MRI-Negative Posterior Reversible Encephalopathy Syndrome

IF 6.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Mayo Clinic proceedings Pub Date : 2026-09-01 Epub Date: 2026-08-01 DOI:10.1016/j.mayocp.2026.01.022

Molly C. Bates MD, Jennifer E. Fugate DO, Jay N. Mandrekar PhD, Alejandro A. Rabinstein MD

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引用次数: 0

Abstract

Objective

To explore whether posterior reversible encephalopathy syndrome (PRES) can present with negative magnetic resonance imaging (MRI) by comparing clinical features between cases of PRES with vasogenic edema and cases of hypertensive encephalopathy without MRI changes.

Patients and Methods

Patients diagnosed with hypertensive encephalopathy from August 1, 2008, to December 31, 2017, were identified retrospectively and matched by age (±5 years) and sex in a 1:2 ratio to patients retrospectively identified as having PRES from January 1, 2002, to November 30, 2017. A review of MRI images and clinical information was performed.

Results

We identified 16 cases of hypertensive encephalopathy and 32 age- and sex-matched controls with PRES showing vasogenic edema on MRI. There were no statistically significant differences in the odds of presentation with headache (odds ratio [OR], 1.372; 95% CI, 0.458 to 4.106), encephalopathy (OR, 2.303; 95% CI, 0.433 to 12.236), visual disturbance (OR, 0.826; 95% CI, 0.185 to 3.697), or focal neurologic deficit (OR, 4.000; 95% CI, 0.767 to 20.872). Seizures were more common in patients with vasogenic edema (OR, 0.082; 95% CI, 0.010 to 0.664). There were no significant differences in odds of acute kidney injury (OR, 2.90; 95% CI, 0.679 to 12.449) or odds of having a history of malignancy (OR, 0.295; 95% CI, 0.076 to 1.152), transplantation (OR, 3.347; 95% CI, 0.594 to 18.880), or autoimmune disease (OR, 0.400; 95% CI, 0.104 to 1.532). Systolic blood pressure at presentation was higher in patients with hypertensive encephalopathy and negative MRI as compared with patients with PRES and vasogenic edema (OR, 1.03; 95% CI, 1.01 to 1.05).

Conclusion

Most presenting symptoms and risk factors were not significantly different between cases of hypertensive encephalopathy with and without vasogenic edema, arguing that the diagnosis of PRES in the setting of acute severe hypertension may not depend on MRI confirmation.

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mri阴性后部可逆性脑病综合征：高血压脑病伴与不伴血管源性水肿的比较。

目的：通过比较后路可逆性脑病综合征（PRES）合并血管源性水肿与无MRI改变的高血压脑病的临床特征，探讨后路可逆性脑病综合征（PRES）是否可出现磁共振成像（MRI）阴性。患者和方法：回顾性鉴定2008年8月1日至2017年12月31日诊断为高血压脑病的患者，并与2002年1月1日至2017年11月30日回顾性鉴定为高血压脑病的患者按年龄（±5岁）和性别1:2匹配。回顾MRI图像和临床资料进行。结果：我们确定了16例高血压脑病和32例年龄和性别匹配的对照，press在MRI上显示血管源性水肿。出现头痛（比值比[OR]， 1.372; 95% CI， 0.458至4.106）、脑病（OR, 2.303; 95% CI， 0.433至12.236）、视觉障碍（OR, 0.826; 95% CI， 0.185至3.697）或局灶性神经功能缺损（OR, 4.000; 95% CI， 0.767至20.872）的几率无统计学差异。癫痫发作在血管源性水肿患者中更为常见（OR, 0.082; 95% CI， 0.010至0.664）。急性肾损伤的几率（OR, 2.90; 95% CI, 0.679 ~ 12.449）、有恶性肿瘤史的几率（OR, 0.295; 95% CI, 0.076 ~ 1.152）、移植史（OR, 3.347; 95% CI, 0.594 ~ 18.880）、自身免疫性疾病史（OR, 0.400; 95% CI, 0.104 ~ 1.532）均无显著差异。与合并PRES和血管源性水肿的患者相比，合并高血压脑病和MRI阴性的患者入院时收缩压更高（OR, 1.03; 95% CI， 1.01至1.05）。结论：合并血管源性水肿的高血压脑病与不合并血管源性水肿的高血压脑病多数表现及危险因素无显著差异，提示急性重症高血压患者PRES的诊断可能不依赖于MRI的证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

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