Type:
Educational Exhibit
Keywords:
Performed at one institution, Observational, Retrospective, Epidemiology, Drugs / Reactions, Acute, Education, MR, CT, Neuroradiology brain, Neuro
Authors:
P. ELVIRA RUIZ, M. J. García Redondo, M. M. Manrique Zegarra, M. F. Arenas García, P. Patilla Vázquez, I. Garrido Morro, J. A. Guzmán de Villoria Lebiedziejewski, P. Fernández García; Madrid/ES
DOI:
10.26044/ecr2020/C-14603
Findings and procedure details
Between 2007 and 2019 we revised retrospectively in our radiological report database patients who met the following diagnostic criteria: neurological manifestations of acute onset, image signs of vasogenic oedema and reversibility of clinical and/or radiological findings.
Clinical, imaging data and outcome of the selected patients (n=33) were analysed (Table 1, 2, 3 and 4).
- The most frequent predisposing factor found was hypertension, observing high blood pressure in nearly half of cases (51%). Most of these patients showed moderate-severe hypertension (mean blood pressure values >106 mmHg). The second predisposing factor was immunosuppressant in 27% of cases. In 18% of patients no predisposing factor was described
- In 30% of cases the clinical onset included visual disturbances and headache.
- The three primary patterns were found 84,5% of cases, slightly more frequent than published incidences. Parieto-occipital pattern frequency was more than three times higher than the rest of primary distributions. The discrepancy between our study and previous research could lie on the variable degree of expression of these patterns and the frequent overlap between the regions involved in each one, which sometimes makes differentiation complex. The odd unilateral distribution frequency (6%) is surprisingly high.
- Our outcome data showed a good prognosis in most of the cases (82%), in accordance with the results of other studies.
Table 1:
Predisposing factor |
Number of patients (%) |
Hypertension |
17 (51%) |
Inmunosuppressants |
9 (27%) |
Chemotherapy |
5 (15%) |
Pre-eclampsia/eclampsia |
5 (15%) |
Infection/sepsis/shock |
4 (12%) |
Autoinmune diseases |
3 (9%) |
Contrast toxicity |
2 (6%) |
Kidney failure |
2 (6%) |
No predisposing factor
|
6 (18%) |
Table 2:
Neurological manifestations |
Number of patients n=33 (%) |
Seizures |
18 (54,5%) |
Headache |
18 (54,5%) |
Disorders of consciousness |
18 (54,5%) |
Visual disturbances |
16 (48,5%) |
Focal neurological deficit |
7 (21%) |
Table 3:
Image findings |
Number of patients n=33 (%) |
Dominant parieto-occipital pattern |
18 (54,5%) |
Holohemispheric watershed pattern |
5 (15%) |
Superior frontal sulcus pattern |
5 (15%) |
Partial and/or asymmetric expression |
5 (15%) |
Unilateral involvement |
2 (6%) |
Cerebellum |
9 (27%) |
Basal ganglia/thalamus |
3 (9%) |
Brainstem |
1 (3%) |
Intracranial haemorrhage |
11 (33%) |
Restricted diffuson |
9 (32%) |
Table 4:
Prognosis |
Numbers of patients n=33 (%) |
Clinical sequelae |
6 (18%) |
Image sequelae |
6 (18%) |