Albuminocytologic Dissociation in Posterior Reversible Encephalopathy Syndrome.
OBJECTIVE
To describe cerebrospinal fluid (CSF) findings in patients with posterior reversible encephalopathy syndrome (PRES) and to study its association with vasogenic edema.


METHODS
Retrospective review of 73 consecutive prospectively collected adults diagnosed with PRES from January 1, 2000, through December 31, 2014, who underwent lumbar puncture.


RESULTS
Seventy-three patients (mean age, 51±17 years), were included in the analysis; of these, 50 (69%) were women. The most common causes for PRES were hypertension (n=61 [84%]) and immunosuppression (n=22 [30%]). Renal failure was present in 42 (58%) patients. The median interval between clinical onset of PRES and CSF analysis was 1 day (interquartile range [IQR], 0-2 days). The median opening pressure was 23 cm H2O or 17 mm Hg (IQR, 18-28 cm H2O or 13-21 mm Hg), although it was available in only 27 patients. The median CSF protein level was 58 mg/dL (IQR, 44-81 mg/dL; normal value, <35 mg/dL). The median CSF protein level was higher in patients with more extensive vasogenic edema. The median white blood cell count was 1 cell/μL (IQR, 1-2 cells/μL).


CONCLUSIONS
Elevated CSF protein level without CSF pleocytosis commonly occurs in patients with PRES and is directly associated with the extent and topographical distribution of cerebral edema. Although mild CSF pleocytosis can also occur, it is an uncommon finding and may prompt consideration for further diagnostic testing.
Division of Critical Care Neurology, Wake Forest Baptist Health, Winston Salem, NC. Electronic address: sdatar@wakehealth.edu.
Sudhir
S
Datar
Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.
Tarun D
TD
Singh
Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.
Jennifer E
JE
Fugate
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Jay
J
Mandrekar
Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.
Alejandro A
AA
Rabinstein
Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.
Sara
S
Hocker
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D015170:Cerebrospinal Fluid Pressure; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007958:Leukocyte Count / Q000379:methods; D007964:Leukocytosis / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D054038:Posterior Leukoencephalopathy Syndrome / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000379:methods
D002556:Cerebrospinal Fluid Proteins