PRES: posterior or potentially reversible encephalopathy syndrome?

Narbone, M. C.; Musolino, Rosa Fortunata; Granata, Francesca; Mazzù, Ilenia; Abbate, Maria Ida; Ferlazzo, Edoardo

doi:10.1007/s10072-006-0667-y

Cited by 62 publications

(44 citation statements)

References 7 publications

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“…Most of them delivered preterm (27 out of 30). The median gestational age at delivery was 34 (31)(32)(33)(34)(35)(36) weeks. In the present study, 17 (57%) patients were delivered by caesarean sections 13 (43%) patients delivered vaginally.…”

Section: Resultsmentioning

confidence: 99%

“…Magnesium decreases neuronal excitability, protects endothelium against damage by free radicals, or reduces cerebral perfusion pressure. 7,33,34 In central nervous system it may also protect the BBB (blood brain barrier) and there by limit cerebral edema formation.…”

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

“…The outcome of pregnant women with PRES was usually reported as favorable, with resolution being rapid and complete after adequate therapy, although permanent damage can persist, and death due to hemorrhage was described. 34,35 Admission of PRES patients to the ICU is advisable, to allow optimum patient monitoring and prevention of possible complications. In the present study 53.3% of our patients had eclampsia related complications and 36.7% required ICU care as compare to study done by Manvi PJ 11% required ICU care.…”

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

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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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“…Also, reversibility of PRES may be clinically or radiologically incomplete [12], and the condition may be complicated by ischaemic or haemorrhagic stroke, and may lead to a chronic seizure disorder or to death [5]. Narbone et al [13] have argued therefore that 'potentially' should replace 'posterior' in the term.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome: a report of a case with atypical features

Pratap¹,

Down

2008

Anaesthesia

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SummaryWe report a case of a young woman presenting with profound depression of consciousness and intra-uterine death in the late stages of an unbooked pregnancy. She proceeded to develop features of cardiovascular, renal, hepatic and haematological failures. The patient was challenging to manage in view of uncertainty regarding the underlying cause, and required multidisciplinary consultation. A diagnosis was subsequently made of posterior reversible encephalopathy syndrome in the context of pre-eclampsia. We review the typical presentation and wide-ranging associations of this recently described clinico-neuroradiological syndrome, and look at how appropriate management may lead to rapid resolution of its often life-threatening features. We highlight the importance to anaesthetists and critical care physicians of recognising even atypical cases such as this one in view of key differences in management from similarly presenting conditions. Posterior reversible encephalopathy syndrome (PRES) presents with a variety of neurological features which, although devastating, are potentially reversible on prompt recognition and institution of appropriate treatment [1], but clinicians often fail to suspect it [2]. Delayed diagnosis is frequent and can lead to long-term neurological disability. We describe a case presenting as coma and intra-uterine death in the late stages of an unbooked pregnancy. This patient was challenging to manage in view of uncertainty regarding the diagnosis and particularly serious features, and required consultation and co-ordination between obstetricians, anaesthetists, intensive care physicians, radiologists, neurosurgeons and neurologists. Case reportA 20-year-old woman was brought to a maternity hospital by ambulance having been found unconscious by her flatmates. On arrival, she was unable to maintain her own airway. An oral airway was inserted. Her respiration was laboured with a rate of 10 breaths.min . The blood pressure was 220 ⁄ 120 mmHg. Capillary refill time measured over the sternum was prolonged at 5 s. There was marked generalised oedema. The Glasgow Coma Score was 4 out of 15 (Motor 1, Eyes 1, Verbal 2). Her pupils were 5 mm in diameter, equal, and reactive. Normal tone and tendon jerk reflexes were present in both upper and lower limbs. Inspection of the abdomen revealed a third trimester pregnancy (of which her friends were unaware), and contractions of early labour. Marks on her thigh were consistent with several hours lying on the floor. Vaginal examination showed that the cervix was dilated to 2 cm with fresh meconium draining. Core temperature was elevated at 38.5°C.Initial arterial blood gas analysis showed pH 7.21, P a CO 2 6.9 kPa, P a O 2 37.0 kPa and standard base excess )6.5 mmol.l . Ultrasonography revealed a fetus with no heartbeat. Urinalysis showed ‡ 20 g.dl )1 proteinuria. A working diagnosis was made of severe preeclampsia or eclampsia with an unwitnessed seizure. Possible aetiologies of the ongoing coma were considered

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“…Since then, many other therms were proposed like 'hypertension encephalopathy' (HTE), 'occipito-parietal encephalopathy' (Pavlakis et al, 1997) or 'potentially reversible encephalopathy syndrome' (Narbone et al, 2006). Casey et al first used the term 'posterior reversible encephalopathy syndrome' or PRES (Casey et al, 2000).…”

Section: Definition Of Presmentioning

confidence: 99%