Posterior reversible encephalopathy syndrome associated with hemorrhage.
BACKGROUND
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity characterized by headache, encephalopathy, visual disturbances, and seizures in association with reversible vasogenic edema on neuroimaging. Intracerebral hemorrhage associated with PRES (PRES-ICH) is generally considered an atypical finding.


METHODS
Retrospective case series.


RESULTS
Seven patients were identified with PRES-ICH, four males and three females. The presenting clinical symptoms included headache (2), encephalopathy (5), vision changes (2), seizures (2), and hemiparesis (1). The co-morbid conditions included acute renal dysfunction (3), solid organ transplantation (3), bone marrow transplant (1), use of calcineurin inhibitor agents (4), and pre-eclampsia (1). Neuroimaging revealed intraparenchymal hemorrhage in six patients and subarachnoid hemorrhage in one patient. Six of the seven patients with PRES-related ICH had underlying bleeding diathesis, including one patient who was anti-coagulated with a heparin drip. The mean platelet count was 82.1 x 10(3)/microl (range, 4-232 x 10(3)/microl), and the mean INR value was 2.18 (range, 0.9-6.7). Two patients died during the acute hospitalization. Among the five survivors, only two patients had good functional outcome (pre-defined as mRS < or = 1).


CONCLUSIONS
In our series, the majority of patients with PRES-ICH (85%) had an underlying bleeding diathesis or coagulopathy. Although PRES is typically considered to have a favorable prognosis, the clinical outcome of PRES with associated ICH can be more variable.
Aranas
Rosalyn M
RM
Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison St #1121, Chicago, IL 60612, USA.
Prabhakaran
Shyam
S
Lee
Vivien H
VH
D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000150:complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult