Posterior Reversible Leukoencephalopathy With Hemorrhagic Features: A Case Series

Area of Science:

• Neurology
• Radiology
• Nephrology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by vasogenic cerebral edema.
• It typically presents with acute or subacute onset and can be associated with capillary permeability disruption.
• While often reversible, PRES can sometimes involve cytotoxic or hemorrhagic lesions.

Purpose of the Study:

• To describe a case series of PRES focusing on patients with hemorrhagic features.
• To compare clinical and radiological variables between PRES patients with and without hemorrhagic manifestations.
• To identify potential differences in management and outcomes related to hemorrhagic PRES.

Main Methods:

• Retrospective collection of electronic medical records for patients diagnosed with PRES between January 2009 and December 2021.
• Data included demographics, medical history, clinical presentation, and outcomes.
• Statistical comparison using the Wilcoxon-Mann-Whitney test for patients with and without hemorrhagic features.

Main Results:

• Out of 33 PRES patients, 10 exhibited hemorrhagic features (microbleeds, hematomas, subarachnoid hemorrhage).
• Hemorrhagic PRES patients had lower corticosteroid use (50% vs. 78.8%) and more restrictive neuroimaging lesions (60% vs. 17%) compared to non-hemorrhagic cases.
• Major hemorrhages were associated with thrombocytopenia; in-hospital mortality was 10%.

Conclusions:

• PRES with hemorrhagic features is associated with distinct radiological findings and treatment patterns.
• Reduced corticosteroid use and increased restrictive lesions characterize PRES with hemorrhage.
• Further research is required to elucidate the clinical implications and optimal management strategies for hemorrhagic PRES.