Hemorrhage in Posterior Reversible Encephalopathy Syndrome: Imaging and Clinical Features

Hefzy, Hebah; Bartynski, Walter S.; Boardman, J.F.; Lacomis, David

doi:10.3174/ajnr.a1588

Cited by 286 publications

(267 citation statements)

References 66 publications

(87 reference statements)

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“…Minute hemorrhages as well as focal hematoma and sulcal hemorrhage can be seen with PRES. 29 Excluding patients with allogenic bone marrow transplant, we noted no correlation between blood pressure and hemorrhage in PRES. 29 Furthermore, Hefzy et al 29 found no statistical significance in the coagulation state between hemorrhagic and nonhemorrhagic patients with PRES.…”

Section: Discussionmentioning

confidence: 95%

Suspicious Neuroimaging Pattern of Thrombotic Microangiopathy

Ellchuk¹,

Shah²,

Hewlett³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:The TMAs are a group of microvascular occlusive disorders characterized by thrombocytopenia and intravascular hemolysis. Literature review reveals a spectrum of neuroimaging findings, including a single case report of multifocal hemorrhagic infarctions. We present a series of 12 patients with TMA demonstrating a similar pattern of multifocal cortical and subcortical hemorrhagic infarctions.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; AML ϭ acute myelogenous leukemia; CLL ϭ chronic lymphocytic leukemia; CNS ϭ central nervous system; CTV ϭ CT venography; DIC ϭ disseminated intravascular coagulation; DWI ϭ diffusion-weighted imaging; GRE ϭ gradient recalled-echo; HIV ϭ human immunodeficiency virus; HUS ϭ hemolytic uremic syndrome; mHTN ϭ malignant hypertension; MRI ϭ MR imaging; MRV ϭ MR venography; PRES ϭ posterior reversible encephalopathy syndrome; SWI ϭ susceptibility-weighted imaging; TMA ϭ thrombotic microangiopathy; TTP ϭ thrombotic thrombocytopenic purpura; vWF ϭ von Willebrand factor T MA was defined by Symmers in 1952 1 as a lesion of arteriole and capillary wall thickening with swelling or detachment of endothelial cells from the basement membrane, accumulation of material in the subendothelial space, and lodging of fibrin-platelet thrombi at the arteriocapillary junction.2 The mechanical injury to erythrocytes results in intravascular hemolysis and schistocytosis. The intraluminal platelet thrombosis results in partial or complete obstruction of the vessel lumina.

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Section: Discussionmentioning

confidence: 95%

Suspicious Neuroimaging Pattern of Thrombotic Microangiopathy

Ellchuk¹,

Shah²,

Hewlett³

et al. 2011

AJNR Am J Neuroradiol

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“…Hemorrhage in PRES is described in 5%-17% of patients, 57,59 with 3 different almost equally distributed patterns: parenchymal hematoma, minute hemorrhages (Ͻ5 mm), and cSAH. The mechanism is unclear, probably due to reperfusion lesions or rupture of pial vessels secondary to severe hypertension and impaired cerebral autoregulation.…”

Section: 52mentioning

confidence: 99%

“…PRES PRES (Fig 7) is a clinical and neuroradiologic entity of various origins, characterized by a variety of symptoms, including headache, altered mental status, visual loss, seizures, and loss of consciousness. [54][55][56][57] CT and MR imaging typically demonstrate bilateral predominantly posterior cerebral edema, which is usually shown on DWI to be of vasogenic origin. 55,56 When present, the cytotoxic edema is reported to be associated with an adverse outcome.…”

Section: 52mentioning

confidence: 99%

Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage

Cuvinciuc¹,

Viguier²,

Calvière³

et al. 2010

AJNR Am J Neuroradiol

128

108

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SUMMARY:Our aim was to review the etiologic background of isolated acute nontraumatic cSAH. While SAH located in the basal cisterns originates from a ruptured aneurysm in approximately 85% of cases, a broad spectrum of vascular and even nonvascular pathologies can cause acute nontraumatic SAH along the convexity. Arteriovenous malformations or fistulas, cortical venous and/or dural sinus thrombosis, and distal and proximal arteriopathies (RCVS, vasculitides, mycotic aneurysms, Moyamoya, or severe atherosclerotic carotid disease) should be sought by noninvasive imaging methods or/and conventional angiography. Additionally, PRES may also be a source of acute cSAH. In elderly patients, cSAH might be attributed to CAA if numerous hemorrhages are demonstrated by GRE T2 images. Finally, cSAH is rarely observed in nonvascular disorders, such as abscess and primitive or secondary brain tumors.ABBREVIATIONS: CAA ϭ cerebral amyloid angiopathy; cSAH ϭ cortical subarachnoid hemorrhage; CTA ϭ CT angiography; CTV ϭ CT venography; CVT ϭ cerebral venous thrombosis; DSA ϭ digital subtraction angiography; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; Gd ϭ gadolinium; GRE T2 ϭ gradient echo T2-weighted imaging; MRA ϭ MR angiography; MRV ϭ MR venography; PRES ϭ posterior reversible encephalopathy syndrome; RCVS ϭ reversible cerebral vasoconstriction syndrome; SAH ϭ subarachnoid hemorrhage; SWI ϭ susceptibility-weighted imaging; TIA ϭ transient ischemic attack; TOF ϭ time of flight N ontraumatic (spontaneous) SAH arises in approximately 85% of cases from rupture of a saccular aneurysm at the base of the brain. Nonaneurysmal perimesencephalic hemorrhages account for another 10%.

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“…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. 39 We observed 10% maternal mortality in the present study mainly in patients who had DIC Pulmonary oedema or HELLP syndrome.…”

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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Hemorrhage in Posterior Reversible Encephalopathy Syndrome: Imaging and Clinical Features

Cited by 286 publications

References 66 publications

Suspicious Neuroimaging Pattern of Thrombotic Microangiopathy

Suspicious Neuroimaging Pattern of Thrombotic Microangiopathy

Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage

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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