Journal of the neurological sciences · 2025
Occipital cerebral microbleeds as a predictor of intracranial hemorrhage in posterior reversible encephalopathy syndrome.
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Jeong Dong Young, Chang Jun Young, Kang Dong-Wha, Kwon Sun U, Kim Chulhong, Kim Bum Joon
Аннотация
BACKGROUND AND OBJECTIVES: Intracranial hemorrhage (ICH), which often occurs in cases of posterior reversible encephalopathy syndrome (PRES), is regarded as a significant predictor of poor disease outcomes. While ICH and cerebral microbleeds (CMBs) can occur due to uncontrolled hypertension, the relationship between these conditions remains unclear.
METHODS: This retrospective case-control study categorized PRES patients according to the presence of ICH on the day of symptom onset. The presence of CMBs or intracranial bleeding was assessed using gradient echo (GRE), susceptibility-weighted imaging (SWI), and computed tomography (CT) scans. CMBs and intracranial hemorrhage were classified according to size (≥5 mm). The brain was divided into nine regions, with the four areas excluding the fronto-parieto-occipito-temporal lobe and the cerebellum grouped as deep structures. Mediation analysis was conducted to evaluate the potential causal relationship in which ICH may mediate the association between the presence of CMBs and complete remission.
RESULTS: The study included 165 patients with PRES, among whom 19 (11.52 %) presented with ICH. The maximal systolic blood pressure at the time of PRES occurrence was not significantly different between PRES patients with ICH and those without (180.0 ± 20.8 mmHg vs. 183.5 ± 29.2 mmHg, p = 0.53). However, PRES cases with ICH exhibited a higher prevalence of CMBs in the parietal and occipital lobes (parietal lobe: 9 [52.9 %] vs. 27 [21.3 %], p = 0.005; occipital lobe: 8 [47.1 %] vs. 15 [11.8 %], p < 0.001). Logistic regression analysis revealed that the presence of CMBs in the occipital lobe was positively associated with the presence of ICH in PRES (odds ratio = 10.71, 95 % CI 1.44-79.63, p = 0.020).
DISCUSSION: This study suggests that in PRES, ICH may occur due to a vulnerable endothelium in the occipital lobe. Furthermore, cases with CMBs in the occipital lobe may experience ICH as a complication of PRES.
METHODS: This retrospective case-control study categorized PRES patients according to the presence of ICH on the day of symptom onset. The presence of CMBs or intracranial bleeding was assessed using gradient echo (GRE), susceptibility-weighted imaging (SWI), and computed tomography (CT) scans. CMBs and intracranial hemorrhage were classified according to size (≥5 mm). The brain was divided into nine regions, with the four areas excluding the fronto-parieto-occipito-temporal lobe and the cerebellum grouped as deep structures. Mediation analysis was conducted to evaluate the potential causal relationship in which ICH may mediate the association between the presence of CMBs and complete remission.
RESULTS: The study included 165 patients with PRES, among whom 19 (11.52 %) presented with ICH. The maximal systolic blood pressure at the time of PRES occurrence was not significantly different between PRES patients with ICH and those without (180.0 ± 20.8 mmHg vs. 183.5 ± 29.2 mmHg, p = 0.53). However, PRES cases with ICH exhibited a higher prevalence of CMBs in the parietal and occipital lobes (parietal lobe: 9 [52.9 %] vs. 27 [21.3 %], p = 0.005; occipital lobe: 8 [47.1 %] vs. 15 [11.8 %], p < 0.001). Logistic regression analysis revealed that the presence of CMBs in the occipital lobe was positively associated with the presence of ICH in PRES (odds ratio = 10.71, 95 % CI 1.44-79.63, p = 0.020).
DISCUSSION: This study suggests that in PRES, ICH may occur due to a vulnerable endothelium in the occipital lobe. Furthermore, cases with CMBs in the occipital lobe may experience ICH as a complication of PRES.