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J Neurol Sci. 2017 Sep 15;380:11-15. doi: 10.1016/j.jns.2017.06.044. Epub 2017 Jun 29.

Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome.

Author information

1
Department of Neurology, Weill Cornell Medical College, New York, NY, USA. Electronic address: nsp2001@nyp.org.
2
Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
3
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
4
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
5
Department of Radiology, Lenox Hill Hospital, New York, USA.
6
Department of Radiology, Weill Cornell Medical College, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
7
Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.

Abstract

BACKGROUND:

Posterior reversible encephalopathy syndrome (PRES) is a variable cerebrovascular syndrome associated with hypertension and autoregulatory failure. Steroids have been reported to both precipitate and treat PRES. We sought to determine the prevalence of steroid therapy at the time of PRES and to assess the relationship between steroid therapy and extent of vasogenic edema.

METHODS:

We performed a retrospective review of radiology reports between 2008 and 2014 from two academic medical centers to identify cases of PRES. Clinical and radiographic data were collected. Descriptive statistics were used to determine the prevalence of corticosteroid therapy at the time of PRES onset and the latency from steroid initiation to PRES onset. The association between steroid therapy and extent of vasogenic edema was assessed in multiple regression models.

RESULTS:

We identified 99 cases of PRES in 96 patients. The median age was 55years (IQR 30-65) and 74% were women. Steroid therapy at time of PRES onset was identified in 44 of 99 cases. Excluding patients on chronic therapy, the median duration of steroid exposure before PRES onset was 6 (IQR, 3-10) days. Steroid therapy was not associated with extent of vasogenic edema in unadjusted or linear and logistic regression models adjusted for age, sex, and maximum systolic blood pressure on day of onset.

CONCLUSION:

Corticosteroid therapy, often of brief duration, frequently preceded the onset of PRES and was not associated with severity of vasogenic edema.

KEYWORDS:

Corticosteroids; Hypertension; Posterior reversible encephalopathy syndrome; Vasogenic edema

PMID:
28870548
PMCID:
PMC5663311
DOI:
10.1016/j.jns.2017.06.044
[Indexed for MEDLINE]
Free PMC Article

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