title: A multi-disciplinary model of risk factors for fatal outcome in posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  To evaluate the relative impact of clinical data, imaging findings, and CSF laboratory values on clinical outcome in patients with posterior reversible encephalopathy syndrome (PRES).
  
  
  METHODS
  47 patients with PRES who underwent a lumbar puncture were retrospectively evaluated. Fatal outcome was defined as death directly ascribed to PRES toxicity. Univariate and multivariate analyses were used to evaluate the association between fatal outcome and clinical factors (demographics, PRES etiology), imaging findings (signal abnormality severity, atypical distribution, restricted diffusion, hemorrhage, enhancement, angiographic abnormalities), and lumbar puncture results (appearance, cell count, glucose, protein, culture results).
  
  
  RESULTS
  Nine patients (19.1%) had a fatal outcome. Odds of a fatal outcome increased nearly 5-fold with hemorrhage on imaging (Adjusted Odds Ratio (AOR) 4.8, 95% CI 3.8-6.0, p=0.03) and nearly doubled with low CSF glucose (AOR 1.9, 95% CI 1.5-2.5, p=0.02). Hypertensive encephalopathy as an etiology was associated with a fatal outcome (AOR 1.6, 95% CI 1.3-2.9, p=0.02), while toxemia of pregnancy was protective, with a 75% decreased risk (AOR 0.25, 95% CI 0.15-0.43, p=0.02).
  
  
  CONCLUSIONS
  Clinical, imaging, and CSF laboratory findings all influence outcome in PRES, with a low CSF glucose, hypertensive encephalopathy, and imaging findings of hemorrhage associated with increased risk of fatal outcome.
authors.affiliation: University of Pittsburgh Medical Center, Department of Radiology, Division of Neuroradiology, UPMC Presbyterian, 200 Lothrop Street, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213, United States. Electronic address: alhilalilm@upmc.edu.
authors.forename: Lea M
authors.initials: LM
authors.lastname: Alhilali
authors.affiliation: University of Pittsburgh Medical Center, Department of Radiology, Division of Neuroradiology, UPMC Presbyterian, 200 Lothrop Street, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213, United States. Electronic address: reynoldsar2@upmc.edu.
authors.forename: Arich R
authors.initials: AR
authors.lastname: Reynolds
authors.affiliation: University of Pittsburgh Medical Center, Department of Radiology, Division of Neuroradiology, UPMC Presbyterian, 200 Lothrop Street, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213, United States. Electronic address: fakhrans@upmc.edu.
authors.forename: Saeed
authors.initials: S
authors.lastname: Fakhran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications* / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005947:Glucose
keywords: CSF; Hypertension; Lumbar puncture; Magnetic resonance imaging; Microhemorrhage; Posterior reversible encephalopathy syndrome