Posterior Reversible Ensefalopati Sendromunda (PRES) Klinik Özellikler, Radyolojik Bulgular ve Hastalığın Sonuçlanmasının Değerlendirilmesi

Year 2023, , 30 - 35, 28.02.2023

Tuba Akdağ , Bülent Güven

https://doi.org/10.54005/geneltip.1158044

Abstract

Giriş: Posterior reversible ensefalopati sendromu (PRES), kendine özgü klinik bulguları ve radyolojik görünümleri olan bir antitedir. Preeklampsi/eklampsi, otoimmün hastalıklar, kemoterapi, kemik iliği ve organ nakli gibi çeşitli durumlar hastalığa yatkınlık yaratmakta ve bu klinik durum görüntüleme, klinik ve laboratuvar özellikleri ile daha iyi aydınlatılmaktadır. Bu çalışmanın amacı PRES'in klinik ve radyolojik bulgularını, tanı ve hasta sonuçlanmasındaki bulguları tanımlamaktır.
Gereç ve yöntemler: Çalışmamız beş yıllık PRES vakalarının geriye dönük bir incelemesidir. Klinik muayene ve görüntüleme teknikleri ile tanı konulan hastalarda; demografik özellikler, ko-morbiditeler, spesifik tedavi ve klinik sonuç dahil olmak üzere hasta özellikleri analiz edildi.
Bulgular: Çalışmaya 2015-2020 yılları arasında PRES tespit edilen 15 hasta dahil edildi. On beş hastanın ortanca yaşı 49.9±17.0 (25-77 yıl), %33,3'ü erkek, %66,7'si kadındı. Hastaların ikisinde aktif kanser, üçünde otoimmün hastalık, dördünde peripartum dönem, ikisinde kronik böbrek yetmezliği, üçünde hipertansiyon ve diyabet gibi sistemik bir hastalık ve birinde solunum yolu enfeksiyonu vardı. Hiçbirinde kemik iliği veya organ nakli öyküsü yoktu. MR görüntülemede %100 hastada vazojenik ödem ve %33,3 oranda difüzyon kısıtlaması görüldü. BT’de ek olarak %30 oranda kanama gösterildi. Tüm hastalara antiödem ve konvülsiyon tedavisi uygulandı. Genel olarak hastalarımızın %86,6'sı erken dönemde sekelsiz iyileşti. 50 yaş ve üstü bireylerin uzun dönem iyi sonuçlanma oranları 50 yaş altı bireylere göre istatistiksel olarak anlamlı derecede düşüktü (p=0,041).
Sonuç: PRES hastalarının retrospektif analizinde genel sağ kalım oranları ve prognoz iyi olarak değerlendirildi. BT ve MRG tanıya katkıda bulunurken çok çeşitli görüntüleme bulguları görülebilir. Prognozu belirlemede hastanın yaşı önemli bir yer tutarken, diğer radyolojik veya demografik parametrelerin kısa veya uzun vadeli sonuçlara etkisi yoktur.

Keywords

bilgisayarlı tomografi, manyetik rezonans görüntüleme, posterior reversible ensefalopati, sendrom, ödem, konvülsiyon, hipertansiyon

Evaluation of Clinical Manifestations, Radiological Features, and Outcomes of Posterior Reversible Encephalopathy Syndrome (PRES)

Abstract

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a state coupled with a unique clinical and radiological appearance. Various conditions such as preeclampsia/eclampsia, autoimmune diseases, chemotherapy bone marrow and organ transplantation are foreseen and this clinical condition is better illuminated along with imaging, clinical and laboratory features. Therefore, the aim of this study is to describe the clinical and radiological manifestations, diagnosis, and outcome of PRES.
Material and methods: A retrospective review of cases of PRES over five years. Patient characteristics, including demographics, comorbidities, specific therapy, and clinical outcome, were analyzed. Diagnosis was made by clinical examination and imaging techniques.
Results: Fifteen patients detected PRES between 2015 and 2020 were included. In fifteen patients, the median age was 49.9±17.0 years (25-77 years), 33.3% were men, and 66.7% were women. Two of the patients had active cancer, none had a history of bone marrow or organ transplantation, three had autoimmune disease, four were peripartum, two had chronic renal failure, three had a systemic disease such as hypertension and diabetes, and one had respiratory infection. MR imaging showed vasogenic edema at 100% and restricted diffusions at 33,3%. CT image showed hemorrhage of 30% additionally. Antiedema and convulsion therapy was administered at 100%. Overall, 86,6% of our patients recovered without sequelae in short term. The rate of individuals aged 50 and over was statistically significantly poor in terms of long-term results compared to the group under 50 years of age individuals (p=0.041).
Conclusion: In this retrospective analysis of PRES patients, the prognosis was good. CT and MRI contribute to the diagnosis, and various imaging findings can be seen. While the patient's age has an important place in determining the prognosis, other radiological or demographic parameters do not have any effect on short-term or long-term results.

Keywords

computed tomography, magnetic resonance imaging, posterior reversible encephalopathy, syndrome, edema, convulsion, hypertension

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