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Critical Care and Emergency Medicine - Neurological Disorders - Neuroscience - Pathology


Determinants of Recovery from Severe Posterior Reversible Encephalopathy Syndrome
Published: Friday, September 14, 2012
Author: Stephane Legriel et al.

by Stephane Legriel, Olivier Schraub, Elie Azoulay, Philippe Hantson, Eric Magalhaes, Isaline Coquet, Cedric Bretonniere, Olivier Gilhodes, Nadia Anguel, Bruno Megarbane, Laurent Benayoun, David Schnell, Gaetan Plantefeve, Julien Charpentier, Laurent Argaud, Bruno Mourvillier, Arnaud Galbois, Ludivine Chalumeau-Lemoine, Michel Rivoal, François Durand, Arnaud Geffroy, Marc Simon, Annabelle Stoclin, Jean-Louis Pallot, Charlotte Arbelot, Martine Nyunga, Olivier Lesieur, Gilles Troché, Fabrice Bruneel, Yves-Sébastien Cordoliani, Jean-Pierre Bedos, Fernando Pico

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.

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