Evaluation of posterior reversible encephalopathy syndrome from different aspects: What is the role of serum LDH and albumin level in pathogenesis?

ABSTRACT

Background: Posterior reversible encephalopathy syndrome (PRES), is characterized by headache, lethargy, visual complaints and epileptic seizures. Brain imaging findings include abnormalities of the white matter and the grey matter.The diagnosis currently relies on clinical manifestations and typical neuroimaging findings. Different pathophysiological factors can play role in the disease process. The purpose of this study is to review causes, clinical aspects, imaging-laboratory findings and prognosis in patients diagnosed with PRES. Method: Patients who showed clinical and magnetic resonance imaging (MRI) findings consistent with PRES between January 2011 and December 2014 were included in the study. Patient data were collected retrospectively from hospital records. Results:Total number of patients was 22 (18 female, 4 male). Median age was 28 years (range 18-84). Comorbid conditions included eclampsia (n=10, 45%), pre-eclampsia (n=1, 4.5%), HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome (n=1), primary kidney disease (n=3, 13%). Acute elevation of blood pressure was found in 9 patients (40%). Five patients (22%) were using steroids or immunosupressive drugs. Typical PRES imaging pattern with bilateral parieto-occipital involvement was present in 15/22 patients (68%) and occipital involvement was present in 3/22 patients (14%). Atypical neuroimaging features included frontal involvement in 10 patients (45%), basal ganglia gray matter lesion in 1 patient (4%) and the cerebellum was involved in 3 patients (14%). Serum LDH level was high in 13 patients (59%). Hypoalbuminemia was detected in 12 patients (54%). Conclusion: Although hypertension is thoughtto be the main pathologic factor in the disease process, endothelial dysfunction seems to be equally important.