Kalpana, R (2014) A Study of the Clinical Spectrum of Posterior Reversible Encephalopathy Syndrome in a Tertiary Care Hospital. Masters thesis, Stanley Medical College, Chennai.
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Abstract
Hinchey and co workers in 1996 first described a clinico-radiologic entity, in which patients presented with a symptom complex of sudden onset headache, altered sensorium, visual symptoms and seizures that, was later termed as Posterior Reversible Encephalopathy Syndrome (PRES). Posterior Reversible Encephalopathy syndrome is a syndrome in which abrupt rise in blood pressure or use of certain drugs or sepsis leads to sudden onset of headache, altered sensorium, visual symptoms and seizures. These symptoms occur in various combinations or sometimes in isolation. Hence a high index of suspicion to diagnose this syndrome is essential whenever a clinical setting that can predispose to Posterior Reversible Encephalopathy Syndrome exists. Cases of Posterior Reversible Encephalopathy Syndrome are reported from age 4 up to 90 years of age, however most cases occur in the young and the middle age group There is a high female preponderance for Posterior Reversible Encephalopathy Syndrome as the cause of the disease is often pre-eclampsia or eclampsia. Other common co morbidities are renal failure, systemic hypertension presenting as accelerated hypertension, bone marrow transplantation and solid organ transplantation Clinical symptoms resolve within few days to weeks with appropriate treatment. Though the term Posterior Reversible Encephalopathy Syndrome denotes reversible encephalopathy, irreversible neurologic deficit occurs if prompt identification of the disease and early appropriate intervention is not done. Ischemic infarcts and hemorrhages are the complications of posterior reversible encephalopathy syndrome that lead to persistent neurological deficit. AIM OF THE STUDY : To study the etiological, clinical and radiological profile of patients diagnosed to have Posterior Reversible Encephalopathy Syndrome. CONCLUSION : * Posterior Reversible Encephalopathy Syndrome is common in females, with a female : male ratio of 7 :1. * The commonest age groups affected are the young and the middle aged, 64%of the patients were in this age group. * Headache (87.09%) is the commonest symptom of Posterior Reversible Encephalopathy Syndrome in this study. Seizures (64.51%) was the second most common symptom in this study. One half of the patients had the other symptoms of PRES - impaired consciousness, visual symptoms and vomiting. * Papillodema is seen in nearly 1/3rd of the patients. * Not all patients have documented hypertension. Hypertension was documented in 64.75% of the patients in this study, the rest, 32.26% of the patients had no hypertension signifying that the abrupt rise of blood pressure from the baseline, is more important than the absolute value of blood pressure in causing Posterior Reversible Encephalopathy Syndrome. * The commonest cause is Pregnancy related Posterior Reversible Encephalopathy Syndrome, with almost all the pregnant patients being primigravida. * There is varied aetiology for Posterior Reversible Encephalopathy Syndrome, ranging from the commoner pregnancy related Posterior Reversible Encephalopathy Syndrome to the rare causes like porphyria, Posterior Reversible Encephalopathy Syndrome following blunt injury abdomen, following OPC poisoning etc, as seen in this study. Hence a high index of suspicion and a thorough knowledge of conditions that could predispose to Posterior Reversible Encephalopathy Syndrome is essential for the early diagnosis. * The commonest radiological pattern is subcortical, symmetrical vasogenic edema in the occipoparietal regions. However cortical involvement was seen in nearly 50% of the patients. Asymmetrical involvement was seen in nearly 1/3rd of the patients. * Recurrent PRES is observed in a small percentage (3.22%) of patients. * Prompt control of blood pressure prevents irreversible complications. * A high index of clinical suspicion in appropriate settings along with radiological correlation, will help in early recognition and prompt management of PRES, which will aid in preventing grave complications.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Posterior Reversible Encephalopathy Syndrome ; Clinical Spectrum ; Tertiary Care Hospital. |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 30 Jun 2017 03:11 |
| Last Modified: | 30 Jun 2017 06:23 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/684 |
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