Srichawla Bahadar S, Găman Mihnea-Alexandru, Can Hande, Kipkorir Vincent, Garcia-Dominguez Maria A
Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Ann Med Surg (Lond). 2025 Aug 5;87(9):6023-6032. doi: 10.1097/MS9.0000000000003676. eCollection 2025 Sep.
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic phenomenon characterized by vasogenic edema, predominantly affecting the posterior regions of the brain. The hemorrhagic variant of PRES has been increasingly recognized, complicating the clinical picture and prognosis.
This meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational studies and case reports/series were included. Extracted data included demographics, clinical presentations, imaging findings, and outcomes. A random-effects model to pool the incidence rate of hemorrhagic PRES and heterogeneity was assessed using the I statistic. The Joanna Briggs Institute scale for case reports/series and the Newcastle-Ottawa scale for cohort studies were used for quality and risk of bias assessment.
A total of 63 individual records and 12 cohort studies were reviewed. Hypertension at arrival was seen in > 90% of cases. Overall, 60.3% of cases occurred in women and the average age was 39.3, with a 12.7% mortality rate. The incidence rate of hemorrhagic PRES was found to be approximately 17%, with significant heterogeneity among the included studies (I = 67%). Seizures (31.7%), headaches (33.3%), and altered mental status (30.1%) were the most reported symptoms. Hypertension (31.7%), immunosuppressive therapy (23.8%), and coagulopathy (11.1%) were identified as the most common risk factors. Hemorrhagic findings included intraparenchymal hemorrhage (77.7%), subarachnoid hemorrhage (15.8%), and microhemorrhages (6.3%).
Hemorrhagic PRES is a significant clinical concern, occurring in approximately 17% of PRES cases, and is often associated with poorer outcomes. We highlight the importance of early recognition, aggressive blood pressure control, and careful monitoring in high-risk patients.
后部可逆性脑病综合征（PRES）是一种临床影像学现象，其特征为血管源性水肿，主要影响大脑后部区域。PRES的出血性变体已越来越受到认可，这使临床情况和预后变得复杂。
本荟萃分析按照系统评价和荟萃分析的首选报告项目指南进行。纳入了观察性研究以及病例报告/系列。提取的数据包括人口统计学信息、临床表现、影像学检查结果和结局。采用随机效应模型汇总出血性PRES的发病率，并使用I²统计量评估异质性。病例报告/系列采用乔安娜·布里格斯研究所量表，队列研究采用纽卡斯尔-渥太华量表进行质量和偏倚风险评估。
共审查了63份个体记录和12项队列研究。超过90%的病例在就诊时患有高血压。总体而言，60.3%的病例发生在女性中，平均年龄为39.3岁，死亡率为12.7%。发现出血性PRES的发病率约为17%，纳入的研究之间存在显著异质性（I² = 67%）。癫痫发作（31.7%）、头痛（33.3%）和精神状态改变（30.1%）是报告最多的症状。高血压（31.7%）、免疫抑制治疗（23.8%）和凝血病（11.1%）被确定为最常见的危险因素。出血性表现包括脑实质内出血（77.7%）、蛛网膜下腔出血（15.8%）和微出血（6.3%）。
出血性PRES是一个重大的临床问题，约占PRES病例的17%，且往往与较差的结局相关。我们强调早期识别、积极控制血压以及对高危患者进行密切监测的重要性。
