Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
J Neurol Sci. 2017 Sep 15;380:11-15. doi: 10.1016/j.jns.2017.06.044. Epub 2017 Jun 29.
Posterior reversible encephalopathy syndrome (PRES) is a variable cerebrovascular syndrome associated with hypertension and autoregulatory failure. Steroids have been reported to both precipitate and treat PRES. We sought to determine the prevalence of steroid therapy at the time of PRES and to assess the relationship between steroid therapy and extent of vasogenic edema.
We performed a retrospective review of radiology reports between 2008 and 2014 from two academic medical centers to identify cases of PRES. Clinical and radiographic data were collected. Descriptive statistics were used to determine the prevalence of corticosteroid therapy at the time of PRES onset and the latency from steroid initiation to PRES onset. The association between steroid therapy and extent of vasogenic edema was assessed in multiple regression models.
We identified 99 cases of PRES in 96 patients. The median age was 55years (IQR 30-65) and 74% were women. Steroid therapy at time of PRES onset was identified in 44 of 99 cases. Excluding patients on chronic therapy, the median duration of steroid exposure before PRES onset was 6 (IQR, 3-10) days. Steroid therapy was not associated with extent of vasogenic edema in unadjusted or linear and logistic regression models adjusted for age, sex, and maximum systolic blood pressure on day of onset.
Corticosteroid therapy, often of brief duration, frequently preceded the onset of PRES and was not associated with severity of vasogenic edema.
后部可逆性脑病综合征（PRES）是一种与高血压和自动调节失败相关的多变脑血管综合征。皮质类固醇被报道既可以引发也可以治疗 PRES。我们旨在确定 PRES 发病时皮质类固醇治疗的流行率，并评估皮质类固醇治疗与血管源性水肿程度之间的关系。
我们对 2008 年至 2014 年期间两个学术医疗中心的放射学报告进行了回顾性分析，以确定 PRES 病例。收集临床和影像学数据。采用描述性统计方法确定 PRES 发病时皮质类固醇治疗的流行率以及从皮质类固醇开始到 PRES 发病的潜伏期。在多元回归模型中评估皮质类固醇治疗与血管源性水肿程度之间的关系。
我们在 96 例患者中确定了 99 例 PRES 病例。中位年龄为 55 岁（IQR 30-65），74%为女性。在 99 例 PRES 发病时，有 44 例接受了皮质类固醇治疗。排除慢性治疗的患者，在 PRES 发病前皮质类固醇暴露的中位时间为 6（IQR，3-10）天。在未调整或线性和逻辑回归模型中，皮质类固醇治疗与血管源性水肿程度无关，这些模型调整了年龄、性别和发病当天的最大收缩压。
皮质类固醇治疗，通常持续时间较短，常先于 PRES 发病，且与血管源性水肿的严重程度无关。
