Posterior Reversible Encephalopathy Syndrome After Transplantation: a Review

Chen, Sheng; Hu, Jun; Xu, Liang; Brandon, Dixon; Yu, Jun; Zhang, Jianmin

doi:10.1007/s12035-015-9560-0

Cited by 36 publications

(22 citation statements)

References 117 publications

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“…When promptly diagnosed and properly treated, the clinical and radiological abnormalities associated with PRES can be reversed entirely. Otherwise, some patients can progress to having hemorrhage, ischemia, massive infarction, and even death (6)(7)(8). Therefore, prompt identification of PRES is very important for the treatment and outcome of patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical and MRI Features of Posterior Reversible Encephalopathy Syndrome With Atypical Regions: A Descriptive Study With a Large Sample Size

Yang²,

Guo

et al. 2020

Front. Neurol.

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Background: Accurate diagnosis and timely treatment for posterior reversible encephalopathy syndrome (PRES) with atypical regions are very important in clinical practice. However, until now, little has been known about the clinical and MRI manifestations of this disease. Therefore, the aim of this study is to investigate the clinical and MRI features of PRES to promote clinical management and deepen our understanding of this disease. Materials and Methods: Data from six PRES patients with atypical regions were collected from our hospital. Data from another 550 cases were obtained by searching the PubMed, EMBASE and Web of Science databases with the keywords "posterior reversible encephalopathy syndrome" "PRES" "reversible posterior leukoencephalopathy" "RPLS" "hypertensive encephalopathy" "hyperperfusion encephalopathy" or "reversible posterior cerebral edema encephalopathy." The clinical and MRI features of these 556 cases were analyzed together. Results: A total of 305 patients were female, and 248 were male, with a median age of 34 years. The information on sex and age of three patients was not available. The most common symptom was headache (282/556, 50.7%), followed by altered mental status (243/556, 43.7%), seizures (233/556, 41.9%), visual disturbances (194/556, 34.9%), nausea/vomiting (130/556, 23.4%), and focal neurological deficits (101/556, 18.2%). Hypertension (425/556, 76.4%), renal diseases (152/556, 27.3%), immunosuppressant drugs (79/556, 14.2%), and chemotherapy/chemoradiotherapy (59/556, 10.6%) were the major predisposing factors. The atypical regions of the lesions were the cerebellum (331/556, 59.5%), basal ganglia (135/556, 24.3%), periventricular/deep white matter (125/556, 22.5%), pons (124/556, 22.3%), brainstem (115/556, 20.7%), thalamus (114/556, 20.5%), midbrain (48/556, 8.6%), spinal cord (33/556, 5.9%), and medulla (29/556, 5.2%). Additionally, the following typical regions were observed: occipital (278/556, 50.0%), parietal (234/556, 42.1%), frontal (150/556, 27.0%), and temporal (124/556, 22.3%) lobes. The major treatments were antihypertensives (358/515, 69.5%), antiepileptics/sedation (126/515, 24.5%), discontinuation/switching agents (67/515, Li et al. PRES With Atypical Regions 13.0%), and steroids (54/515, 10.5%). The median time of the clinical state improved and abnormal neuroimaging resolved is 2-3 weeks after appropriate treatment. Conclusion: The common symptoms of PRES with atypical regions include headaches, altered mental status, seizures, visual disturbances, nausea or vomiting, and focal neurological deficits. The frequent predisposing factors include hypertension, renal diseases, immunosuppressant drugs and chemotherapy/chemoradiotherapy. MRI features are mainly characterized by vasogenic edema in central zones always accompanied by typical regions. Most cases can be reversed in 2-3 weeks when promptly recognized and properly treated.

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Section: Introductionmentioning

confidence: 99%

Clinical and MRI Features of Posterior Reversible Encephalopathy Syndrome With Atypical Regions: A Descriptive Study With a Large Sample Size

Yang²,

Guo

et al. 2020

Front. Neurol.

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“…In addition to the endothelial dysfunction and disruption of the blood brain barrier, PRES occurs. (16)(17)(18) Out of ve patients who did not show any signi cant change nor acute lesion in the image, in this study, four patients survived with 11 ± 10 average days of ICU admission. Fifteen patients in cases of abnormalities detected in the brain image survived, the hospitalized days in the ICU was 10 ± 6 days in average.…”

Section: Discussionmentioning

confidence: 55%

Seizure After Cardiopulmonary bypass Surgery: A Retrospective Study

Kim

Jang²,

Kim³

et al. 2021

Preprint

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Background: We are to investigate prognostic factors of seizure after cardiopulmonary bypass surgery based on the incidence, the operation parameters, and the outcomes of seizure.Methods: Consecutive patients presented a seizure after a cardiac or aortic surgery using a cardiopulmonary bypass (CPB) during the admission between January 2006 and January 2019 were retrospectively enrolled. Patients with a previous seizure history were excluded. The medical records were reviewed on the demographics, associated medical conditions, laboratory, electroencephalography (EEG), and imaging findings, cardiopulmonary bypass parameters, types of seizure, and prognosis.Results: Among the 488 patients who received cardiopulmonary surgery using CPB, 29 patients were diagnosed with seizure during admission. There were nine cases of aortic valve replacement, six of mitral valve replacement, four of aorta graft, two of patent ductus arteriosus closure, coronary artery bypass graft, tricuspid annuloplasty, and tumor resection for each. The average durations of the operation and of cardiopulmonary bypass were 278±119 and 108±55 minutes, respectively. The average aortic cross clamping time was 72±41 minutes. The median detection time of a seizure was 34.38±83.37 hours after surgery. Twenty-three patients (79.3%) did not show recovery of mental status after surgery until the seizure was detected. Seventeen patients were diagnosed with status epilepticus, and two of them had nonconvulsive status epilepticus. Nine showed repetitive seizures and three presented a single seizure. EEG analysis showed five cases of spike-and-wave, four of periodic discharges, four of rhythmic delta, and one of burst suppression. From the image studies, sixteen patients showed stroke, two revealed posterior reversible encephalopathy syndrome, and two showed seizure related changes. Nine (31.0%) expired in 25±27 postoperative day. For the survived patients, the average duration of ICU admission was 9±7 days.Conclusions: Due to its difficulty of detecting preclinical seizure after the surgery, evaluation including performance of EEG in early postoperative phase should be considered.

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“…Thus, MRI is the most important tool of observing RPLS lesions. [ 11 ] Brain MRI of RPLS demonstrates bilateral asymmetric T1 hypointensities or isointensities, T2 and FLAIR hyperintensities commonly scattered throughout the parietal and occipital regions, occasionally in other areas such as the cerebellum, brain stem, basal ganglia, and the spinal cord. [ 12 – 13 ] Moreover, our report shows that the centrum ovale, paraventricular area, and corpus callosum can also be involved.…”

Section: Discussionmentioning

confidence: 99%

Reversible posterior leukoencephalopathy syndrome due to adrenal pheochromocytoma

Han

Tang

et al. 2020

Medicine

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Rationale: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neuropathic syndrome with typical clinical and radiological features. There are large amounts of risk factors resulting in RPLS, those including hypertension, eclampsia, neoplasia treatment, renal failure, systemic infections, chemotherapy, and immunosuppressive therapy after organ transplantation. Patient Concerns: A 27-year-old male patient was admitted for a 2-week history of paroxysmal tic of limbs along with consciousness disorder. Blood pressure elevation was discovered for the first time on admission, and the highest record was 210/150 mmHg during hospitalization. Neurological examinations were positive among mental state, speech, reaction and pathological reflex. The computed tomography scan of the abdomen demonstrated a mass derived from right adrenal gland. The magnetic resonance imaging of the brain showed reversible lesions in the centrum ovale, paraventricular, area and corpus callosum. Diagnoses: After control of blood pressure and rationally preoperative preparation, the mass was radically resected and verified to be pheochromocytoma by postoperative pathologic findings. He was diagnosed as having RPLS due to adrenal pheochromocytoma. Interventions: The right adrenal gland mass was completely removed after 2 weeks of α-blockers and β-blockers to treat hypertension. Outcomes: One week after surgery, the cerebral lesions of RPLS gradually faded and the blood pressure was easy to control well. Lessons: A few case reports of RPLS related to pheochromocytomas had been documented in the literature. Therefore, we believe that pheochromocytomas may be a potential risk factor of RPLS. If patients receive timely diagnosis and treatment, it can often lead to a favorable prognosis.

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Posterior Reversible Encephalopathy Syndrome After Transplantation: a Review

Cited by 36 publications

References 117 publications

Clinical and MRI Features of Posterior Reversible Encephalopathy Syndrome With Atypical Regions: A Descriptive Study With a Large Sample Size

Clinical and MRI Features of Posterior Reversible Encephalopathy Syndrome With Atypical Regions: A Descriptive Study With a Large Sample Size

Seizure After Cardiopulmonary bypass Surgery: A Retrospective Study

Reversible posterior leukoencephalopathy syndrome due to adrenal pheochromocytoma

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