Autoimmune Vs. Non-Autoimmune Pres: A Decade-Long Cohort Study On Differences In Clinical, Imaging, And Prognostic Features
Laura Ballen1, Andres Hormaza1, Ana Granados1, Andres Tascon1, Valentina Mejía1, Daniela Peñaloza2, Nathalia Coral2, Carlos Guzman2, Julian Rivillas1
1Hospital Universitario Fundación Clínica Valle de Lili; Universidad Icesi, 2Hospital Universitario Fundación Clínica Valle de Lili
Objective:
To comprehensively characterize the distinct clinical, radiological profiles and outcomes of autoimmune and non-autoimmune PRES.
Background:
Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder that is often reversible and can extend beyond the posterior regions of the brain. This study compares the clinical, radiological, and prognostic differences between autoimmune and non-autoimmune PRES using, given that the differences are not clear.
Design/Methods:
We conducted a 13-year retrospective review (2011–2024) of PRES patients, identified through ICD-10-CM codes. A panel of neuroradiologists, rheumatologists, and neurologists analyzed and classified the cases. Sociodemographic, clinical, imaging, and outcome data were collected. Fisher's exact test and the Chi-square test were used to detect significant differences (p < 0.05) between the groups.
Results:
Among the 146 patients with PRES, 86% were female. Autoimmune disorders (AD) were present in 32.8% of cases. Acute renal failure was associated with PRES in 71% of patients with AD (vs. 41% in the non-autoimmune group [NA]; p < 0.001). Diagnostic brain MRI showed vasogenic edema localized in the cerebellum in 38% of patients with AD PRES (vs. 15% in NA; p < 0.003). Status epilepticus occurred as a complication in 15% of patients with autoimmune PRES (vs. 4% in NA; p < 0.041). Long-term neurological sequelae were observed in 31% of patients with AD (vs. 52% in NA; p < 0.018). Conversely, motor manifestations were more frequent in the non-autoimmune group (14% vs. 2.1% in AD; p = 0.022).
Conclusions:
Our study found that autoimmune PRES is associated with higher rates of acute renal failure, cerebellar involvement, and status epilepticus, yet results in fewer long-term neurological sequelae. In contrast, non-autoimmune PRES exhibited more motor symptoms. These distinctions suggest the need for tailored diagnostic and treatment approaches based on etiology. Prospective studies are needed to confirm and understand these findings.
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