Determinants of recovery from severe posterior reversible encephalopathy syndrome

PLoS One. 2012;7(9):e44534. doi: 10.1371/journal.pone.0044534. Epub 2012 Sep 14.

Abstract

Objective: Few outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.

Design: 70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.

Main results: Consciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOS<5 were highest glycaemia on day 1 (OR, 1.22; 95%CI, 1.02-1.45, p = 0.03) and time to causative-factor control (OR, 3.3; 95%CI, 1.04-10.46, p = 0.04), whereas GOS = 5 was associated with toxaemia of pregnancy (preeclampsia/eclampsia) (OR, 0.06; 95%CI, 0.01-0.38, p = 0.003).

Conclusions: By day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brain / pathology
  • Cohort Studies
  • Female
  • Humans
  • Lod Score
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuroimaging
  • Posterior Leukoencephalopathy Syndrome / diagnosis*
  • Posterior Leukoencephalopathy Syndrome / mortality
  • Posterior Leukoencephalopathy Syndrome / rehabilitation*
  • Posterior Leukoencephalopathy Syndrome / therapy
  • Pre-Eclampsia
  • Pregnancy
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Tomography, Emission-Computed
  • Treatment Outcome

Grant support

This study was supported by the Hospital of Versailles. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.