A multi-disciplinary model of risk factors for fatal outcome in posterior reversible encephalopathy syndrome

Authors

Lea M. Alhilali, 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.Follow
Arich R. Reynolds, 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.
Saeed Fakhran, 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.

Document Type

Article

Abstract

PURPOSE: 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). CONCLUSION: 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.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage (etiology, mortality, pathology); Female; Glucose (cerebrospinal fluid); Humans; Hypertension (complications, mortality); Magnetic Resonance Imaging; Male; Middle Aged; Posterior Leukoencephalopathy Syndrome (complications, etiology, mortality, pathology); Risk Assessment; Risk Factors; Young Adult

Publication Date

12-15-2014

Publication Title

Journal of the neurological sciences

E-ISSN

1878-5883

Volume

347

Issue

1-2

First Page

59

Last Page

65

PubMed ID

25271189

Digital Object Identifier (DOI)

10.1016/j.jns.2014.09.019

Recommended Citation

Alhilali, Lea M.; Reynolds, Arich R.; and Fakhran, Saeed, "A multi-disciplinary model of risk factors for fatal outcome in posterior reversible encephalopathy syndrome" (2014). Neurology. 1270.
https://scholar.barrowneuro.org/neurology/1270