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Influential factors and clinical significance of an atypical presentation of posterior reversible encephalopathy syndrome in patients with eclampsia

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Abstract

Background and purpose

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity for which eclampsia is one of the most common predisposing conditions. Despite the imaging changes typically reported, the predisposing factors and clinical implications of atypical presentations have yet to be fully clarified.

Methods

A total of 56 patients with PRES were selected for study. Demographic, clinical, and laboratory data were analyzed, focusing on atypical presentations of PRES. Multiple logistic regression was applied to identify factors impacting such atypical presentations, and functional outcomes were assessed upon patient discharge.

Results

Overall, 22 of the 56 patients (39.3%) displayed features of atypical PRES. By multiple logistic regression, headache (OR = 5.39; 95% CI, 1.24–23.51; p = 0.025) and frequent convulsions (OR = 4.41; 95% CI, 1.09–17.91; p = 0.038) proved to be independent factors associated with atypical PRES. Ultimately, outcomes of 18 patients were gauged as poor, based on the modified Rankin Scale (mRS). Logistic regression indicated that visual disturbances (OR = 9.02; 95% CI, 1.37–59.35; p = 0.02), frequent convulsions (OR = 9.47; 95% CI, 1.67–53.63; p = 0.01), and restricted diffusion on imaging (OR = 11.96; 95% CI, 1.76–81.11; p = 0.01) were independently associated with poor outcomes in patients with eclampsia-related PRES.

Conclusion

Headache and frequent convulsions are independently associated with atypical presentations of PRES. If present, restricted diffusion may help in predicting poor outcomes of such patients upon discharge.

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  1. Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People’s Republic of China

    Xiaoyu Dong & Jianfei Nao

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  1. Xiaoyu Dong
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Correspondence to Jianfei Nao.

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This study conformed to Ethical Guidelines for Medical and Health Research Involving Human Subjects endorsed by the Chinese government and was authorized by the Ethics Committee of Shengjing Hospital at China Medical University.

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Dong, X., Nao, J. Influential factors and clinical significance of an atypical presentation of posterior reversible encephalopathy syndrome in patients with eclampsia. Neurol Sci 40, 377–384 (2019). https://doi.org/10.1007/s10072-018-3642-5

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