PLoS ONE (Jan 2012)

Determinants of recovery from severe posterior reversible encephalopathy syndrome.

  • Stephane Legriel,
  • Olivier Schraub,
  • Elie Azoulay,
  • Philippe Hantson,
  • Eric Magalhaes,
  • Isaline Coquet,
  • Cedric Bretonniere,
  • Olivier Gilhodes,
  • Nadia Anguel,
  • Bruno Megarbane,
  • Laurent Benayoun,
  • David Schnell,
  • Gaetan Plantefeve,
  • Julien Charpentier,
  • Laurent Argaud,
  • Bruno Mourvillier,
  • Arnaud Galbois,
  • Ludivine Chalumeau-Lemoine,
  • Michel Rivoal,
  • François Durand,
  • Arnaud Geffroy,
  • Marc Simon,
  • Annabelle Stoclin,
  • Jean-Louis Pallot,
  • Charlotte Arbelot,
  • Martine Nyunga,
  • Olivier Lesieur,
  • Gilles Troché,
  • Fabrice Bruneel,
  • Yves-Sébastien Cordoliani,
  • Jean-Pierre Bedos,
  • Fernando Pico,
  • Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS)

DOI
https://doi.org/10.1371/journal.pone.0044534
Journal volume & issue
Vol. 7, no. 9
p. e44534

Abstract

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ObjectiveFew outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.Design70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.Main resultsConsciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOSConclusionsBy day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement.