Introduction :
Posterior reversible encephalopathy syndrome (PRES) is a rare but important disease entity that need to be recognized promptly due to its reversibility with correct clinical management of removing triggering factors. Majority of the studies of PRES are from western countries and there is little clinical series from Asian countries or regions for clinical characterization and outcome measurement.
Methodology :
Patients with diagnosis of PRES admitted between 1st January, 2006 and 31st December, 2020 were identified retrospectively from Queen Elizabeth Hospital and Tseung Kwan O Hospital. Patient records were independently reviewed by a neurologist and a neuroradiologist for ascertaining the diagnosis. Comprehensive review of patient demographics, predisposing medical conditions and factors, triggering factors, clinical features, radiological features, medication management, clinical outcome assessed by modified Rankin scale (mRS) were performed. Statistical analysis was performed to look for associations between clinical subgroups and radiological features. Univariate analysis and multivariate analysis with logistic regression were performed to look for factors associated with unfavorable clinical outcomes.
Result & Outcome :
49 patients with 50 episodes of PRES were included in the study. The mean age was 46 years (Standard deviation [SD] ±16 years), 58% are female. Mean peak systolic blood pressure is 199 mmHg (SD ±30mmHg) and mean peak diastolic blood pressure is 117mmHg (SD ±23 mmHg). Acute triggering factors included hypertension (88%), sepsis (30%), new immunosuppressive drugs/chemotherapy (14%), eclampsia/preeclampsia (12%). Chronic predisposing conditions included hypertension (40%), chronic kidney disease (40%), autoimmune disease (30%), long-term immunosuppressive drugs (20%). Clinical presentations included seizure (n=33, [66%]), altered mental status (n=24, [48%]), headache (n=15, [30%]), visual impairment (n=13, [26%]). Status epilepticus is rare (n=2, [4%]) but a possible presentation. Classical parietal-occipital region involvement in imaging is most commonly found (n=42, [84%]), followed by frontal lobe (n=15, [30%]), cerebellum (n=10, [20%]), brainstem (n=9, [18%]). Majority had favorable clinical outcome (mRS <3, n=35, [70%]). Patients with sepsis are more likely to have frontal lobe involvement (p< 0.001). Patient with sepsis is associated with unfavorable clinical outcome as defined by mRS (OR=9.4; 95% CI 1.01-87.4; P value = 0.049).
CONCLUSIONS: Clinical features and outcomes are comparable to other regions in the world. Sepsis is a statistically significant risk factor for unfavorable clinical outcome.
