Posterior Reversible Encephalopathy Syndrome Associated with Hemodynamic Augmentation in Aneurysmal Subarachnoid Hemorrhage
Posterior Reversible Encephalopathy Syndrome Associated with Hemodynamic Augmentation in Aneurysmal Subarachnoid Hemorrhage
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DOI：
10.1007/s12028-011-9515-x
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发表时间：
2011-06-01
影响因子：
3.5
通讯作者：
Wijdicks, Eelco F. M.
中科院分区：
文献类型：
--
作者：
Giraldo, Elias A.;Fugate, Jennifer E.;Wijdicks, Eelco F. M.
背景脑血管痉挛已成为神经科学重症监护病房（NSICU）中动脉瘤性蛛网膜下腔出血（aSAH）患者最关注的并发症。血流动力学增强常用于治疗血管痉挛引起的脑缺血。在过去5年中，在3份单一病例报告中报告了可逆性后部脑病综合征（PRES）作为血流动力学增强的并发症。我们描述了一个额外的三个病人看到在我们institution.Methods描述的临床过程中的三个病人的安全动脉瘤治疗与血流动力学增强脑vasospassion.Results我们确定了三名患者（两名女性和一名男性），年龄范围从62至70岁谁开发PRES治疗后诱导或允许动脉高压。在NSICU住院期间，病例1头痛和意识模糊加重，病例2和3意识水平下降。神经影像学与血管源性水肿的特点PRES兼容。动脉血压降低了一个完整的临床和影像分辨率PRES。结论PRES可以是一个恶化的原因，aSAH患者治疗与血流动力学增强。PRES应与脑血管痉挛引起的进展性梗死相鉴别。血压逐渐正常后，临床表现和神经影像学检查结果是可逆的。
Background Cerebral vasospasm has become the most concerning complication in patients with aneurysmal subarachnoid hemorrhage (aSAH) seen in the neurosciences intensive care unit (NSICU). Hemodynamic augmentation is frequently used to treat cerebral ischemia from vasospasm. In the last 5 years, posterior reversible encephalopathy syndrome (PRES) has been reported in three single case reports as a complication of hemodynamic augmentation. We describe an additional three patients seen in our institution.Methods Description of clinical course of three patients with a secured aneurysm treated with hemodynamic augmentation for cerebral vasospasm.Results We identified three patients (two female and one male), ranged in age from 62 to 70 years who developed PRES after treatment with induced or permissive arterial hypertension. During their NSICU stay, case 1 had worsening headache and confusion, case 2 and 3 had a decline in level of consciousness. Neuroimaging was compatible with vasogenic edema characteristic of PRES. Arterial blood pressure was reduced with a complete clinical and imaging resolution of PRES.Conclusions PRES can be a cause of deterioration in patients with aSAH treated with hemodynamic augmentation. PRES should be differentiated from evolving infarctions due to cerebral vasospasm. Clinical manifestations and neuroimaging findings are reversible after gradual normalization of blood pressure.