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Posterior Reversible Encephalopathy Syndrome Associated with Hemorrhage

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Abstract

Background

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity characterized by headache, encephalopathy, visual disturbances, and seizures in association with reversible vasogenic edema on neuroimaging. Intracerebral hemorrhage associated with PRES (PRES-ICH) is generally considered an atypical finding.

Methods

Retrospective case series.

Results

Seven patients were identified with PRES-ICH, four males and three females. The presenting clinical symptoms included headache (2), encephalopathy (5), vision changes (2), seizures (2), and hemiparesis (1). The co-morbid conditions included acute renal dysfunction (3), solid organ transplantation (3), bone marrow transplant (1), use of calcineurin inhibitor agents (4), and pre-eclampsia (1). Neuroimaging revealed intraparenchymal hemorrhage in six patients and subarachnoid hemorrhage in one patient. Six of the seven patients with PRES-related ICH had underlying bleeding diathesis, including one patient who was anti-coagulated with a heparin drip. The mean platelet count was 82.1 × 103/μl (range, 4–232 × 103/μl), and the mean INR value was 2.18 (range, 0.9–6.7). Two patients died during the acute hospitalization. Among the five survivors, only two patients had good functional outcome (pre-defined as mRS ≤ 1).

Conclusion

In our series, the majority of patients with PRES-ICH (85%) had an underlying bleeding diathesis or coagulopathy. Although PRES is typically considered to have a favorable prognosis, the clinical outcome of PRES with associated ICH can be more variable.

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Authors and Affiliations

  1. Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison St #1121, Chicago, IL, 60612, USA

    Rosalyn M. Aranas, Shyam Prabhakaran & Vivien H. Lee

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  1. Rosalyn M. Aranas
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  2. Shyam Prabhakaran
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  3. Vivien H. Lee
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Correspondence to Vivien H. Lee.

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Aranas, R.M., Prabhakaran, S. & Lee, V.H. Posterior Reversible Encephalopathy Syndrome Associated with Hemorrhage. Neurocrit Care 10, 306–312 (2009). https://doi.org/10.1007/s12028-009-9200-5

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  • DOI: https://doi.org/10.1007/s12028-009-9200-5

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