Posterior reversible encephalopathy syndrome: differences between pregnant and non-pregnant patients

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic entity not yet understood, that presents with transient neurologic symptoms and particular radiological findings. Few papers show the differences between pregnant and non-pregnant patients. We review the cases of 38 women diagnosed with PRES, in order to find significant differences between pregnant (18) and non-pregnant (20) patients. We found differences among the age of patients (25.83 years old in pregnant and 29.31 years old in non pregnant; P=0.001); in the mean of highest systolic blood pressure, that was higher in non-pregnant group (185:162 mmHg; P=0.121); and in creatinine levels that was higher in non-pregnant group (3.47:1.04 mg/dL; P=0.001). To our knowledge, just a few papers analyzed whether PRES syndrome presented in the same way in pregnant and non-pregnant patients. The differences and the possible pathophisiology of this syndrome still remain enigmatic.

Posterior reversible encephalopathy syndrome, preeclampsia or stroke? A diagnostic dilemma

“…The absence of these MRI characteristics in our case meant that the neurologists quickly excluded PRES as a diagnosis. Additionally, although Marrone et al described a lower average systolic blood pressure trigger in pregnant patients with PRES (162 mm Hg), as compared with non-pregnant patients with PRES (185 mm Hg),4 our patient’s systolic blood pressure did not exceed 129 at any point, again making PRES an extremely unlikely diagnosis in the presence of MRI findings which were more in keeping with an acute stroke (figure 1).…”

Multisystem Effects of Hypertensive Disorders of Pregnancy

“…41 PRES is manifested by transient neurologic symptoms, such as headache, mental status changes, visual impairment, or seizures with neuroradiologic findings of vasogenic edema in the posterior circulation of the brain. 40,42 When encountered in the setting of hypertensive disorders of pregnancy, treatment typically focuses on attenuating hypertension in an attempt to avert irreversible ischemic injury of the brain. 41…”

Malignant Posterior Reversible Encephalopathy Syndrome: A Case of Posterior Irreversible Encephalopathy Syndrome

“… 1 There are two prevailing hypotheses: cytotoxic and vasogenic. 4 5 Eclampsia, renal failure, autoimmune diseases, and chemotherapy treatment and other factors may trigger PRES. 1 5 Despite its classically favorable outcome, PRES is associated with direct mortality in 5-15% of cases.…”