Posterior Reversible Ensefalopati Sendromunda (PRES) Klinik Özellikler, Radyolojik Bulgular ve Hastalığın Sonuçlanmasının Değerlendirilmesi
Abstract
Giriş: Posterior reversible ensefalopati sendromu (PRES), kendine özgü klinik bulguları ve radyolojik görünümleri olan bir antitedir. Preeklampsi/eklampsi, otoimmün hastalıklar, kemoterapi, kemik iliği ve organ nakli gibi çeşitli durumlar hastalığa yatkınlık yaratmakta ve bu klinik durum görüntüleme, klinik ve laboratuvar özellikleri ile daha iyi aydınlatılmaktadır. Bu çalışmanın amacı PRES'in klinik ve radyolojik bulgularını, tanı ve hasta sonuçlanmasındaki bulguları tanımlamaktır.
Gereç ve yöntemler: Çalışmamız beş yıllık PRES vakalarının geriye dönük bir incelemesidir. Klinik muayene ve görüntüleme teknikleri ile tanı konulan hastalarda; demografik özellikler, ko-morbiditeler, spesifik tedavi ve klinik sonuç dahil olmak üzere hasta özellikleri analiz edildi.
Bulgular: Çalışmaya 2015-2020 yılları arasında PRES tespit edilen 15 hasta dahil edildi. On beş hastanın ortanca yaşı 49.9±17.0 (25-77 yıl), %33,3'ü erkek, %66,7'si kadındı. Hastaların ikisinde aktif kanser, üçünde otoimmün hastalık, dördünde peripartum dönem, ikisinde kronik böbrek yetmezliği, üçünde hipertansiyon ve diyabet gibi sistemik bir hastalık ve birinde solunum yolu enfeksiyonu vardı. Hiçbirinde kemik iliği veya organ nakli öyküsü yoktu. MR görüntülemede %100 hastada vazojenik ödem ve %33,3 oranda difüzyon kısıtlaması görüldü. BT’de ek olarak %30 oranda kanama gösterildi. Tüm hastalara antiödem ve konvülsiyon tedavisi uygulandı. Genel olarak hastalarımızın %86,6'sı erken dönemde sekelsiz iyileşti. 50 yaş ve üstü bireylerin uzun dönem iyi sonuçlanma oranları 50 yaş altı bireylere göre istatistiksel olarak anlamlı derecede düşüktü (p=0,041).
Sonuç: PRES hastalarının retrospektif analizinde genel sağ kalım oranları ve prognoz iyi olarak değerlendirildi. BT ve MRG tanıya katkıda bulunurken çok çeşitli görüntüleme bulguları görülebilir. Prognozu belirlemede hastanın yaşı önemli bir yer tutarken, diğer radyolojik veya demografik parametrelerin kısa veya uzun vadeli sonuçlara etkisi yoktur.
Keywords
bilgisayarlı tomografi manyetik rezonans görüntüleme posterior reversible ensefalopati sendrom ödem konvülsiyon hipertansiyon
References
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- 4. Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017 Aug;264(8):1608-1616.
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- 6. Gao B, Lerner A, Law M. The Clinical Outcome of Posterior Reversible Encephalopathy Syndrome. AJNR Am J Neuroradiol. 2016;37:E55–E56.
- 7. Bartynski WS, Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol, 2008; 29(6): 1036–42
- 8. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334: 494–500.
- 9. Pedraza R, Marik PE, Varon J. Posterior Reversible Encephalopathy Syndrome: A Review. Crit Care & Shock. 2009;12:135–143.
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- 14. Wagih A, Mohsen L, Rayan MM, et al. Posterior Reversible Encephalopathy Syndrome (PRES): Restricted Diffusion does not Necessarily Mean Irreversibility. Pol J Radiol. 2015 Apr 25;80:210-6.
- 15. Moon SN, Jeon SJ, Choi SS, et al. Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)? Acta Radiol. (2013) 54:1182–90.
Evaluation of Clinical Manifestations, Radiological Features, and Outcomes of Posterior Reversible Encephalopathy Syndrome (PRES)
Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a state coupled with a unique clinical and radiological appearance. Various conditions such as preeclampsia/eclampsia, autoimmune diseases, chemotherapy bone marrow and organ transplantation are foreseen and this clinical condition is better illuminated along with imaging, clinical and laboratory features. Therefore, the aim of this study is to describe the clinical and radiological manifestations, diagnosis, and outcome of PRES.
Material and methods: A retrospective review of cases of PRES over five years. Patient characteristics, including demographics, comorbidities, specific therapy, and clinical outcome, were analyzed. Diagnosis was made by clinical examination and imaging techniques.
Results: Fifteen patients detected PRES between 2015 and 2020 were included. In fifteen patients, the median age was 49.9±17.0 years (25-77 years), 33.3% were men, and 66.7% were women. Two of the patients had active cancer, none had a history of bone marrow or organ transplantation, three had autoimmune disease, four were peripartum, two had chronic renal failure, three had a systemic disease such as hypertension and diabetes, and one had respiratory infection. MR imaging showed vasogenic edema at 100% and restricted diffusions at 33,3%. CT image showed hemorrhage of 30% additionally. Antiedema and convulsion therapy was administered at 100%. Overall, 86,6% of our patients recovered without sequelae in short term. The rate of individuals aged 50 and over was statistically significantly poor in terms of long-term results compared to the group under 50 years of age individuals (p=0.041).
Conclusion: In this retrospective analysis of PRES patients, the prognosis was good. CT and MRI contribute to the diagnosis, and various imaging findings can be seen. While the patient's age has an important place in determining the prognosis, other radiological or demographic parameters do not have any effect on short-term or long-term results.
Keywords
computed tomography magnetic resonance imaging posterior reversible encephalopathy syndrome edema convulsion hypertension
References
- 1. Gewirtz AN, Gao V, Parauda SC, Robbins MS. Posterior Reversible Encephalopathy Syndrome. Curr Pain Headache Rep. 2021 Feb 25;25(3):19.
- 2. Schweitzer AD, Parikh NS, Askin G, et al. Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome. Neuroradiology. 2017 Apr;59(4):379-386.
- 3. Fugate JE, Claassen DO, Cloft HJ, et al. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85:427–432.
- 4. Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017 Aug;264(8):1608-1616.
- 5. McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904–912.
- 6. Gao B, Lerner A, Law M. The Clinical Outcome of Posterior Reversible Encephalopathy Syndrome. AJNR Am J Neuroradiol. 2016;37:E55–E56.
- 7. Bartynski WS, Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol, 2008; 29(6): 1036–42
- 8. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334: 494–500.
- 9. Pedraza R, Marik PE, Varon J. Posterior Reversible Encephalopathy Syndrome: A Review. Crit Care & Shock. 2009;12:135–143.
- 10. Washio T, Watanabe H, Ogoh S. Dynamic cerebral autoregulation in anterior and posterior cerebral circulation during cold pressor test. J Physiol Sci. 2020 Jan 29;70(1):1.
- 11. Liman TG, Bohner G, Heuschmann PU, et al. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol. (2012) 259:155– 64.
- 12. Hiremath SB, Massicotte-Tisluck K, Chakraborty S. Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome. Neurol Sci. 2022 Jul 19. Epub ahead of print. PMID: 35852658.
- 13. Bansal S, Bansal R, Goyal MK, et al. Clinical, Etiological and Imaging Profile of Posterior Reversible Encephalopathy Syndrome: A Prospective and Follow-Up Study. Ann Indian Acad Neurol. 2020 Mar-Apr;23(2):182-188.
- 14. Wagih A, Mohsen L, Rayan MM, et al. Posterior Reversible Encephalopathy Syndrome (PRES): Restricted Diffusion does not Necessarily Mean Irreversibility. Pol J Radiol. 2015 Apr 25;80:210-6.
- 15. Moon SN, Jeon SJ, Choi SS, et al. Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)? Acta Radiol. (2013) 54:1182–90.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Article |
| Authors | |
| Publication Date | February 28, 2023 |
| Submission Date | August 5, 2022 |
| Published in Issue | Year 2023 Volume: 33 Issue: 1 |
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