Posterior Reversible Encephalopathy Syndrome: Clinical Differences in Patients with Exclusive Involvement of Posterior Circulation Compared to Anterior or Global Involvement.
BACKGROUND
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic syndrome not yet fully understood and characterized by transient neurologic symptoms in addition to typical radiological findings. There are only a few articles that describe the clinical differences between patients with PRES that involve carotid and vertebrobasilar circulations. Our study aims to further evaluate the differences between predominantly anterior and posterior circulation PRES.


METHODS
We review 54 patients who had received the diagnosis of PRES from 2009 to 2015. The patients were divided into 2 groups: (1) exclusively in posterior zones; and (2) anterior plus posterior zones or exclusively anterior zones. Several clinical characteristics were evaluated, including the following: age, sex, previous diseases, the neurologic manifestations, the highest blood pressure in the first 48 hours of presentation, highest creatinine level during symptoms, and the neuroimaging alterations in brain magnetic resonance imaging.


RESULTS
Mean age at diagnosis was 28.5 years old (9 men and 45 women) and mean systolic blood pressure among patients with lesions only in posterior zones was 162.1 mmHg compared to 179.2 mmHg in the anterior circulation. The most common symptoms in the 2 groups were headache and visual disturbances.


CONCLUSIONS
PRES may have several radiological features. A higher blood pressure seems to be 1 of the factors responsible for developing widespread PRES, with involvement of carotid vascular territory. This clinical-radiological difference probably occurs because of the larger number of autonomic receptors in the carotid artery in comparison to the vertebral-basilar system.
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: lcpmarrone@gmail.com.
Luiz Carlos Porcello
LCP
Marrone
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
William Alves
WA
Martins
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Magno Tauceda
MT
Borges
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Bruna Carvalho
BC
Rossi
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
João Pedro Farina
JPF
Brunelli
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Viviane Maria
VM
Vedana
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Nathalia
N
Missima
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Ricardo Bernardi
RB
Soder
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Antônio Carlos Huf
ACH
Marrone
Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Jaderson Costa
JC
da Costa
D000293:Adolescent; D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D062186:Arterial Pressure; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006706:Homeostasis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014786:Vision Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
PRES; Posterior reversible encephalopathy syndrome; blood pressure; cerebral autoregulation; cerebral edema