Advertisement
Mayo Clinic Proceedings Home

Albuminocytologic Dissociation in Posterior Reversible Encephalopathy Syndrome

Published:September 05, 2015DOI:https://doi.org/10.1016/j.mayocp.2015.07.018

      Abstract

      Objectives

      To describe cerebrospinal fluid (CSF) findings in patients with posterior reversible encephalopathy syndrome (PRES) and to study its association with vasogenic edema.

      Patients and Methods

      Retrospective review of 73 consecutive prospectively collected adults diagnosed with PRES from January 1, 2000, through December 31, 2014, who underwent lumbar puncture.

      Results

      Seventy-three patients (mean age, 51±17 years), were included in the analysis; of these, 50 (69%) were women. The most common causes for PRES were hypertension (n=61 [84%]) and immunosuppression (n=22 [30%]). Renal failure was present in 42 (58%) patients. The median interval between clinical onset of PRES and CSF analysis was 1 day (interquartile range [IQR], 0-2 days). The median opening pressure was 23 cm H2O or 17 mm Hg (IQR, 18-28 cm H2O or 13-21 mm Hg), although it was available in only 27 patients. The median CSF protein level was 58 mg/dL (IQR, 44-81 mg/dL; normal value, <35 mg/dL). The median CSF protein level was higher in patients with more extensive vasogenic edema. The median white blood cell count was 1 cell/μL (IQR, 1-2 cells/μL).

      Conclusion

      Elevated CSF protein level without CSF pleocytosis commonly occurs in patients with PRES and is directly associated with the extent and topographical distribution of cerebral edema. Although mild CSF pleocytosis can also occur, it is an uncommon finding and may prompt consideration for further diagnostic testing.

      Abbreviations and Acronyms:

      CNS (central nervous system), CSF (cerebrospinal fluid), IQR (interquartile range), MRI (magnetic resonance imaging), OP (opening pressure), PRES (posterior reversible encephalopathy syndrome)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hinchey J.
        • Chaves C.
        • Appignani B.
        • Breen J.
        • Pao L.
        • Wang A.
        • et al.
        A reversible posterior leukoencephalopathy syndrome.
        N Engl J Med. 1996; 334: 494-500
        • Fugate J.E.
        • Claassen D.O.
        • Cloft H.J.
        • Kallmes D.F.
        • Kozak O.S.
        • Rabinstein A.A.
        Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings.
        Mayo Clin Proc. 2010; 85: 427-432
        • Lee V.H.
        • Wijdicks E.F.
        • Manno E.M.
        • Rabinstein A.A.
        Clinical spectrum of reversible posterior leukoencephalopathy syndrome.
        Arch Neurol. 2008; 65: 205-210
        • Rabinstein A.A.
        • Mandrekar J.
        • Merrell R.
        • Kozak O.S.
        • Durosaro O.
        • Fugate J.E.
        Blood pressure fluctuations in posterior reversible encephalopathy syndrome.
        J Stroke Cerebrovasc Dis. 2012; 21: 254-258
        • Vaughan C.J.
        • Delanty N.
        Hypertensive emergencies.
        Lancet. 2000; 356: 411-417
        • Bartynski W.S.
        Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema.
        AJNR Am J Neuroradiol. 2008; 29: 1043-1049
        • Bartynski W.S.
        • Boardman J.F.
        Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome.
        AJNR Am J Neuroradiol. 2007; 28: 1320-1327
        • Bartynski W.S.
        • Boardman J.F.
        • Zeigler Z.R.
        • Shadduck R.K.
        • Lister J.
        Posterior reversible encephalopathy syndrome in infection, sepsis, and shock.
        AJNR Am J Neuroradiol. 2006; 27: 2179-2190
        • Tenembaum S.
        • Chitnis T.
        • Ness J.
        • Hahn J.S.
        Acute disseminated encephalomyelitis.
        Neurology. 2007; 68: S23-S36
        • Benjamini Y.
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J Royal Stat Soc Ser B (Methodol). 1995; 57: 289-300
        • Glickman M.E.
        • Rao S.R.
        • Schultz M.R.
        False discovery rate control is a recommended alternative to Bonferroni-type adjustments in health studies.
        J Clin Epidemiol. 2014; 67: 850-857
        • Fishman R.A.
        Cerebrospinal Fluid in Diseases of the Nervous System.
        2nd edition. Saunders, Philadelphia, PA1992: 319-320