Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia‐eclampsia and other predisposing diseases

Liman, Thomas; Böhner, Georg; Heuschmann, Peter U.; Scheel, Michael; Endres, Matthias; Siebert, Eberhard

doi:10.1111/j.1468-1331.2011.03629.x

Cited by 91 publications

(78 citation statements)

References 30 publications

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“…Hypertension therefore cannot be the sole driver of injury in all cases. Indeed PRES is often encountered in the context of a systemic process such as autoimmune disease [15], organ transplantation [13,14] and pre-eclampsia [16]. These conditions share many pathophysiological features including upregulation of the acquired immune response and endothelial cell activation and/or injury.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in End-Stage Kidney Disease: Not Strictly Posterior or Reversible

2015

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Posterior reversible encephalopathy syndrome (PRES) is an uncommon clinico-radiological condition that can result in severe brain injury. The pathogenesis of cerebral vasogenic edema, the hallmark of PRES, is not fully understood. Despite its name, there is substantial heterogeneity both in terms of imaging findings and outcome. Relatively little is known about PRES in kidney disease despite the clustering of risk factors including hypertension, autoimmune disease and immunosuppression. In a retrospective observational study of incident end-stage kidney disease patients in Southwest Ireland over a ten year period, we discovered five cases of PRES representing an incidence of 0.84% in this patient population. These five cases highlight the variability in clinical presentation and the potentially life-threatening nature of this condition. We provide an in-depth review of the existing literature regarding PRES in terms of its pathogenesis and heterogeneity, as well as the experience of PRES in ESKD patients. PRES appears to be rare in the ESKD population but could be under-recognized. Marked hypertension is a cardinal risk factor in this population, associated with extracellular fluid volume expansion. Neuroimaging findings can be diverse involving both anterior and posterior circulation territories. Three of the five patients described had commenced haemodialysis within four weeks of their presentation. These patients may be particularly vulnerable to microvascular brain injury, which can be devastating. This emphasises the need for clinicians to pay meticulous attention to extracellular fluid volume control during this potentially hazardous period.

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in End-Stage Kidney Disease: Not Strictly Posterior or Reversible

2015

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“…The second theory states that cerebral vasoconstriction due to various factors results in hypoperfusion of the brain leading to ischaemia, capillary leak and vasogenic oedema. This theory explains the association of PRES with systemic diseases such as chronic kidney disease, and pre-eclampsia [10]. Many cases have been reported due to elevated blood urea in patients with CKD in the presence of normal or slightly elevated blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome (PRES); in a 5 years old, dialysis dependent child with chronic kidney disease.

Herath

Vishvanathan²,

Pinto³

2017

J. Postgrad. Inst. Med.

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“…Most of them delivered preterm (27 out of 30). The median gestational age at delivery was 34 (31)(32)(33)(34)(35)(36) weeks. In the present study, 17 (57%) patients were delivered by caesarean sections 13 (43%) patients delivered vaginally.…”

Section: Resultsmentioning

confidence: 99%

“…15 Death has been reported in up to 15 % of patients with PRES, but contributing and/or associated factors to the fatal outcomes are unclear. 36 Martin and Sighai reported that 5-12% of cases had irreversible brain damage leading to severe neurologic deficits or deaths. 37,38 Few case reports reported mortality due to haemorrhage in eclamptic women complicated with PRES.…”

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

Karanth

Gonsalves

Sheela

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: PRES can be associated with number of medical conditions and was observed frequently in patients with preeclampsia and eclampsia. Neuroimaging is important for the diagnosis of PRES. Study was conducted to find out the maternal and perinatal outcome in patients with eclampsia complicated by posterior reversible encephalopathy syndrome (PRES).Methods: This is a retrospective study done at St. Johns Medical College Bangalore, between October 2013 and October 2016. We reviewed case records of all the patients with eclampsia who underwent neuro imaging studies and a diagnosis of PRES was made. The maternal and perinatal outcomes in these women were studiedResults: In the past three years we had 55 cases of eclampsia who underwent neuroimaging studies for persistent neurological symptoms after 24 hours of MgSO4 treatment. Of these women 30 were diagnosed to have PRES. In the present study PRES was common in multiparous women and more in patients with antepartum eclamptic women. Mean age at diagnosis of PRES was 26±5.1 years. Common presenting symptoms were headache (93.3%) and vomiting (53.3%). The mean SBP/DBP was 180/110 mmHg. All patients who had recurrent seizures were controlled with MgSO4 alone. 53.3% of our patients had eclampsia related complications and 36.7% required ICU care. There were 3 maternal deaths (10%). Perinatal mortality was 20%.Conclusions: Neuroimaging in eclamptic patients with persistent neurological symptoms could help in early diagnosis of PRES and multidisciplinary approach in management could contribute significantly in reducing the maternal mortality and morbidity.

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Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia‐eclampsia and other predisposing diseases

Abstract: In our PRES cohort, we found major clinicoradiological differences between preeclampsia-eclampsia and other predisposing causes pointing toward a less severe course of disease in preeclampsia-eclampsia.

Cited by 91 publications

References 30 publications

Posterior Reversible Encephalopathy Syndrome in End-Stage Kidney Disease: Not Strictly Posterior or Reversible

Posterior Reversible Encephalopathy Syndrome in End-Stage Kidney Disease: Not Strictly Posterior or Reversible

Posterior Reversible Encephalopathy Syndrome (PRES); in a 5 years old, dialysis dependent child with chronic kidney disease.

Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

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