TY - JOUR
T1 - Albuminocytologic Dissociation in Posterior Reversible Encephalopathy Syndrome
AU - Datar, Sudhir
AU - Singh, Tarun D.
AU - Fugate, Jennifer E.
AU - Mandrekar, Jay
AU - Rabinstein, Alejandro A.
AU - Hocker, Sara
N1 - Publisher Copyright:
© 2015 Mayo Foundation for Medical Education and Research.
PY - 2015/10
Y1 - 2015/10
N2 - 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.
AB - 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.
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U2 - 10.1016/j.mayocp.2015.07.018
DO - 10.1016/j.mayocp.2015.07.018
M3 - Article
C2 - 26349950
AN - SCOPUS:84955370753
SN - 0025-6196
VL - 90
SP - 1366
EP - 1371
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 10
ER -