Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study

Abstract

Background Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus. Methods We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition. Results A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality. Conclusion PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.

Posterior Reversible Encephalopathy Syndrome in a Patient with Systemic Lupus Erythematosus: A Case Report

“…A previous study of patients hospitalized with PRES showed that PRES mostly affected women (71.7%), 87.0% of patients had hypertension and 45.5% had hypertensive crisis. 11 In another study, patients with PRES mostly presented with seizures (74.0%), encephalopathy (28.0%), headache (26.0%) and visual disturbances (20.0%), and 45.0% of patients had autoimmune diseases, including thrombotic thrombocytopenic purpura and SLE. 9 Our patient had SLE and hypertension as risk factors.…”

Hindsight is 20/20, an unexpected ocular telltale sign of bilateral renal artery dissection

“…Despite PRES being a well-known entity, it remains underdiagnosed given its variable clinical presentations. 2 For our patient, non-organic cause of vision loss was entertained and assessed with optokinetic testing given the initial vague combination of visual changes, hypertension, and renal abnormality (though our patient did eventually develop seizure after diagnosis of PRES). Nevertheless, since as high as 9.9% of patients have vision loss in PRES, 2 it is important for ophthalmologists to obtain detailed history, attend to vital signs, and consider pathology in the retro-orbital visual pathway when there is no evidence of ocular abnormality.…”

“…Indeed, visual changes is a poor diagnostic criterion for PRES and a high clinical suspicion is needed. 2 , 3 Certainly, while PRES can be reversible, it is not always the case and can in fact lead to death in 3–6% of cases secondary to intracranial hemorrhage, increased intracranial pressure, and hydrocephalus or brain stem compression from cerebral edema. 1 As a result, PRES requires prompt workup and timely management of the underlying condition.…”

Demographic Disparities in the Incidence, Clinical Characteristics, and Outcome of Posterior Reversible Encephalopathy Syndrome in the United States

“…12 Previous studies have reported varying PRES-associated mortality ranging from 2.2% to 26.9%. [12][13][14][15] However, most of these studies are limited by small sample sizes or focused on intensive care unit patients who may be sicker than the average patient. 14 Remarkably, whereas outcome after PRES is expected to be favorable, we found that <50% of patients with PRES are discharged home without assistance.…”