Examining the Spectrum of Reversibles: Cerebral ischemia in PRES and RCVS

Objective: To evaluate the occurrence of cerebral ischemia in PRES and RCVS. Background: PRES refers to a disorder of reversible vasogenic brain edema causing acute neurologic symptoms. RCVS is a syndrome of thunderclap headache associated with cerebral arterial narrowing. Previous literature has demonstrated comorbid PRES and RCVS at a rate of 15–30%. Previous literature has documented cerebral ischemia as a complication of both PRES and RCVS. Limited data exists regarding the rate of cerebral ischemia in patients with comorbid PRES and RCVS. Design/Methods: A 10 year retrospective review of cases of PRES and RCVS at Mayo Clinic Arizona was performed. Data was collected using diagnosis codes, text retrieval from radiology reports, and physician logs. PRES was defined as (1) clinical history of acute neurologic changes; (2) brain imaging demonstrating focal vasogenic edema; and (3) clinical or radiologic proof of reversibility. RCVS was defined as evidence of reversible cerebral vasospasm without other diagnosis to better account for vasoconstriction. Cerebral ischemia was defined as 1) Diffusion restriction on MRI with ADC correlate; or 2) Evidence of ischemic stroke on CT or MRI within 12 week s of presentation. Results: 5000 charts were reviewed. 70 cases of PRES and 39 cases of RCVS were identified. 16 of these cases had both PRES and RCVS (23%). Cerebral ischemia was identified in 36% of PRES cases, 18.2% of RCVS cases, and 50% with concomitant PRES and RCVS. Conclusions: This is a retrospective review aimed at characterizing the rates of cerebral ischemia in PRES and RCVS. This study confirms that cerebral ischemia is a common complication of PRES and RCVS both in isolation and as comorbid diagnoses. A high level of suspicion for vascular events should be entertained and appropriate vascular imaging should be pursued in these patients. Disclosure: Dr. Pena has nothing to disclose. Dr. O9Carroll has nothing to disclose. Dr. Steenerson has nothing to disclose. Dr. Starling has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder, Amgen, Eli Lilly u0026 Company, eNeura.