Arterial hypertension and posterior reversible encephalopathy syndrome


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Abstract

The cardiological and neurological interdisciplinary aspects of posterior reversible encephalopathy syndrome (PRES) as a variant of acute hypertensive encephalopathy are presented in the article. The aim of the article is to draw attention of the clinicians to the rare complication of hypertensive crisis and acute hypertensive encephalopathy - PRES. Fast and accurate medical diagnostic and treatment can prevent transformation of this reversible condition (vasogenic edema of the brain) into severe neurological complications. In this article the clinical and radiological aspects of typical and atypical PRES variants are analyzed. Special attention is devoted to the clinical presentations of PRES in the settings of hypertensive crisis: the possibility of formation of the «central variant» of PRES with clinical-radiological dissociation, hemorrhagic transformation and other complications. The main treatment strategy in patients with PRES and hypertensive crisis is a stepwise lowering of blood pressure (BP). Within the first 2-4 hours the BP should be lowered no more than 20-25% of the initial blood pressure, with gradual reduction within the next 24 hours.

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About the authors

Mikhail Yu. Martynov

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia; Federal Center for Brain and Neurotechnologies of the Federal Medical and Biological Agency of Russia

Email: m-martin@mbox.ru
Dr. med. habil., professor, corresponding member of RAS, first deputy director of Federal Center for Brain and Neurotechnologies; professor of the Department of neurology, neurosurgery and medical genetics 119415, Moscow, 42/6 Lobachevskogo Str

Valentina V. Gudkova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: gudkova.valentina@gmail.com
PhD in Medicine, professor of the Department of neurology, neurosurgery and medical genetics 119415, Moscow, 42/6 Lobachevskogo Str

Evgenia A. Koltsova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: koltsovaevgenia@rambler.ru
PhD in Medicine, professor of the Department of neurology, neurosurgery and medical genetics 119415, Moscow, 42/6 Lobachevskogo Str

Olga D. Razinskaya

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: july2000@mail.ru
assistant at the Department of neurology, neurosurgery and medical genetics 119415, Moscow, 42/6 Lobachevskogo Str

Natalya N. Abramenkova

War Veteran's Hospital No. 3 of the Department of Healthcare of Moscow

Email: vedmochka@mail.ru
neurologist at the 8th Neurological Department for patients with acute disorders of cerebral circulation 129336, Moscow, 4 Startovaya Str

Evgeny S. Solntsev

War Veteran's Hospital No. 3 of the Department of Healthcare of Moscow

Email: solntsev.jenyok21@yandex.ru
neurologist at the 8th Neurological Department for patients with acute disorders of cerebral circulation 129336, Moscow, 4 Startovaya Str

Dmitry I. Ulyanov

War Veteran's Hospital No. 3 of the Department of Healthcare of Moscow

Email: ulan.11n.com@inbox.ru
head of the Neurological Department 129336, Moscow, 4 Startovaya Str

Svetlana E. Chuprina

Voronezh Regional Clinical Hospital No. 1

Email: chuprinasveta@mail.ru
head of the Neurological Department for patients with cerebrovascular disorders 394066, Voronezh, 151А Moskovsky Avenue

References

  1. Hinchey J., Chaves C., Appignani B. et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996; 334(8): 494-500. https://dx.doi.org/10.1056/nejm/199602223340803.
  2. Li K., Yang Y., Guo D. et al. Clinical and MRI features of posterior reversible encephalopathy syndrome with atypical regions: A descriptive study with a large sample size. Front. Neurol. 2020; 11: 194. https://dx.doi.org/10.3389/fneur.2020.00194.
  3. Богданов Э.И., Хасанов И.А. Синдром задней обратимой энцефалопатии и артериальная гипертензия. Журнал неврологии и психиатрии им. С.С. Корсакова. 2020; 120(6): 17-23. https://dx.doi.org/10.17116/jnevro202012006117. EDN: QESGHM.
  4. Гудкова В.В., Кимельфельд Е.И., Стаховская Л.В. Малоизвестный синдром задней обратимой энцефалопатии, требующий неотложной помощи. Consilium Medicum. 2018; 20(2): 84-89. https://dx.doi.org/10.26442/2075-1753_2018.2.84-89. EDN: RQSAJJ.
  5. Chen X., Zhao J.G., Gao B. et al. Posterior reversible encephalopathy syndrome with a special focus on seizures. J Clin Neurosci. 2022; 95(1): 38-43. https://dx.doi.org/10.1016/j.jocn.2021.11.009.
  6. Bartynski W.S. Posterior reversible encephalopathy syndrome, Part 1: Fundamental imaging and clinical. AJNR Am J Neuroradiol. 2008; 29(6): 1036-42. https://dx.doi.org/10.3174/ajnr.A0928.
  7. Fugate J.E., Rabinstein A.A. Posterior reversible encephalopathy syndrome: Clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015; 14(9): 914-25. https://dx.doi.org/10.1016/s1474-4422(15)00111-8.
  8. Casey S.O., Sampaio R.C., Michel E. et al. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol. 2000; 21(7): 1199-206.
  9. Kastrup O., Schlamann M., Moenninghoff C. et al. Posterior reversible encephalopathy syndrome: The spectrum of MR imaging patterns. Clin Neuroradiol. 2015; 25(2): 161-71. https://dx.doi.org/10.1007/s00062-014-0293-7.
  10. Lee V., Wijdicks E., Manno E., Rabinstein A. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008; 65(2): 45-46. https://dx.doi.org/10.1001/archneurol.2007.46.
  11. Stevens C.J., Heran M.K. The many faces of posterior reversible encephalopathy syndrome. Br J Radiol. 2012; 85(2020): 1566-75. https://dx.doi.org/10.1259/bjr/25273221.
  12. McKinney A.M., Jagadeesan B.D., Truwit C.L. Central-variant posterior reversible encephalopathy syndrome: Brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema. AJR. 2013; 201(3): 631-38. https://dx.doi.org/10.2214/AJR.12.9677.
  13. Скворцова В.И., Губский Л.В., Мельникова Е.А. Синдром задней обратимой энцефалопатии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2010; 5: 104-109. EDN: NQZNSJ.
  14. Ozawa T., Tanaka R., Nagaoka R. et al. Data on characteristics of reported cases of unilateral posterior reversible encephalopathy syndrome (PRES). Data Brief. 2019; 27: 104648. https://dx.doi.org/10.1016/j.dib.2019.104648.
  15. Liu C., Cao J., Su Z., Xu S. Isolated brainstem involvement in posterior reversible encephalopathy syndrome: A case report and review of the literature.Int J Neurosci. 2019; 129(8): 808-13. https://dx.doi.org/10.1080/00207454.2018.1561452.
  16. Chaudhari D.M., Renjen P.N., Goyal N., Mishra A. Central variant reversible encephalopathy syndrome. BMJ Case Rep. 2022; 15(2): e245636. https://dx.doi.org/10.1136/bcr-2021-245636.
  17. Hefzy H.M., Bartynski W.S., Boardman J.F., Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: Imaging and clinical features. AJNR Am J Neuroradiol. 2009; 30(7): 1371-79. https://dx.doi.org/10.3174/ajnr.A1588.
  18. Liman T.G., Bohner G., Heuschmann P.U. et al. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: The retrospective Berlin PRES study. J Neurol. 2012; 259(1): 155-64. https://dx.doi.org/10.1007/s00415-011-6152-4.
  19. Bartynski W.S. Posterior reversible encephalopathy syndrome, part 2: Controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008; 29(6): 1043-49. https://dx.doi.org/10.3174/ajnr.A0929.
  20. Chen Z., Shen G.Q., Lerner A., Gao B. Immune system activation in the pathogenesis of posterior reversible encephalopathy syndrome. Brain Res Bull. 2017; 131: 93-99. https://dx.doi.org/10.1016/j.brainresbull.2017.03.012.
  21. Marra A., Vargas M., Striano P. et al. Posterior reversible encephalopathy syndrome: the endothelial hypotheses. Med Hypotheses. 2014; 82(5): 619-22. https://dx.doi.org/10.1016/j.mehy.2014.02.022.
  22. Ainslie P.N., Ashmead J.C., Ide K. et al. Differential responses to CO2 and sympathetic stimulation in the cerebral and femoral circulations in humans. J Physiol. 2005; 566 (Pt 2): 613-24. https://dx.doi.org/10.1113/jphysiol.2005.087320.
  23. Mayhan W.G., Werber A.H., Heistad D.D. Protection of cerebral vessels by sympathetic nerves and vascular hypertrophy. Circulation. 1987; 75(1 Pt 2): 107-12.
  24. Maillard P., Seshadri S., Beiser A. et al. Effects of systolic blood pressure on white-matter integrity in young adults in the Framingham Heart Study: A cross-sectional study. Lancet Neurol. 2012; 11(12): 1039-47. https://dx.doi.org/10.1016/S1474-4422(12)70241-7.
  25. Babici D., Hindi F., Hanafy K.A. Posterior reversible encephalopathy syn-drome due to unilateral renal artery stenosis: A case report. Brain Circ. 2022; 8(2): 108-11. https://dx.doi.org/10.4103/bc.bc_14_22.
  26. Claassen J.A.H.R., Thijssen D.H.J., Panerai R.B., Faraci F.M. Regulation of cerebral blood flow in humans: Physiology and clinical implications of autoregulation. Physiol Rev. 2021; 101(4): 1487-559. https://dx.doi.org/10.1152/physrev.00022.2020.
  27. Lee M.K., Cho Y.J., Lee S.K. et al. The effect of presymptomatic hypertension in posterior reversible encephalopathy syndrome. Brain Behav. 2018; 8(8): e01061. https://dx.doi.org/10.1002/brb3.1061.
  28. Johansson B. Brain barrier pathology in acute arterial hypertension. Adv Exp Med Biol. 1976; 69: 517-27. https://dx.doi.org/10.1007/978-1-4684-3264-0_38.
  29. Ziylan Y.Z. Pathophysiology of the opening of the blood-brain and blood-cerebrospinal fluid barriers in acute hypertension. Exp Neurol. 1984; 84(1): 18-28. https://dx.doi.org/10.1016/0014-4886(84)90002-5.
  30. Gowan J.M., Liu A. Isolated pan-pontine posterior reversible encephalopathy syndrome in a patient with uncontrolled hypertension. Clin Case Rep. 2019; 7(1): 32-36. https://dx.doi.org/10.1002/ccr3.1888.
  31. Beausang-Linder M., Bill A. Cerebral circulation in acute arterial hypertension - protective effects of sympathetic nervous activity. Acta Physiol Scand. 1981; 111(2): 193-99. https://dx.doi.org/10.1111/j.1748-1716.1981.tb06724.x.
  32. Roloff E.V., Tomiak-Baquero A.M., Kasparov S., Paton J.F. Parasympathetic in-nervation of vertebrobasilar arteries: Is this a potential clinical target? J Physiol. 2016; 594(22): 6463-85. https://dx.doi.org/10.1113/JP272450.
  33. Cantone M., Lanza G., Puglisi V. et al. Hypertensive crisis in acute cerebrovas-cular diseases presenting at the emergency department: A narrative review. Brain Sci. 2021; 11(1): 70. https://dx.doi.org/10.3390/brainsci_11010070.
  34. Кобалава Ж.Д., Конради А.О., Недогода С.В. с соавт. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(3): 149-218. https://dx.doi.org/10.15829/1560-4071-2020-3-3786. EDN: TCRBRB.

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