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

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

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

References

1. Parauda SC, Zhang C, Salehi Omran S, Schweitzer AD, Murthy SB, Merkler AE,et al. Risk of stroke after posterior reversible encephalopathy syndrome. Stroke 2022;53(11):3313-9. google scholar
2. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A.,et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;22;334(8):494-500. google scholar
3. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 2008;29(6):1036-42. google scholar
4. Tek ŞÇ, Uyar AŞ, Çakıcı Z, İnal MT, Memiş D, Tekataç A, et al. Posterior reversible ensefalopati sendromu: iki olgunun sunumu. Turk J Intensive Care 2019;17:44-8. google scholar
5. Martin JN, Jr Brewer JM, Blake PG, Owens MY, LaMarca B. PP137. Posterior reversible encephalopathy syndrome (PRES) is a constant component of eclampsia. Pregnancy Hypertens 2012;2(3):314. google scholar
6. Triplett JD, Kutlubaev MA, Kermode AG, Hardy T. Posterior reversible encephalopathy syndrome (PRES): diagnosis and management. Pract Neurol 2022;22(3):183-9. google scholar
7. Stott VL, Hurrell MA, Anderson TJ. Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed. Intern Med J 2005;35(2):83-90. google scholar
8. Chao AS, Chen YL, Chang YL, Chao A, Su, SY, Wang TH. Severe pre-eclamptic women with headache: is posterior reversible encephalopathy syndrome an associated concurrent finding? BMC Pregnancy Childbirth 2020;1;20(1):336. google scholar

9. Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, et al. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology 2000;217(2):371-6. google scholar
10. Furtado A, Hsu A, La Colla L, Zuccoli G. Arterial blood pressure but not serum albumin concentration correlates with ADC ratio values in pediatric posterior reversible encephalopathy syndrome. Neuroradiology 2015;57(7):721-8. google scholar
11. Strandgaard S, Paulson OB. Cerebral autoregulation. Stroke 1984;15(3):413-6. google scholar
12. Rabinstein AA, Mandrekar J, Merrell R, Kozak OS, Durosaro O, Fugate JE. Blood pressure fluctuations in posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis 2012;21(4):254-8. google scholar
13. Akgün N, Karaman M, Başyiğit S, Yılmaz H, Özcan AA. Posterior reversible ensefalopati: 2 olgu sunumu. İstanbul Tıp Dergisi 2010;11(2): 82-5. google scholar
14. Doelken M, Lanz S, Rennert J, Alibek S, Richter G, Doerfler A. Differentiation of cytotoxic and vasogenic edema in a patient with reversible posterior leukoencephalopathy syndrome using diffusion-weighted MRI. Diagn Interv Radiol 2007;13(3):125-8. google scholar
15. Fazeli S, Noorbakhsh A, Imbesi SG, Bolar DS. Cerebral perfusion in posterior reversible encephalopathy syndrome measured with arterial spin labeling MRI. Neuroimage Clin 2022;35:103017. google scholar
16. Donaldson L, Margolin E. Posterior Reversible Encephalopathy Syndrome in Acute COVID19 Pneumonia. Can J Neurol Sci 2022;49(6):791-2. google scholar
17. Vandenbossche G, Maquet J, Vroonen P, Lambert G, Nisolle M, Kridelka F, et al. A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia. Facts Views Vis Obgyn 2016;8(3):173-7. google scholar
18. Eastabrook G, Brown M, Sargent I. The origins and end-organ consequence of pre-eclampsia. Best Pract Res Clin Obstet Gynaecol 2011;25(4):435-47. google scholar
19. Granata G, Greco A, Iannella G, Granata M, Manno A, Savastano E, Magliulo G. Posterior reversible encephalopathy syndrome--Insight into pathogenesis, clinical variants and treatment approaches. Autoimmun Rev 2015;14(9):830-6. google scholar
20. Ferraldeschi M, Tari Capone F, Di Lisi F, Patella R, Ceschim V, Cao M, et al. When a pregnancy required a neurological consultation: a case report. Clin Ter 2012;163(6):487-90. google scholar
21. Vandenbossche G, Maquet J, Vroonen P, Lambert G, Nisolle M, Kridelka F, et al. A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia. Facts Views Vis Obgyn 2016;8(3):173-7. google scholar
22. Pizon AF, Wolfson AB. Postpartum focal neurologic deficits: posterior leukoencephalopathy syndrome. J Emerg Med 2005;29(2):163-6. google scholar
23. Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg 2010;112(10):886-91. google scholar
24. Servillo G, Bifulco F, De Robertis E, Piazza O, Striano P, Tortora F, et al. Posterior reversible encephalopathy syndrome in intensive care medicine. Intensive Care Med 2007;33(2):230-6. google scholar
25. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65(2):205-10. google scholar
26. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334(8):494-500. google scholar
27. Casey SO, Sampaio RC, Michel E, Truwit C.L. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 2000;21(7):1199-206. google scholar
28. Vandenbossche G, Maquet J, Vroonen P, Lambert G, Nisolle M, Kridelka F, et al. A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia. Facts Views Vis Obgyn 2016;8(3):173-7. google scholar