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Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome.

TitleCorticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome.
Publication TypeJournal Article
Year of Publication2017
AuthorsParikh NS, Schweitzer AD, Young RJ, Giambrone AE, Lyo J, Karimi S, Knobel A, Gupta A, Navi BB
JournalJ Neurol Sci
Volume380
Pagination11-15
Date Published2017 Sep 15
ISSN1878-5883
KeywordsAdolescent, Adrenal Cortex Hormones, Adult, Aged, Brain Edema, Female, Humans, Linear Models, Logistic Models, Male, Methylprednisolone, Middle Aged, Posterior Leukoencephalopathy Syndrome, Prevalence, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Young Adult
Abstract

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a variable cerebrovascular syndrome associated with hypertension and autoregulatory failure. Steroids have been reported to both precipitate and treat PRES. We sought to determine the prevalence of steroid therapy at the time of PRES and to assess the relationship between steroid therapy and extent of vasogenic edema.

METHODS: We performed a retrospective review of radiology reports between 2008 and 2014 from two academic medical centers to identify cases of PRES. Clinical and radiographic data were collected. Descriptive statistics were used to determine the prevalence of corticosteroid therapy at the time of PRES onset and the latency from steroid initiation to PRES onset. The association between steroid therapy and extent of vasogenic edema was assessed in multiple regression models.

RESULTS: We identified 99 cases of PRES in 96 patients. The median age was 55years (IQR 30-65) and 74% were women. Steroid therapy at time of PRES onset was identified in 44 of 99 cases. Excluding patients on chronic therapy, the median duration of steroid exposure before PRES onset was 6 (IQR, 3-10) days. Steroid therapy was not associated with extent of vasogenic edema in unadjusted or linear and logistic regression models adjusted for age, sex, and maximum systolic blood pressure on day of onset.

CONCLUSION: Corticosteroid therapy, often of brief duration, frequently preceded the onset of PRES and was not associated with severity of vasogenic edema.

DOI10.1016/j.jns.2017.06.044
Alternate JournalJ. Neurol. Sci.
PubMed ID28870548
PubMed Central IDPMC5663311
Grant ListK23 NS091395 / NS / NINDS NIH HHS / United States
P30 CA008748 / CA / NCI NIH HHS / United States
T32 NS007153 / NS / NINDS NIH HHS / United States
UL1 TR000457 / TR / NCATS NIH HHS / United States

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