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. 2021 Dec 25:10:53.
doi: 10.4103/abr.abr_243_19. eCollection 2021.

Prevalence and Risk Factors of Posterior Reversible Encephalopathy Syndrome in Isfahan, Iran

Behnaz Ansari  1 , Mohammad Saadatnia  1
Affiliations

Prevalence and Risk Factors of Posterior Reversible Encephalopathy Syndrome in Isfahan, Iran

Behnaz Ansari et al. Adv Biomed Res. .

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical-radiological syndrome characterized by such symptoms as headaches, altered consciousness, blurred vision, seizure, and focal neurological deficits. We herein present well-documented PRES cases and discuss the risk factors and characteristic imaging patterns of this syndrome.

Materials and methods: We prospectively examined 31 patients with PRES in Alzahra Hospital, Isfahan, Iran, and compared the underlying diseases of PRES in terms of their clinical features and cranial magnetic resonance imaging (MRI) findings.

Results: The most common underlying disease was hypertension (90.3%), followed by systemic lupus erythematosus (32.3%), preeclampsia (25.8%), chronic renal failure (22.6%), and rheumatoid arthritis (22.6%). Interestingly, we also reported heroin abuse as a possible risk factor for PRES (9.7%). The most frequent clinical signs were headaches (54.8%), seizure (54.8%), and blurred vision (35.5%). The most frequent lesions on cranial MRI were in the parieto-occipital area (87.1%), followed by the cerebellum (19.4%) and the frontal lobe (12.9%). Other abnormalities on MRI were less common. In addition, 16.1% of the study population had vasospasm on magnetic resonance arteriography (MRA). Clinical recovery was followed by radiological resolution in all the patients.

Conclusions: The clinical presentation is nonspecific, most patients present with a combination of symptoms, particularly headaches and seizure. MRI is crucial for the diagnosis of PRES, and MRA is useful in that it can identify associated vasospasm. Timely diagnosis and treatment are required to avoid a devastating outcome.

Keywords: Headache; posterior reversible encephalopathy syndrome; seizures; vasospasm.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Features of posterior reversible encephalopathy syndrome on axial fluid-attenuated inversion recovery images, showing edema in the central pons. (b) Features of posterior reversible encephalopathy syndrome on axial fluid-attenuated inversion recovery images, demonstrating edema extending into the parietal and temporal lobes, as well as within both cerebellar hemispheres
See this image and copyright information in PMC

References

    1. Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: Clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14:914–25. - PubMed
    1. Singh RR, Ozyilmaz N, Waller S, U-King-Im JM, Lim M, Siddiqui A, et al. A study on clinical and radiological features and outcome in patients with posterior reversible encephalopathy syndrome (PRES) Eur J Pediatr. 2014;173:1225–31. - PubMed
    1. Pereira PR, Pinho J, Rodrigues M, Rocha J, Sousa F, Amorim J, et al. Clinical, imagiological and etiological spectrum of posterior reversible encephalopathy syndrome. Arq Neuropsiquiatr. 2015;73:36–40. - PubMed
    1. Gao B, Lyu C, Lerner A, McKinney AM. Controversy of posterior reversible encephalopathy syndrome: What have we learnt in the last 20 years? J Neurol Neurosurg Psychiatry. 2018;89:14–20. - PubMed
    1. 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. - PubMed

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