Andrew D Schweitzer1, Neal S Parikh2,3, Gulce Askin4, Ajay Nemade5, John Lyo6, Sasan Karimi6, Anna Knobel6, Babak B Navi2,3, Robert J Young6, Ajay Gupta5,3. 1. Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, Box 141, Office: Starr 8A-29, New York, NY, 10065, USA. ans2046@med.cornell.edu. 2. Department of Neurology, Weill Cornell Medicine, New York, NY, USA. 3. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA. 4. Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA. 5. Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, Box 141, Office: Starr 8A-29, New York, NY, 10065, USA. 6. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes. METHODS: We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge. RESULTS: We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019). CONCLUSIONS: Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes.
PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes. METHODS: We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge. RESULTS: We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019). CONCLUSIONS: Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes.
Authors: Jennifer E Fugate; Daniel O Claassen; Harry J Cloft; David F Kallmes; Osman S Kozak; Alejandro A Rabinstein Journal: Mayo Clin Proc Date: 2010-05 Impact factor: 7.616
Authors: Alejandro A Rabinstein; Jay Mandrekar; Ryan Merrell; Osman S Kozak; Olayemi Durosaro; Jennifer E Fugate Journal: J Stroke Cerebrovasc Dis Date: 2011-05-04 Impact factor: 2.136
Authors: Neal S Parikh; Andrew D Schweitzer; Robert J Young; Ashley E Giambrone; John Lyo; Sasan Karimi; Anna Knobel; Ajay Gupta; Babak B Navi Journal: J Neurol Sci Date: 2017-06-29 Impact factor: 3.181
Authors: E Lin; J E Lantos; S B Strauss; C D Phillips; T R Campion; B B Navi; N S Parikh; A E Merkler; S Mir; C Zhang; H Kamel; M Cusick; P Goyal; A Gupta Journal: AJNR Am J Neuroradiol Date: 2020-08-20 Impact factor: 3.825
Authors: Colin A Ellis; Andrew C McClelland; Suyash Mohan; Emory Kuo; Scott E Kasner; Cen Zhang; Pouya Khankhanian; Ramani Balu Journal: Neurohospitalist Date: 2018-09-27