title: Arterial blood pressure but not serum albumin concentration correlates with ADC ratio values in pediatric posterior reversible encephalopathy syndrome.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity affecting both adults and children characterized by neurotoxicity often in setting of hypertension coupled with distinct brain magnetic resonance imaging features. Decreased serum albumin level has been suggested to correlate with the presence of vasogenic brain edema in adult PRES. Serum albumin has thus been hypothesized to protect against neurotoxicity in PRES by reducing vasogenic brain edema through its role in maintaining plasma osmotic pressure and endothelial integrity. The purpose of our study was to investigate if such correlation between decreased serum albumin level and PRES-related vasogenic edema could be found in children.
  
  
  METHODS
  We conducted a retrospective study of 25 pediatric patients diagnosed with PRES. Underlying clinical conditions, presenting symptoms, blood pressures, and serum albumin levels at onset of symptoms were collected. Brain MR imaging studies were reviewed. We used a quantitative method to evaluate the degree of vasogenic edema by measuring apparent diffusion coefficient (ADC) values of the T2-FLAIR hyperintense brain lesions.
  
  
  RESULTS
  No significant correlation was found between serum albumin level and degree of PRES-related vasogenic edema. A significant correlation was found between elevated blood pressure and degree of vasogenic edema in the temporal lobes (p = 0.02 and 0.04, respectively) but not in the other cerebral lobes or cerebellum.
  
  
  CONCLUSIONS
  Our initial results suggest blood pressure, not serum albumin level, as a main biomarker for brain edema in children with PRES. Thus, our study does not suggest a protective role of serum albumin against PRES-related neurotoxicity in children.
authors.affiliation: Department of Radiology, Section of Neuroradiology Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Furtado
authors.forename: Ariel
authors.initials: A
authors.lastname: Hsu
authors.forename: Luca
authors.initials: L
authors.lastname: La Colla
authors.forename: Giulio
authors.initials: G
authors.lastname: Zuccoli
mesh_terms: D000293:Adolescent; D000367:Age Factors; D062186:Arterial Pressure / Q000502:physiology; D001929:Brain Edema / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D055815:Young Adult
chemical_list: D012709:Serum Albumin
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