IS WHAT WE KNOW ABOUT POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) TRUE?

Year 2023, Volume: 6 Issue: 2, 143 - 148, 26.06.2023

Özlem Karabay Akgül , Erhan Okuyan , Evrim Ebru Kovalak , Güzide Ece Akıncı , Mehmet Salih Sevdi , Hakan Güraslan , Nurşen Kurtoğlu Aksoy , Neşe Hayırlıoğlu

https://doi.org/10.26650/JARHS2023-1226562

Abstract

Objective: The aim of this study is to evaluate the risk factors and clinical course in cases of posterior reversible encephalopathy syndrome (PRES).
Material and Methods: In this study, we retrospectively reviewed the data of pregnant or puerperal women diagnosed with PRES in the tertiary center emergency obstetrics outpatient clinic and intensive care unit between 2017 and 2022. All patients were evaluated by obstetrics, neurology, ophthalmology, radiology, and intensive care physicians, and blood tests and imaging were performed in the same center. Application complaints, laboratory values, imaging methods, comorbidities, mode of delivery, and postpartum period were evaluated for each patient.
Results: In five years, a total of seven patients were diagnosed with PRES based on imaging methods and clinical findings. One of these patients had PRES twice, three years apart. Six of them presented with eclampsia. One patient was diagnosed with PRES postpartum in the first week, while other patients were diagnosed at pregnancy. Four patients had blurred vision, two patients had blindness, and one patient had no visual complaints. Three of the patients had mood changes (one patient confused, two patients agitated). One of the patients had diabetes mellitus (DM), which was known and treated with oral antidiabetics. One patient was under follow-up and treatment because of hypertension (HT) that started before pregnancy and three patients were under follow-up due to hypertension that started during pregnancy. There was no known additional disease in one patient. The delivery week of the patients was between 28 and 34 weeks of gestation. Pathological laboratory values were most frequently seen in LDH, albumin, and protein values. Every patient was discharged with outpatient follow-up. Epilepsy continues in one patient, HT in two patients, and isolated nephropathy in one patient after PRES.
Conclusion: PRES should be considered especially in pregnant women with neurological symptoms including visual impairment and headache. Clinical suspicion and neuroimaging are required for the diagnosis of PRES.

Keywords

PRES, eclampsia, blindness, visual changes

Project Number

Yoktur

POSTERİOR REVERSİBL ENSEFALOPATİ SENDROMU (PRES) HAKKINDA BİLDİKLERİMİZ DOĞRU MU?

Abstract

Amaç: Bu çalışmanın amacı posterior reversible ensefalopati sendromunun (PRES) risk faktörlerini ve klinik gidişatı değerlendirmektir.
Gereç ve Yöntem: Bu çalışmada 2017-2022 yılları arasında tersiyer bir sağlık merkezinin acil kadın doğum polikliniği ve yoğun bakım ünitesinde PRES tanısı almış gebe veya lohusalara ait veriler retrospektif olarak incelendi. Tüm hastalar kadın doğum, nöroloji, göz, radyoloji ve yoğun bakım hekimleri tarafından değerlendirildi, kan tahlilleri ve görüntülemeleri aynı sağlık kuruluşunda yapıldı. Her hastanın başvuru şikâyetleri, laboratuvar değerleri, görüntüleme yöntemleri, eşlik eden hastalıklar, doğum şekli ve doğum sonrası dönemi ile ilgili verileri kaydedildi.
Bulgular: Beş yılda görüntüleme yöntemleri ve klinik bulgulara göre toplam yedi hastaya PRES tanısı kondu. Bu hastalardan birinde üç yıl arayla iki kez PRES gelişmişti. Altı hasta eklampsi ile başvurdu. Bir hastaya postpartum ilk haftada, diğer hastalara gebelikte tanı kondu. Hastalardan 42’sinde bulanık görme, 2’sinde körlük varken 1 hastada görme şikâyeti yoktu. Hastaların 3 tanesinde yeni başlayan mood değişiklikleri (bir hastada konfüzyon, iki hastada ajite) vardı. Ek hastalık sorgulamasında hastalardan birinde bilinen diabetes mellitus (DM) vardı oral antidiyabetik kullanıyordu. Bir hasta gebelik öncesi başlayan hipertansiyon (HT), üç hasta gebelikte başlayan hipertansiyon nedeniyle takip ve tedavi altındaydı. Bir hastada bilinen ek hastalık yoktu. Hastaların doğum haftası 28-34 gebelik haftaları arasındaydı. En sık LDH, albümin ve protein değerlerinde anormal kan düzeyi saptanmıştı. Tüm hastalar ayaktan taburcu edildi. PRES sonrası bir hastada epilepsi, iki hastada HT ve bir hastada izole nefropati varlığı devam etmişti.
Sonuçlar: PRES özellikle görme bozukluğu ve baş ağrısı gibi nörolojik semptomları olan gebe ve lohusalarda akla gelmelidir ve tanı için nörogörüntüleme gereklidir.

Keywords

PRES, eklampsi, körlük, görme bozukluğu

Supporting Institution

Yoktur

Project Number

Yoktur

Thanks

Yoktur

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