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Abstract Details

Re-Thinking the ‘Posterior’ in Posterior Reversible Encephalopathy Syndrome: A Single Center Chart Review of 95 Patients
Cerebrovascular Disease and Interventional Neurology
P10 - Poster Session 10 (5:30 PM-6:30 PM)
4-017
To describe neuroimaging findings, comorbidities, and outcomes in a group of patients with Posterior Reversible Encephalopathy Syndrome 

Posterior Reversible Encephalopathy Syndrome (PRES) is an uncommon disease of neurological symptoms in the setting of characteristic imaging findings, most commonly bilateral vasogenic edema of the parieto-occipital white matter. PRES has been associated with many causes, but pathophysiology remains unclear. A leading hypothesis is disruption of cerebral autoregulation leading to damage of the blood-brain barrier.
A single center, retrospective chart review was conducted, including adult patients, admitted from December 2012 to October 2018, with a primary diagnosis of PRES. MRI or CT head images were reviewed for location of edema. Demographics, medical comorbidities, and complications were reviewed and compared.
A total of 95 cases were identified. Mean age was 54.7+/- 13.4 years, and 77.9% were female. Of these, 49.5% met hypertensive emergency criteria, 26.3% had COPD, 24.4% had chronic kidney injury, and 15.8% had immunosuppressant use. PRES was complicated by intracerebral hemorrhage in 12.6%, and ischemic stroke in 11.7% of cases. 
Vasogenic edema was most commonly multifocal, and localized to the parietal lobes (88.4%) and occipital lobes (80%), followed by frontal lobe (66.3%). Involvement of the temporal lobe, cerebellum, and thalamus were 29.5%, 33.7%, and 10.5%, respectively.  Anterior circulation involvement was seen in 90.5% of patients overall. Only 9.5% had isolated posterior circulation territory involvement.  Outcomes were largely favorable, with 75.8% discharged home; however poor outcomes were seen in 8.7%.

Multi-focal PRES may occur more often than either posterior or anterior involvement alone. The prevailing hypothesis of outstripped cerebral autoregulation should affect territories supplied by the vertebral-basilar system preferentially, due to relative differences in sympathetic innervation. However, only 9.5% of patients studied had isolated posterior circulation involvement. An alternative pathogenic mechanism of blood-brain barrier damage may explain this. Further research is needed.  
Authors/Disclosures
Molly Bates, MD
PRESENTER 		Dr. Bates has nothing to disclose.
Kyle Darpel, MD (St. Elizabeth Physicians) Dr. Darpel has nothing to disclose.
Jessica D. Lee, MD, FÂ鶹´«Ã½Ó³»­ (University of Kentucky) Dr. Lee has received personal compensation for serving as an employee of Â鶹´«Ã½Ó³»­. The institution of Dr. Lee has received research support from Janssen.