Posterior reversible encephalopathy syndrome: A variant of hypertensive encephalopathy

Mirza, Ayoub

doi:10.1016/j.jocn.2005.03.042

Cited by 51 publications

(47 citation statements)

References 17 publications

(9 reference statements)

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“…30 This syndrome is a variant of hypertensive encephalopathy with diverse causes, including immunosuppressive therapy, systemic lupus erythematosus, acute glomerulonephritis, and pregnancy. 31 Both hypertensive encephalopathy and PRES can arise from an acute elevation in blood pressure that overcomes the myogenic vasoconstriction of cerebral arteries and arterioles causing loss of autoregulatory capacity, BBB disruption, and vasogenic edema. 8,[12][13][14][15] The concept that eclampsia can cause PRES has arisen from numerous similarities in clinical presentation including comparable imaging findings on computed tomography and MRI, 3,5,18,[31][32][33] the same neurologic symptoms (headache, vomiting, cortical blindness, and seizures), 3,9,16,17 and the prompt reversibility of symptoms after blood pressure has been restored.…”

Section: Eclampsia As a Form Of Posterior Reversible Encephalopathy Smentioning

confidence: 99%

“…3,9 The difference between hypertensive encephalopathy and PRES is that PRES can develop without a significant elevation in blood pressure. 31 In fact, eclampsia can occur at blood pressures that are considerably lower than those reported for hypertensive encephalopathy (discussed below), 31,34 making the designation of PRES more appropriate. The occurrence of cerebral edema and neurologic complications at normal blood pressures during eclampsia suggests that autoregulatory breakthrough is not necessary but may be more related to diminished autoregulatory capacity or enhanced BBB permeability (because of either normal pregnancy or endothelial damage, discussed below) or a combination of both.…”

Section: Eclampsia As a Form Of Posterior Reversible Encephalopathy Smentioning

confidence: 99%

“…4,14,[31][32][33] In addition, many women who develop eclampsia do so at pressures that are considerably lower than those reported for PRES or hypertensive encephalopathy, 23,31,78 -80 suggesting that the autoregulatory curve is shifted to the lower range of pressures during pregnancy or that autoregulatory capacity is severely affected (Figure 2). A shift in the autoregulatory curve would promote breakthrough at considerably lower pressures and may explain the development of edema without a significant elevation in pressure in some eclamptic women.…”

Section: Autoregulation During Pregnancy and Eclampsiamentioning

confidence: 99%

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Cerebrovascular Function in Pregnancy and Eclampsia

2007

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Section: Eclampsia As a Form Of Posterior Reversible Encephalopathy Smentioning

confidence: 99%

Section: Eclampsia As a Form Of Posterior Reversible Encephalopathy Smentioning

confidence: 99%

Section: Autoregulation During Pregnancy and Eclampsiamentioning

confidence: 99%

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Cerebrovascular Function in Pregnancy and Eclampsia

2007

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“…[9][10][11] However various studies have demonstrated that the primary pathology behind the neurological symptoms is posterior reversible encephalopathy (PRES). [12][13][14] This syndrome represents a type of hypertensive encephalopathy and has been postulated to result from acute elevations in arterial blood pressure resulting in autoregulatory breakthrough in cerebral circulation leading to blood brain barrier (BBB) disruption and vasogenic edema. [12][13][14] Our study aims at identifying the nature and distribution of the cranial lesions on magnetic resonance imaging in women suffering from eclampsia and severe preeclampsia, and also correlate these findings with clinical and laboratory data obtained from these patients.…”

Section: Discussionmentioning

confidence: 99%

Cranial MR Imaging in Eclampsia and Severe Preeclampsia: A Prospective Study

Sharma¹,

Joshi²,

Purohit³

et al. 2014

jemds

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BACKGROUND: This study was planned with an aim to identify the nature and distribution of cranial lesions on magnetic resonance imaging (MRI) and its correlation with clinical and laboratory data in eclampsia and severe preeclampsia. MATERIAL AND METHODS: 40 patients admitted for indication of severe preeclampsia or eclampsia with or without neurological signs were first stabilized and then underwent cranial MRI. Following MRI they were divided into two groups; Group MP (n=24) including patients with positive finding on the cranial MRI and Group MN (n=16) which included patients with normal Cranial MR imaging. Nature and distribution of the lesions were documented and statistical comparison was made on the basis of clinical findings, arterial blood pressure and laboratory data in both the groups. Patient with cerebral changes in the MRI were also called back for repeat MRI postnatal after two 2 months. RESULTS: Out of the 40 patients who underwent cranial MRI 24 patients had cerebral changes (Group MP) whereas 16 patients had normal scan (Group MN). In 21 out of 24 (87.5%) MRI finding positive patients the finding was consistent with diagnosis of posterior reversible encephalopathy syndrome (PRES). The most commonly involved areas in patients with PRES were parietal (85.7%,), frontal (71.42%) and occipital lobe (71.42), followed by temporal lobe (38.09) and basal ganglia (33.33) and cerebellum. All the patients who were diagnosed with PRES had a normal MR scan on the follow up at two months after the initial presentation. There was a significantly greater incidence of seizures and neurological disturbances in patients with positive MRI findings as compared to patients with no MRI findings (p<0.001). There was no statistical difference between the blood pressure measurements of the two groups. Markers of endothelial dysfunction like Serum LDH (p=0.002) Serum creatinine (p=0.006) and abnormal red blood cell morphology (0.002) was significantly higher in patients with positive MRI findings compared to MRI Finding Negative group. CONCLUSION: Our study suggests that PRES is the core component of the pathogenesis of cerebral findings of eclampsia and development of PRES is associated with endothelial dysfunction and not elevated blood pressure alone.

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“…The difference between hypertensive encephalopathy and PRES is that PRES can develop without a significant elevation in blood pressure (3) Detecting the cause and pathogenesis is of great importance in directing therapy. If spasm induced thrombosis & ischemia is the cause, so cytotoxic edema is responsible for the radiological findings and a clinician might tend to decrease intracranial pressure to maintain cerebral perfusion or to prescribe anticoagulant to prevent ischemic events.…”

Section: Introduction Reeclampsia (Pe)mentioning

confidence: 99%

The Dilemma of the Unusual Distribution of MR Encephalopathy in Pre-Eclamptic/Eclamptic Female Patients : Detection and Pitfalls

Abdulmonaema¹,

Almolla²,

Almassrya³

et al. 2015

Zagazig University Medical Journal

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Purposes: To evaluate the MRI findings in pre-eclamptic/ eclamptic encephalopathy and to evaluate the usefulness of diffusion weighted MRI (DW-MRI) as an imaging tool and its prognostic implication in changing treatment protocol. Patients & methods: Prospective study included24 patients, diagnosed clinically as preeclampsia (14 cases) and eclampsia in (10 cases). Their ages ranged from 25 to 45 years with mean age of 35.6 years. They examined on a standard 1.5 Tesla MR unit. Initially conventional T2 and FLAIRimages were done followed by Diffusion weighted imaging . Results: All 24 patients were acutely hypertensive at presentation. All patients develop abnormal increased signal on T2 and FLAIR sequences predominantly involving the posterior circulation. 20 ofthese patients demonstrate increased SI on diffusion weighted images denoting vasogenic edema while only 4 patients showed corresponding low signal on DW-MRI (cytotoxic edema). Follow up study confirmed the resolution of the lesions (in 20 patients) successfully with reversible neurologic impairment while those 4 patients with cytotoxic edema pattern,they develop permanent T2 / FLAIR hyper intense signal and neurological impairment. Conclusion: Involvement of the parietal and occipital lobes is common in patients with eclampsia, and the signal abnormalities on MRI are reversible if recognized and treated early.DWI can correlates well with the patient's outcome, and should be performed in all eclamptic patients and that may affect greatly their management.

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Posterior reversible encephalopathy syndrome: A variant of hypertensive encephalopathy

Cited by 51 publications

References 17 publications

Cerebrovascular Function in Pregnancy and Eclampsia

Cerebrovascular Function in Pregnancy and Eclampsia

Cranial MR Imaging in Eclampsia and Severe Preeclampsia: A Prospective Study

The Dilemma of the Unusual Distribution of MR Encephalopathy in Pre-Eclamptic/Eclamptic Female Patients : Detection and Pitfalls

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