Pilato Fabio, Calandrelli Rosalinda, Distefano Marisa, Panfili Marco, Della Marca Giacomo, Colosimo Cesare
UOC Neurologia, Dipartimento di scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy.
UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy.
Clin Neurol Neurosurg. 2019 Oct;185:105459. doi: 10.1016/j.clineuro.2019.105459. Epub 2019 Aug 8.
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of acute or subacute onset characterized by varied neurological symptoms including headache, impaired visual acuity or visual field deficits, confusion, disorders of consciousness, seizures, and motor neurological deficits. Even if recognition of severe forms of PRES has improved, mainly due to magnetic resonance imaging, pathogenesis is still unclear and management of these patients remains challenging. Moreover, prognosis is unpredictable varying from complete recovery to death and factors related to prognosis are still lacking. We studied early magnetic resonance imaging characteristics and their relationships with prognosis.
We performed a retrospective analysis in patients with clinical and neuroradiological charateristics of PRES performing magnetic resonance of the brain within 2 days of symptoms onset.
After reviewing site database of magnetic resonance imaging and clinical records compatible with PRES, 157 patients were selected. After imaging reviewing, 25 patients with clinical and neuroradiological diagnosis of PRES were enrolled, 22 (88%) females. Mean age of enrolled patients at presentation was 44.4+18.4 years (range, 21-84 years). Patients were classified according to neuroradiological characteristics such as ischemic lesions, distribution and severity of edema, hemorrhage and contrast enhancement. In our group 23 patients (92%) showed an almost complete recovery but 2 patients (8%) died during hospitalization. Outcome was significantly related with hypointensity on ADC (p = 0.002) and CE (p < 0.001).
Early MR features may be helpful in suggesting prognosis. Moreover, neuroimaging at the early stage of PRES may give new insights in pathophysiological mechanisms underlying brain damage and neurological impairment.
后部可逆性脑病综合征（PRES）是一种急性或亚急性起病的神经系统疾病，其特征为多种神经症状，包括头痛、视力受损或视野缺损、意识模糊、意识障碍、癫痫发作和运动神经功能缺损。即使由于磁共振成像技术，对严重形式的PRES的识别有所改善，但其发病机制仍不清楚，对这些患者的管理仍然具有挑战性。此外，预后不可预测，从完全康复到死亡不等，且仍缺乏与预后相关的因素。我们研究了早期磁共振成像特征及其与预后的关系。
我们对具有PRES临床和神经放射学特征且在症状发作后2天内进行脑部磁共振检查的患者进行了回顾性分析。
在查阅与PRES相符的磁共振成像部位数据库和临床记录后，选择了157例患者。经影像学检查，纳入25例临床和神经放射学诊断为PRES的患者，其中22例（88%）为女性。纳入患者就诊时的平均年龄为44.4±18.4岁（范围21 - 84岁）。根据神经放射学特征对患者进行分类，如缺血性病变、水肿的分布和严重程度、出血和对比增强情况。在我们的研究组中，23例患者（92%）几乎完全康复，但2例患者（8%）在住院期间死亡。结果与ADC图上的低信号（p = 0.002）和对比增强（p < 0.001）显著相关。
早期磁共振特征可能有助于提示预后。此外，PRES早期的神经影像学检查可能为脑损伤和神经功能障碍的病理生理机制提供新的见解。
