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Determinants of Recovery from Severe Posterior Reversible Encephalopathy Syndrome

2012; Public Library of Science; Volume: 7; Issue: 9 Linguagem: Inglês

10.1371/journal.pone.0044534

1932-6203

Stéphane Legriel, Olivier Schraub, Élie Azoulay, Philippe Hantson, Éric Magalhaes, Isaline Coquet, Cédric Bretonnière, Olivier Gilhodes, Nadia Anguel, Bruno Mégarbane, Laurent Benayoun, David Schnell, Gaëtan Plantefève, Julien Charpentier, Laurent Argaud, Bruno Mourvillier, Arnaud Galbois, Ludivine Chalumeau-Lemoine, Michel Rivoal, François Durand, Arnaud Geffroy, Marc Simón, Annabelle Stoclin, J.-L. Pallot, Charlotte Arbelot, Martine Nyunga, Olivier Lesieur, Gilles Troché, Fabrice Bruneel, Yves‐Sebastien Cordoliani, Jean‐Pierre Bédos, Fernando Pico,

Moyamoya disease diagnosis and treatment

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.