Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198-8440, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Neurocrit Care. 2023 Jun;38(3):726-732. doi: 10.1007/s12028-022-01642-9. Epub 2022 Dec 1.
Posterior reversible encephalopathy syndrome (PRES) is manifested by acute neurological symptoms in patients with varied predisposing factors and characteristic findings on brain imaging. Cerebrovascular autoregulation is thought to be altered in PRES. However, it remains unclear whether cerebral hypoperfusion or hyperperfusion is the initiating event. We aimed to describe the brain perfusion status in untreated patients with PRES.
Patients with PRES who underwent cerebral perfusion studies on presentation were retrospectively identified from (1) a prospective database of patients with PRES admitted to Saint Mary's Hospital, Mayo Clinic, Rochester from January 2005 to December 2021 and (2) University of Nebraska Medical Center electronic database from January 2010 to December 2021. Demographics, past medical history, presenting symptoms, cause of PRES, and clinical outcomes were recorded. Brain imaging studies were reviewed. We recorded the location of brain lesions, the time from symptoms onset to perfusion study, blood pressure at the time of the perfusion study, and blood pressure lowering treatments.
Five patients (four women, median age 66 years) were included. Causes of PRES were acute hypertension (n = 3), perioperative blood pressure fluctuations, and treatment with pazopanib. Four patients had chronic hypertension. Presenting symptoms were encephalopathy (n = 5), focal neurological symptoms (n = 4), and seizures (n = 2). All patients underwent computed tomography (CT) perfusion performed within 12 h of symptoms onset. All but one patient was hypertensive at the time of CT perfusion. Scans showed diffuse cerebral hypoperfusion, more pronounced in the corona radiata and areas with brain edema. No patient had critical cerebral ischemia or arterial vasoconstriction on CT angiogram.
Patients with PRES can have cerebral hypoperfusion despite severe hypertension. A perfusion study in the acute setting may be helpful to better understand the perfusion status and guide blood pressure treatment.
后部可逆性脑病综合征（PRES）表现为有多种诱发因素的患者出现急性神经症状，脑部影像学有特征性表现。人们认为 PRES 患者的脑血管自动调节功能发生改变。然而，脑灌注不足或过度灌注是否为初始事件尚不清楚。我们旨在描述未经治疗的 PRES 患者的脑灌注状态。
我们从 2005 年 1 月至 2021 年 12 月期间圣玛丽医院 Mayo 诊所前瞻性 PRES 患者数据库（1）和 2010 年 1 月至 2021 年 12 月期间内布拉斯加大学医学中心电子数据库（2）中，回顾性地识别出 PRES 患者的脑部灌注研究。记录患者的人口统计学资料、既往病史、起病症状、 PRES 病因和临床结局。对脑部影像学检查进行了回顾。我们记录了脑部病变的位置、从症状发作到灌注研究的时间、灌注研究时的血压以及降压治疗情况。
共纳入 5 名患者（4 名女性，中位年龄 66 岁）。PRES 的病因包括急性高血压（n=3）、围手术期血压波动和使用帕唑帕尼治疗。4 名患者有慢性高血压。起病症状包括脑病（n=5）、局灶性神经症状（n=4）和癫痫发作（n=2）。所有患者均在症状发作后 12 小时内进行了 CT 灌注检查。除 1 名患者外，所有患者在 CT 灌注时均有高血压。扫描显示弥漫性脑灌注不足，在放射冠和脑水肿区域更为明显。CT 血管造影未见患者有严重的脑缺血或动脉血管收缩。
尽管有严重的高血压，PRES 患者仍可能存在脑灌注不足。在急性期进行灌注研究可能有助于更好地了解灌注状态并指导血压治疗。
