Posterior Reversible Encephalopathy Syndrome: Clinical Differences in Patients with Exclusive Involvement of Posterior Circulation Compared to Anterior or Global Involvement

Marrone, Luiz Carlos Porcello; Martins, William Alves; Borges, Magno Tauceda; Rossi, Bruna Carvalho; Brunelli, João Pedro Farina; Vedana, Viviane; Missima, Nathalia Guarienti; Soder, Ricardo Bernardi; Marrone, A.; Costa, Jaderson Costa da

doi:10.1016/j.jstrokecerebrovasdis.2016.03.042

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…One hypothesis is that blood flow in the brain is maintained by the cerebrovascular autoregulation and an increase in blood pressure exceeding the cerebrovascular autoregulatory limits leads to vasodilation following a disruption of the blood-brain barrier and extravasation of plasma and macromolecules, presenting vasogenic rather than cytotoxic edema in MRI imaging. One research study demonstrated that mean blood pressure plays a vital role in the blood-brain barrier disruption in the evolution of a possible model of PRES ( 30 ). However, the endothelial theory rests on the assumption that the initial factor is endothelial damage secondary to systemic toxicity in immunosuppressive therapy, eclampsia, and sepsis.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome With Isolated Involving Infratentorial Structures

Xia

Wang

et al. 2018

Front. Neurol.

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Typical neuroimaging findings of posterior reversible encephalopathy syndrome include symmetrical white matter edema in subcortical white matter of bilateral occipital and parietal lobes, although variations do occur and more and more attention is being focused upon disease of infratentorial-isolated involved posterior reversible encephalopathy syndrome. In this article, we described 1 case of posterior reversible encephalopathy syndrome with isolated infratentorial brain involvement and reviewed the literature to identify an additional 36 cases in the PubMed database. We used various search terms, such as “brainstem/cerebella/spinal posterior reversible encephalopathy syndrome,” “brainstem/cerebella/spinal reversible posterior leukoencephalopathy syndrome,” “brainstem/cerebella/spinal hypertensive encephalopathy,” “infratentorial posterior reversible encephalopathy syndrome,” and “posterior reversible encephalopathy syndrome variant.” Then, we systematically analyzed the clinical and imaging characteristics of the 37 cases and found that posterior reversible encephalopathy syndrome with isolated involving infratentorial structures predominantly affect male patients compared with typical posterior reversible encephalopathy syndrome. The presence of extremely high blood pressure at onset is essential to the development of infratentorial-isolated involved posterior reversible encephalopathy syndrome. A relatively high rate of hydrocephalus and spinal cord involvement can be a distinctive feature of this kind of variant. Symptoms and outcomes are basically similar to typical posterior reversible encephalopathy syndrome.

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome With Isolated Involving Infratentorial Structures

Xia

Wang

et al. 2018

Front. Neurol.

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“…Patients with PRES can be divided into two groups: (a) exclusively in posterior zones; and (b) anterior plus posterior zones or exclusively anterior zones. 10 Patient falls in the second group, and radiological findings were consistent with generalised cerebral oedema, and a small haemorrhage and a hypodensity in the MCA and PCA territories, respectively. TCD showed evidence of increased flow velocities in both MCA and PCA.…”

Section: Discussionmentioning

confidence: 81%

Transcranial Doppler ultrasound in posterior reversible encephalopathy syndrome: A case report

Khan

2019

Anaesth Intensive Care

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I describe a case and brief discussion to illustrate the clinical utility of transcranial Doppler ultrasound in suspected posterior reversible encephalopathy syndrome. A 26-year-old female presented with headache, visual disturbance, dyspnoea and hypertension. Past medical history included heart transplantation and hypertension. Cytomegalovirus pneumonia with acute respiratory distress syndrome was diagnosed requiring mechanical ventilation and extracorporeal membrane oxygenation. A brain computed tomographic scan showed changes suggestive of posterior reversible encephalopathy syndrome. Transcranial Doppler showed increased velocities with low pulsatility index consistent with cerebral hyperaemia. After antihypertensive treatment flow velocities and computed tomography normalised with complete clinical recovery.

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“…Pregnancy-induced hypertension also has adverse effects on pregnancy outcomes. It was found that the PIH mothers all had abnormal manifestations, which is common and typical in PIH ( Marrone et al, 2016 ). The present PIH group included three infants (3/16, 18.8%) with maternal PRES.…”

Section: Discussionmentioning

confidence: 97%

“…We propose that the involved pathophysiological mechanism is related to cerebral autoregulation. When blood pressure exceeds the cerebrovascular autoregulatory limits, it might lead to unrestrained vasodilation followed by endothelial damage, disruption of the blood–brain barrier, and vasogenic edema ( Laptook et al, 2005 ; Marrone et al, 2016 ). PRES was often located in the occipital regions on the MRI.…”

Section: Discussionmentioning

confidence: 99%

“…PRES is a radio-clinical entity that is caused by an acute elevation of blood pressure above the upper limit of hemodynamic autoregulation ( Ollivier et al, 2017 ). PRES is characterized by headache, alertness impairment, seizures, and visual disturbance, and can be accompanied by vasogenic edema in the white matter ( Marrone et al, 2016 ). Iatrogenic premature birth, especially a birth at <34 weeks gestation, is known to have a higher risk of intrauterine growth restriction (IUGR) and lower birth weight (LBW) ( Lu et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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The Association Between Pregnancy-Induced Hypertension and Neonatal Cerebral Metabolism, Hemodynamics, and Brain Injury as Determined by Physiological Imaging

Lin

Zhao

et al. 2022

Front. Physiol.

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Pregnancy-induced hypertension (PIH) is common and may affect maternal and children’s healthcare. However, the neurobiological status of neonates born from mothers with PIH has yet to be elucidated. The present study employed physiological imaging to investigate the association between maternal PIH and a number of neonatal health parameters, including cerebral metabolism, hemodynamics, and pathophysiological vulnerabilities. Following the acquisition of ethical approval, we recruited 16 neonates with maternal PIH and 22 normal neonates (non-PIH) as controls. All neonates underwent magnetic resonance imaging (MRI) of the brain. Phase-contrast (PC) MRI and T2-relaxation-under-spin-tagging (TRUST) MRI were performed to determine global cerebral blood flow, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2). These physiological parameters were then compared between PIH neonates and controls. Linear regression analysis was performed to investigate the associations between maternal PIH and each of the physiological parameters. Receiver operating characteristic curves (ROCs) were used to determine whether maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) which could facilitate the diagnosis of neonatal brain injuries. PIH neonates showed significantly lower OEF (25.5 ± 8.8% vs. 32.6 ± 7.3%, P = 0.01) and CMRO2 (29.7 ± 9.4 vs. 40.9 ± 15.0 μmol/100 g/min, P = 0.01) compared to the controls. Maternal blood pressure levels [PIH or non-PIH groups, each one standard deviation (SD) increase in SBP, DBP, and MAP, respectively] were negatively associated with OEF [regression coefficient (β) = −7.9, P = 0.007; β = −4.2, P = 0.004; β = −3.6, P = 0.02; β = −4.0, P = 0.008, respectively). Furthermore, each one SD increase in maternal DBP and MAP was negatively associated with CMRO2 (β = −4.7, P = 0.03; β = −4.4, P = 0.04, respectively). The areas under the curves (AUCs) with 95% confidence intervals (CIs) for maternal SBP, DBP, and MAP were 0.90 (0.80–0.97), 0.85 (0.73–0.97), and 0.89 (0.76–0.99), respectively. The AUC values for maternal SBP, DBP, and MAP indicated good diagnostic ability for identifying neonatal brain injuries. The present study demonstrated that maternal PIH may be associated with a lower oxygen extraction and lower cerebral metabolism in neonates.

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Posterior Reversible Encephalopathy Syndrome: Clinical Differences in Patients with Exclusive Involvement of Posterior Circulation Compared to Anterior or Global Involvement

Cited by 10 publications

References 18 publications

Posterior Reversible Encephalopathy Syndrome With Isolated Involving Infratentorial Structures

Posterior Reversible Encephalopathy Syndrome With Isolated Involving Infratentorial Structures

Transcranial Doppler ultrasound in posterior reversible encephalopathy syndrome: A case report

The Association Between Pregnancy-Induced Hypertension and Neonatal Cerebral Metabolism, Hemodynamics, and Brain Injury as Determined by Physiological Imaging

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