Posterior Reversible Encephalopathy Syndrome: Associated Clinical and Radio logic Findings
Posterior Reversible Encephalopathy Syndrome: Associated Clinical and Radio logic Findings
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DOI：
10.4065/mcp.2009.0590
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发表时间：
2010-05-01
影响因子：
8.9
通讯作者：
Rabinstein, Alejandro A.
中科院分区：
文献类型：
--
作者：
Fugate, Jennifer E.;Claassen, Daniel O.;Rabinstein, Alejandro A.
目的：为了确定和定义可逆性后部脑病综合征（PRES）的临床相关性和放射学表现，患者和方法：2005年10月1日至2009年4月30日前瞻性诊断为PRES的患者与1999年8月1日至2005年9月30日收治的回顾性识别患者合并。我们对临床信息进行了详细的回顾，包括人口统计学、症状、病史和风险因素。所有患者均接受了脑计算机断层扫描或磁共振成像。结果：我们在113例患者（平均年龄48岁）中确定了120例PRES。平均收缩压峰值为199 mm Hg（最小-最大，160-268 mm Hg），平均舒张压峰值为109 mm Hg（最小-最大，60-144 mm Hg）。PRES的病因包括高血压（n=69 [61%]）、细胞毒性药物（n=21 [19%]）、败血症（n=8 [7%]）、先兆子痫或子痫（n=7 [6%]）和多器官功能障碍（n=1 [1%]）。51例患者（45%）存在自身免疫性疾病。临床表现包括癫痫发作（n=84 [74%]）、脑病（n=32 [28%]）、头痛（n=29 [26%]）和视力障碍（n=23 [20%]）。在115例（109例患者）有可用的磁共振成像结果的病例中，顶枕区最常受累（n=108 [94%]），其次是额叶（n=88 [77%]）、颞叶（n=74 [64%]）和小脑（n=61 [53%]）。小脑受累在有自身免疫史的患者中更常见（P= 0.008），脓毒症患者更可能有皮质受累（P
OBJECTIVE: To identify and define clinical associations and radiologic findings of posterior reversible encephalopathy syndrome (PRES).PATIENTS AND METHODS: Patients prospectively diagnosed as having PRES from October 1, 2005, through April 30, 2009, were pooled with retrospectively identified patients admitted from August 1, 1999, through September 30, 2005. We performed a detailed review of clinical information, including demographics, presenting symptoms, medical history, and risk factors. All patients underwent computed tomography of the brain or magnetic resonance imaging. Findings on magnetic resonance imaging were analyzed independently by 2 neuroradiologists.RESULTS: We identified 120 cases of PRES in 113 patients (mean age, 48 years). Mean peak systolic blood pressure was 199 mm Hg (minimum-maximum, 160-268 mm Hg), and mean peak diastolic blood pressure was 109 mm Hg (minimum-maximum, 60-144 mm Hg). Etiologies of PRES included hypertension (n=69 [61%]), cytotoxic medications (n=21 [19%]), sepsis (n=8 [7%]), preeclampsia or eclampsia (n=7 [6%]), and multiple organ dysfunction (n=1 [1%]). Autoimmune disease was present in 51 patients (45%). Clinical presentations included seizures (n=84 [74%]), encephalopathy (n=32 [28%]), headache (n=29 [26%]), and visual disturbances (n=23 [20%]). In the 115 cases (109 patients) for which magnetic resonance imaging findings were available, the parieto-occipital regions were the most commonly involved (n=108 [94%]), followed by the frontal lobe (n=88 [77%]), temporal lobe (n=74 [64%]), and cerebellum (n=61 [53%]). Cerebellar involvement was significantly more frequent in patients with a history of autoimmunity (P=.008), and patients with sepsis were more likely to have cortical involvement (P