lobes (postpartum eclampsia with blood pressure 180/110 mmHg)

Figure 3

(A1 and 2) Coronal T2-FLAIR and axial gradient-recalled echo showing abnormal signals involving bilateral parietal lobe, occipital lobe, and temporal lobe with acute intraparenchymal hemorrhage in the right temporal lobe and focal subarachnoid hemorrhage in right frontal lobe (antenatal eclampsia presented with a blood pressure of 180/120 mmHg)