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Jeong DY, Shin YN, Ha SH, Chang JY, Kang DW, Kwon SU, Kim BJ. Association between renal insufficiency and lesion characteristics of posterior reversible encephalopathy syndrome. Neurol Sci 2024; 45:3907-3915. [PMID: 38480646 DOI: 10.1007/s10072-024-07446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/03/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is characterized by cerebral blood flow dysregulation and the blood-brain barrier (BBB) disruption. While renal insufficiency has been considered a factor in BBB fragility, the relationship between renal insufficiency and the PRES lesions volume remains unclear. METHODS This observational study was performed retrospectively. PRES patients were categorized into two groups with renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 on the day of symptom occurrence. Lesion volume was measured using fluid-attenuated inversion recovery (FLAIR) imaging, and the brain was divided into nine regions. The volume of the parietal-occipital-temporal lobe was considered typical, while the other six regions were labeled as atypical. RESULTS The study included 200 patients, of whom 94 (47%) had renal insufficiency. Patients with renal insufficiency had a larger lesion volume (144.7 ± 125.2 cc) compared to those without renal insufficiency (110.5 ± 93.2 cc; p = 0.032); particularly in the atypical lesions volume (49.2 ± 65.0 vs. 29.2 ± 44.3 cc; p = 0.013). However, there was no difference in the reversibility of the lesions (35.2 ± 67.5 vs. 18.8 ± 33.4 cc; p = 0.129). Multiple regression analysis revealed that decreases in eGFR (β = -0.34, 95% CI -0.62-0.05, p = 0.020) were positively associated with total lesion volume. CONCLUSION Our findings suggest that PRES patients with renal insufficiency experience more severe lesion volumes, likely due to the atypical brain regions involvement. The lesions involving atypical regions may have a similar pathophysiology to typical lesions, as the PRES lesions reversibility was found to be similar between individuals with and without renal insufficiency.
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Affiliation(s)
- Dong Young Jeong
- School of Convergence Science and Technology, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Yea Na Shin
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hee Ha
- Department of Neurology, Gil Medical Center, Gachon College of Medicine, Incheon, Republic of Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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A study on clinicoradiological characteristics and pregnancy outcomes of reversible posterior leukoencephalopathy syndrome in preeclampsia or eclampsia. Hypertens Res 2017; 40:982-987. [DOI: 10.1038/hr.2017.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 03/06/2017] [Accepted: 04/05/2017] [Indexed: 11/08/2022]
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Gao B, Lerner A, Law M. The Clinical Outcome of Posterior Reversible Encephalopathy Syndrome. AJNR Am J Neuroradiol 2016; 37:E55-6. [PMID: 27365328 DOI: 10.3174/ajnr.a4853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- B Gao
- Department of Radiology Yantai Yuhuangding Hospital Qingdao University Yantai, Shandong, China Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
| | - A Lerner
- Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
| | - M Law
- Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
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Gao B, Yu BX, Li RS, Zhang G, Xie HZ, Liu FL, Lv C. Cytotoxic Edema in Posterior Reversible Encephalopathy Syndrome: Correlation of MRI Features with Serum Albumin Levels. AJNR Am J Neuroradiol 2015; 36:1884-9. [PMID: 26138140 DOI: 10.3174/ajnr.a4379] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/28/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Posterior reversible encephalopathy syndrome is a clinicoradiologic entity with typical MR imaging showing predominant vasogenic and occasional cytotoxic edema. It is unclear whether MR imaging correlates with levels of serum albumin. We determined potential risk factors for development of cytotoxic edema in posterior reversible encephalopathy syndrome. MATERIALS AND METHODS Seventy-nine cases with typical clinical symptoms and characteristic neuroradiologic findings conformed to posterior reversible encephalopathy syndrome diagnostic criteria and were included in this study. FLAIR, DWI, and ADC maps were interpreted to evaluate the severity and type of edema. MR imaging was correlated with the levels of serum albumin, and cytotoxic edema was compared with the location and severity of brain edema. RESULTS Pure vasogenic edema was found in 53 cases (67.09%), and vasogenic edema complicated with cytotoxic components, in 26 patients (32.91%). There was no difference in serum albumin levels between patients with cytotoxic components and those with vasogenic edema (P = .983). There was a significant difference in the edema scale scores between patients with cytotoxic edema and those with vasogenic edema (P = .006). The percentage of cytotoxic edema located in the area with higher scale scores of edema was significantly larger than that in areas with lower scale scores of edema (P = .002). CONCLUSIONS Serum albumin may contribute to the development of edema in PRES but is not a decisive factor for edema type. Cytotoxic edema in posterior reversible encephalopathy syndrome is probably related to regional decreased perfusion and arteriolopathy. Further work should be undertaken to discover the pathophysiologic mechanisms involved.
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Affiliation(s)
- B Gao
- From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China Department of Radiology (B.G.), Zhongda Hospital, Southeast University, Nanjing, China
| | - B X Yu
- From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China
| | - R S Li
- From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China
| | - G Zhang
- From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China
| | - H Z Xie
- From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China
| | - F L Liu
- From the Department of Radiology (B.G., B.X.Y., R.S.L., G.Z., H.Z.X., F.L.L.), Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, China
| | - C Lv
- Department of Neurology (C.L.), Yantai City Yantaishan Hospital and Yantai Sino-France Friendship Hospital, Shandong Province, China.
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