Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S. Kingshighway Blvd, St. Louis, MO 63110, USA.
Neuroradiology. 2010 Oct;52(10):855-63. doi: 10.1007/s00234-009-0632-6. Epub 2009 Dec 3.
Intracranial hemorrhage (ICH) has been rarely described in the setting of posterior reversible encephalopathy syndrome (PRES). However, existing studies have even more rarely addressed the imaging pattern of PRES-related intracranial hemorrhage. The primary purpose of this study was to define the imaging characteristics of subarachnoid and intraparenchymal hemorrhage in the setting of PRES, including the location of hemorrhage with respect to the regions of parenchymal edema. We also reviewed PRES-related clinical features.
We conducted a retrospective review of 263 patients with PRES seen at our institution between 2001 and 2008, and identified patients with PRES-related hemorrhage. We reviewed clinical charts and imaging studies of these patients in detail. The clinical data studied included factors predisposing to PRES (such as hypertension, eclampsia, immunosuppressant toxicity, etc.), mean arterial pressure, and coagulation parameters. Imaging characteristics we analyzed included the amount of hemorrhage, its location, multiplicity, and spatial relationship with parenchymal edema.
We identified a total of 51 patients with PRES-related hemorrhage. The blood pressure was elevated in 80% of these patients, while 47% patients showed coagulopathy. Intraparenchymal hemorrhage (IPH) was present in 46 patients and subarachnoid hemorrhage (SAH) in 14. SAH spared basal cisterns in all patients, and was usually small in amount. IPH was often multifocal, and associated mass effect was rare. In most of the 51 patients, hemorrhage occurred near the parenchymal edema.
The prevalence of ICH in PRES was 19.4% in our series. Both SAH and IPH can occur in association with PRES, typically in a location approximating that of parenchymal edema.
颅内出血（ICH）在后部可逆性脑病综合征（PRES）的情况下很少见。然而，现有的研究对 PRES 相关颅内出血的影像学模式甚至更少关注。本研究的主要目的是定义 PRES 背景下蛛网膜下腔和脑实质出血的影像学特征，包括出血相对于实质水肿区域的位置。我们还回顾了 PRES 相关的临床特征。
我们对 2001 年至 2008 年期间在我们机构就诊的 263 例 PRES 患者进行了回顾性分析，并确定了 PRES 相关出血的患者。我们详细回顾了这些患者的临床病历和影像学研究。研究的临床数据包括促使 PRES 发生的因素（如高血压、子痫、免疫抑制剂毒性等）、平均动脉压和凝血参数。我们分析的影像学特征包括出血量、位置、多发性和与实质水肿的空间关系。
我们共确定了 51 例 PRES 相关出血的患者。这些患者中有 80%的血压升高，而 47%的患者表现出凝血障碍。46 例患者存在脑实质出血（IPH），14 例患者存在蛛网膜下腔出血（SAH）。所有患者的基底池均未累及 SAH，且量通常较小。IPH 常为多灶性，且很少有占位效应。在我们的 51 例患者中，大多数出血发生在实质水肿附近。
在我们的系列研究中，PRES 中 ICH 的患病率为 19.4%。SAH 和 IPH 均可与 PRES 同时发生，通常位于接近实质水肿的位置。
