Posterior reversible encephalopathy syndrome associated with hemorrhage.

Abstract

BACKGROUND:

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity characterized by headache, encephalopathy, visual disturbances, and seizures in association with reversible vasogenic edema on neuroimaging. Intracerebral hemorrhage associated with PRES (PRES-ICH) is generally considered an atypical finding.

METHODS:

Retrospective case series.

RESULTS:

Seven patients were identified with PRES-ICH, four males and three females. The presenting clinical symptoms included headache (2), encephalopathy (5), vision changes (2), seizures (2), and hemiparesis (1). The co-morbid conditions included acute renal dysfunction (3), solid organ transplantation (3), bone marrow transplant (1), use of calcineurin inhibitor agents (4), and pre-eclampsia (1). Neuroimaging revealed intraparenchymal hemorrhage in six patients and subarachnoid hemorrhage in one patient. Six of the seven patients with PRES-related ICH had underlying bleeding diathesis, including one patient who was anti-coagulated with a heparin drip. The mean platelet count was 82.1 x 10(3)/microl (range, 4-232 x 10(3)/microl), and the mean INR value was 2.18 (range, 0.9-6.7). Two patients died during the acute hospitalization. Among the five survivors, only two patients had good functional outcome (pre-defined as mRS < or = 1).

CONCLUSION:

In our series, the majority of patients with PRES-ICH (85%) had an underlying bleeding diathesis or coagulopathy. Although PRES is typically considered to have a favorable prognosis, the clinical outcome of PRES with associated ICH can be more variable.

• Authors: Rosalyn M Aranas, Shyam Prabhakaran, Vivien H Lee
• Journal: Neurocritical care (Neurocrit Care) Vol. 10 Issue 3 Pg. 306-12 ( 2009) ISSN: 1541-6933 [Print] United States
• PMID: 19225908 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Cerebral Hemorrhage (diagnosis, etiology, therapy)
• Cohort Studies
• Critical Care
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Posterior Leukoencephalopathy Syndrome (complications, diagnostic imaging, pathology)
• Retrospective Studies
• Risk Factors
• Thrombocytopenia (complications)
• Tomography, X-Ray Computed
• Treatment Outcome
• Young Adult