MR-Negative Posterior Reversible Encephalopathy Syndrome: Clinical Characteristics are Similar in Hypertensive Encephalopathy without Vasogenic Edema and Typical PRES
Abstract Body: Introduction: Posterior reversible encephalopathy syndrome (PRES) has been defined based on classic risk factors, clinical characteristics, and evidence of reversibility. Radiographic evidence of vasogenic edema, which is best seen on MRI, is considered a cornerstone of the diagnosis. Yet, severity of clinical presentation does not correlate with extent of edema on MRI. We sought to explore whether PRES can present with negative MRI by comparing clinical features between cases of PRES with classic MRI findings and cases of hypertensive encephalopathy without MRI changes. Methods: Patients diagnosed with hypertensive encephalopathy from August 1, 2008 to December 31, 2017 were identified retrospectively and matched by age (+/- 5 years) and sex in a 2:1 ratio to patients retrospectively identified as having PRES from January 1st, 2002 to November 30th, 2017. All patients had undergone MRI, and images were reviewed. A detailed review of clinical information from the medical records was performed and included analysis of presenting symptoms, risk factors, and medical history. Results: We identified 16 cases of hypertensive encephalopathy and 32 age and sex matched controls with PRES on MRI. There were no statistically significant differences in the odds of presentation with headache (OR=1.372, 95% CI [0.458, 4.106]), encephalopathy (OR=2.303, 95% CI [0.433, 12.236]), visual disturbance (OR= 0.826, 95% CI [0.185, 3.697]), or focal neurologic deficit (OR=4.000, 95% CI [0.767, 20.872]). Seizures were more common at presentation in patients with typical PRES with vasogenic edema (OR=0.082, 95% CI [0.010, 0.664]). There was no significant difference in baseline creatine (OR= 0.874, 95% CI [0.424, 1.799]), admission creatine (OR= 1.215, 95% CI [0.819, 1.803]), or odds of acute kidney injury (OR=2.90, 95% CI [0.679, 12.449]). There were no statistically significant differences in the odds of having a past medical history of malignancy (OR= 0.295, 95% CI [0.076, 1.152]), transplant (OR= 3.347, 95% CI [0.594, 18.880]), or autoimmune disease (OR= 0.400, 95% CI [0.104, 1.532]). Resolution to baseline was the norm and occurred similarly in both groups. Conclusions: Most presenting symptoms and key risk factors were not significantly different between cases of hypertensive encephalopathy without vasogenic edema on MRI and typical PRES, arguing that the diagnosis of PRES, at least in the setting of acute severe hypertension, should not depend on MRI confirmation.
Bates, Molly
( MAYO CLINIC NEUROLOGY
, Rochester
, Minnesota
, United States
)
Fugate, Jennifer
( Mayo Clinic
, Rochester
, Minnesota
, United States
)
Mandrekar, Jay
( Mayo Clinic
, Rochester
, Minnesota
, United States
)
Rabinstein, Alejandro
( MAYO CLINIC NEUROLOGY
, Rochester
, Minnesota
, United States
)
Author Disclosures:
Molly Bates:DO NOT have relevant financial relationships
| Jennifer Fugate:DO NOT have relevant financial relationships
| Jay Mandrekar:DO NOT have relevant financial relationships
| Alejandro Rabinstein:DO have relevant financial relationships
;
Advisor:Chiesi:Past (completed)
; Other (please indicate in the box next to the company name):Boehringer Ingelheim (CEC member):Active (exists now)
; Other (please indicate in the box next to the company name):Boston Scientific (CEC member):Active (exists now)
; Advisor:Shionogi:Active (exists now)
; Advisor:Ceribell:Past (completed)
Trout Amanda, Harp Jordan, Dornbos Iii David, Pennypacker Keith, Stowe Ann, Fraser Justin, Roberts Jill, Odell Christopher, Prince Christiaan, Walker Mayah, Whitnel Laura, Frank Jacqueline, Milson Nathan, Pahwa Shivani
