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Abstract Details

Atypical Presentations of Posterior Reversible Encephalopathy Syndrome (PRES) and Intracranial Hemorrhage (ICH) - A Case Series and Comprehensive Literature Review
Cerebrovascular Disease and Interventional Neurology
P04 - (-)
079
BACKGROUND: The Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-radiographic syndrome of heterogeneous etiologies grouped together due to similar imaging findings. There is an ongoing controversy about the exact pathophysiology of PRES. As variable as its etiologies, PRES can present clinically in multiple and sometimes very subtle ways. Despite its generally benign course PRES -if not recognized and treated in a timely manner- can lead to major complications with potentially fatal outcomes. In particular, intracranial hemorrhage (ICH) is a life-threatening complication of PRES that has only been studied in a few retrospective case series.
DESIGN/METHODS: We report a case series of PRES in four female patients (age 30 to 78) who presented with various imaging findings including ICH but very different, atypical clinical symptoms. We particularly focus on risk factors for the development and the outcome of ICH in the setting of PRES.
RESULTS: The clinical presentations ranged from simple-partial seizures, non-convulsive status epilepticus, and thunderclap headache to catatonic behavior. The outcomes varied from complete neurological recovery to rapid decline and death. Major risk factors for the development of PRES and ICH were treatment with immunosuppressants, serious co-morbidities and poorly controlled seizures.
CONCLUSIONS: Based on a comprehensive literature review and the clinical courses in our case series, it is clear that ICH associated with PRES may be under recognized, presenting a diagnostic challenge to the physician and posing a threat of serious if not fatal outcome. Further investigation into specific risk factors predisposing patients with PRES to hemorrhage is warranted, as this may promote heightened clinical awareness of the phenomenon.
Authors/Disclosures
Wolfgang Muhlhofer, MD (University of Washington)
PRESENTER 		Dr. Muhlhofer has nothing to disclose.
Michael Manchak, MD (Sanford Fargo) Dr. Manchak has nothing to disclose.
Mark S. Freedman, MD, FAAN (University of Ottawa) Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Actelion(Janssen/J&J). Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BiogenIdec. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS/Celgene. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Inc. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion (Janssen/J&J). Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Atara Biotherapeutics. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer Healthcare. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BiogenIdec. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Clene Nanomedicine. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GRI Bio. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Magenta Therapeutics. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Freedman has received research support from Sanofi Genzyme.
Adam Kelly, MD, FAAN (University of Rochester) Dr. Kelly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grand Rounds/Included Health. Dr. Kelly has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. Dr. Kelly has received personal compensation in the range of $500-$4,999 for serving as a Question writer for various educational offerings with 好色先生.