Article Figures & Data
Figures
- Fig 1.
A 27-year-old man with necrotic pneumonia and lung abscess. A, MR FLAIR image demonstrates PRES vasogenic edema in the parietal and frontal lobes (arrows). B, Gradient image demonstrates minute hemorrhages in the left frontal lobe (arrows).
- Fig 2.
A 50-year-old woman with fever and severe hypertension. A and B, FLAIR MR image demonstrates sulcal signal abnormality and PRES vasogenic edema in the left frontal lobe (arrowheads) and edema in the occipital lobes bilaterally (open arrows). C, Gradient MR image demonstrates linear low signal intensity consistent with sulcal subarachnoid hemorrhage (arrows). D, CT image demonstrates high attenuation consistent with the MR imaging appearance, further confirming the sulcal subarachnoid hemorrhage (arrow).
- Fig 3.
A 50-year-old man status post allo-BMT for acute myelogenous leukemia. CT scan demonstrates PRES vasogenic edema in the parietal region bilaterally (arrowheads), along with an acute hematoma in the left parietal lobe (arrow).
Tables
- Table 1:
Hemorrhage in PRES: relationship to clinical associations and blood pressure at toxicity
Toxicity Association Total No. Pts with PRES Patients with PRES and Hemorrhage No. Hemorrhage (%) Blood Pressure in Pts with PRES Hemorrhage Normotensive (MAP ≤ 105) Mild HTN (MAP, 106–115) Severe HTN (MAP ≥ 116) Immunosuppression‡ 50 11 (22.0) 3 1 7 Solid-organ transplant 34 4 (11.8) 2 1 1 Allo-BMT 15 7 (46.7) 1 0 6 Other* 1 0 (0.0) – – – Infection/sepsis/shock 52 6 (11.5) 4 1 1 Autoimmune 12 2 (16.7) 0 0 2 Chemotherapy 10 1 (10.0) 0 1 0 Eclampsia† 18 1 (5.6) 0 0 1 Unknown 9 2 (22.2) 0 0 2 Total 151 23 (15.2) 7 3 13 Note:—Pts indicates patients; CsA, cyclosporine; HTN, hypertension; –, none; PRES, posterior reversible encephalopathy syndrome; MAP, mean arterial pressure; FK-506, tacrolimus; Allo-BMT, allogeneic bone marrow transplantation.
* A single patient with psoriasis on cyclosporine.
† Patients with eclampsia and delayed eclampsia.
‡ Transplant, on cyclosporine, or tacrolimus (FK-506).
- Table 2:
Hemorrhage subtypes in PRES: relationship to clinical associations and adverse clinical outcomes
Toxicity Association Total No. Pts with PRES Patients with PRES and Hemorrhage No. Pts with Hemorrhage Hemorrhage Subtypes (No. Pts) Minute Sulcal Hematoma Immunosuppression‡ 50 11 5 4 3 Solid-organ transplant 34 4 4 (1D) 1 0 Allo-BMT 15 7 1 (1D) 3 (1D) 3 (2D) Other† 1 0 0 0 0 Infection/sepsis/shock 52 6 4 1 4 (1D) Autoimmune 12 2 2* 0 2* Chemotherapy 10 1 1 0 0 Eclampsia 18 1 0 1 1 Unknown 9 2 0 1 1 Total 151 23 12 7 11 Note:—D indicates that the patient died.
* A single patient with autoimmune disease and both minute hemorrhage and focal hematoma who sustained a permanent deficit (homonymous hemianopsia, hemiparesis, and facial droop).
† A single patient with psoriasis on cyclosporine.
‡ Transplant, on cyclosporine, or tacrolimus (FK-506).
Blood Pressure at Toxicity Total No. Pts with PRES Patients with PRES and Hemorrhage No. (%) Hemorrhage Subtype Minute Sulcal Focal Hematoma + Sulcal Hematoma + Minute Sulcal + Minute Normotensive (MAP ≤ 105) 44 7 (15.9) 2 2 0 0 3 0 Mildly hypertensive (MAP = 106–115) 20 3 (15) 2 0 1 0 0 0 Severe hypertension (MAP ≥ 116) 87 13 (14.9) 2 3 4 1 2 1 Total 151 23 (15.2) 6 5 5 1 5 1 - Table 4:
Coagulation state and blood pressures at toxicity in 150 patients with PRES: 23 with hemorrhage, 127 without hemorrhage
Blood Pressure at Toxicity No. Pts Normal Coagulation Platelets, Coagulation Parameters, and No Medications (No. Pts with PRES) Abnormal Coagulation Intrinsic Coagulopathy Thrombocytopenia or Abnormal PT, PTT, INR (No. Pts with PRES) Subtherapeutic, on Medications Affecting Platelet Function or Coagulation (No. Pts with PRES) Therapeutic, on Medication Affecting Platelet Function or Coagulation (No. Pts with PRES) W/O Hem With Hem W/O Hem With Hem W/O Hem With Hem W/O Hem With Hem Normotensive (MAP ≤ 105) 44 15 3 17 1 3 1 2 2 Mild HTN (MAP, 106–115) 20 8 2 5 1 3 0 0 1 Severe HTN (MAP ≥ 116) 86 45 5 15 6 10 0 4 1 Total 150 68 10 37 8 16 1 6 4 Note:—W/O indicates without; Hem, hemorrhage; PT, prothrombin time; PTT, partial thromboplastin time; INR, international normalized ratio.
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