Prasad Pratibha
Department of Neurology, AIIMS, Deoghar, Jharkhand, India.
Indian J Crit Care Med. 2023 Jul;27(7):488-492. doi: 10.5005/jp-journals-10071-24492.
Though epileptic seizures are common in posterior reversible encephalopathy syndrome (PRES), status epilepticus (SE) as the presenting feature is rare.
To study the clinical spectrum and outcome of patients with SE as presenting feature of PRES.
This is a retrospective study. PRES was diagnosed based on the clinical features and imaging findings on brain MRI ( = 40) which became normal after 6 months follow-up imaging. Patients with SE as the initial manifestation of PRES were identified. Baseline information regarding the clinical presentation, etiology, past history of illness, treatment history, imaging findings, EEG and long-term clinical outcome.
Seizure was the most common presentation seen in 31 patients (77.5%). The etiologies in PRES were preeclampsia, or eclampsia [ = 33 (82.5%)], hypertensive encephalopathy [ = 3 (7.5%)], systemic lupus erythematosus (SLE), AIP, and chronic renal failure (CRF) in one patient each [ = 01 (2.5%)]. Brain MRI showed the involvement of parieto-occipital lobes ( = 33 [82.5%]) mostly. Status epilepticus (generalized convulsive) was the presenting feature in eight cases (20%). Among them, five cases (0.5%) had a history of chronic epilepsy. In the remaining three patients, SLE and acute intermittent porphyria, CRF precipitated the SE.
The study highlights the clinico-etiological spectrum of PRES and the identification of SE within its context leading to the early diagnosis and management if treated early. The role of antenatal care is important for the identification and treatment of etiologies, blood pressure, proper antiepileptic drug compliance and appropriate counseling.
Prasad P. Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience. Indian J Crit Care Med 2023;27(7):488-492.
虽然癫痫发作在后可逆性脑病综合征（PRES）中很常见，但以癫痫持续状态（SE）为首发特征的情况很少见。
研究以SE为PRES首发特征的患者的临床谱及预后。
这是一项回顾性研究。PRES根据临床特征及脑部MRI的影像学表现进行诊断（n = 40），随访6个月后的影像学检查显示正常。确定以SE为PRES初始表现的患者。收集有关临床表现、病因、既往病史、治疗史、影像学表现、脑电图及长期临床预后的基线信息。
癫痫发作是最常见的表现，见于31例患者（77.5%）。PRES的病因包括先兆子痫或子痫[n = 33（82.5%）]、高血压脑病[n = 3（7.5%）]、系统性红斑狼疮（SLE）、急性间歇性卟啉病（AIP）及慢性肾衰竭（CRF）各1例[n = 01（2.5%）]。脑部MRI显示顶枕叶受累最多见[n = 33（82.5%）]。癫痫持续状态（全身性惊厥）为8例（20%）的首发特征。其中，5例（0.5%）有慢性癫痫病史。其余3例患者中，SLE、急性间歇性卟啉病、CRF诱发了SE。
本研究突出了PRES的临床 - 病因谱以及在此背景下SE的识别，早期诊断并治疗可实现早期管理。产前护理对于病因识别与治疗、血压控制、正确的抗癫痫药物依从性及适当的咨询指导具有重要作用。
Prasad P. 癫痫持续状态作为后可逆性脑病综合征的首发特征：三级医疗中心经验。《印度重症监护医学杂志》2023；27（7）：488 - 492。
