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Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome

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Abstract

Purpose

Assess factors in posterior reversible encephalopathy syndrome (PRES) related to intensive care unit (ICU) admissions, mechanical ventilation, and length of stay (LoS).

Methods

Retrospectively, we collected clinical, biochemical, and imaging data of PRES patients. MRI studies were assessed for imaging severity, and complications, including restricted diffusion and hemorrhage. Univariate and multivariate regression analyses were performed for factors associated with ICU admission, mechanical ventilation, and LoS. We assessed for association between clinical and biochemical factors and imaging severity grading systems and complications.

Results

We had 57 subjects with mean ± SD age of 56.3 ± 14.5 years and 68.3% were females. In 60 cases, 36.7% had hypertension, 23.3% had chronic renal disease, 18.3% had sepsis, 16.7% were on active chemotherapy, 10% underwent hematopoietic stem cell transplantation (HSCT), 10% with active cancer, 6.7% were eclampsia/preeclampsia, and 1.7% had radiotherapy. We had 17 (26.6%) grade 1, 26 (46.8%) grade 2, 17 (26.6%) grade 3 PRES based on vasogenic edema extent, and 28 (46.7%) severe PRES (≥ 5 areas) cases. 19 (31.7%) had restricted diffusion with hemorrhage in 19 (31.7%) cases. On multivariate analysis, ICU admissions showed significant association with hypertension (OR = 5.57, 95% CI: 0.96–32.23; p = 0.05), and raised INR (OR = 119, 95% CI: 1.1–1244.3; p = 0.04); LoS with HSCT, mean arterial pressure (MAP), intraparenchymal hematoma, and sepsis; and extent of vasogenic edema with restricted diffusion (OR = 4.31, 95% CI: 1.5–12.33; p < 0.01).

Conclusion

In summary, PRES with hypertension and elevated INR are associated with ICU admissions. HSCT, MAP, intraparenchymal hematoma, and sepsis correlated with LoS. Imaging severity grading based on vasogenic edema extent may be better due to association with restricted diffusion.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

    Shivaprakash B. Hiremath, Karine Massicotte-Tisluck & Santanu Chakraborty

  2. Department of Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada

    Shivaprakash B. Hiremath

  3. Département d’Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada

    Karine Massicotte-Tisluck

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  1. Shivaprakash B. Hiremath
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  3. Santanu Chakraborty
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All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.

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Correspondence to Santanu Chakraborty.

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The ethics approval was obtained from the institutional Research and Ethics Board (REB: 20190724-01H).

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Hiremath, S.B., Massicotte-Tisluck, K. & Chakraborty, S. Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome. Neurol Sci 43, 6461–6470 (2022). https://doi.org/10.1007/s10072-022-06271-w

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  • DOI: https://doi.org/10.1007/s10072-022-06271-w

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