title: Determinants of recovery from severe posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  Few outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.
  
  
  METHODS
  70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.
  
  
  RESULTS
  Consciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOS<5 were highest glycaemia on day 1 (OR, 1.22; 95%CI, 1.02-1.45, p = 0.03) and time to causative-factor control (OR, 3.3; 95%CI, 1.04-10.46, p = 0.04), whereas GOS = 5 was associated with toxaemia of pregnancy (preeclampsia/eclampsia) (OR, 0.06; 95%CI, 0.01-0.38, p = 0.003).
  
  
  CONCLUSIONS
  By day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement.
authors.affiliation: Medical-Surgical Intensive Care Department, CH Versailles-Site André Mignot, Le Chesnay, France. slegriel@ch-versailles.fr
authors.forename: Stephane
authors.initials: S
authors.lastname: Legriel
authors.forename: Olivier
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authors.forename: Elie
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authors.forename: Nadia
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authors.forename: Bruno
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authors.lastname: Megarbane
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authors.forename: David
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authors.lastname: Schnell
authors.forename: Gaetan
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authors.lastname: Plantefeve
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Laurent
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authors.lastname: Argaud
authors.forename: Bruno
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authors.lastname: Mourvillier
authors.forename: Arnaud
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authors.lastname: Galbois
authors.forename: Ludivine
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authors.lastname: Chalumeau-Lemoine
authors.forename: Michel
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authors.lastname: Rivoal
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authors.forename: Arnaud
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authors.forename: Marc
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authors.lastname: Simon
authors.forename: Annabelle
authors.initials: A
authors.lastname: Stoclin
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pallot
authors.forename: Charlotte
authors.initials: C
authors.lastname: Arbelot
authors.forename: Martine
authors.initials: M
authors.lastname: Nyunga
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesieur
authors.forename: Gilles
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authors.lastname: Troché
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Yves-Sébastien
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authors.lastname: Cordoliani
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bedos
authors.forename: Fernando
authors.initials: F
authors.lastname: Pico
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008126:Lod Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation* / Q000628:therapy; D011225:Pre-Eclampsia; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome