Posterior reversible encephalopathy syndrome associated with hemorrhage

Rosalyn M. Aranas, Shyam Prabhakaran, Vivien H. Lee

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity characterized by headache, encephalopathy, visual disturbances, and seizures in association with reversible vasogenic edema on neuroimaging. Intracerebral hemorrhage associated with PRES (PRES-ICH) is generally considered an atypical finding. Methods: Retrospective case series. Results: Seven patients were identified with PRES-ICH, four males and three females. The presenting clinical symptoms included headache (2), encephalopathy (5), vision changes (2), seizures (2), and hemiparesis (1). The co-morbid conditions included acute renal dysfunction (3), solid organ transplantation (3), bone marrow transplant (1), use of calcineurin inhibitor agents (4), and pre-eclampsia (1). Neuroimaging revealed intraparenchymal hemorrhage in six patients and subarachnoid hemorrhage in one patient. Six of the seven patients with PRES-related ICH had underlying bleeding diathesis, including one patient who was anti-coagulated with a heparin drip. The mean platelet count was 82.1 × 103/μl (range, 4-232 × 103/μl), and the mean INR value was 2.18 (range, 0.9-6.7). Two patients died during the acute hospitalization. Among the five survivors, only two patients had good functional outcome (pre-defined as mRS ≤ 1). Conclusion: In our series, the majority of patients with PRES-ICH (85%) had an underlying bleeding diathesis or coagulopathy. Although PRES is typically considered to have a favorable prognosis, the clinical outcome of PRES with associated ICH can be more variable.

Original languageEnglish (US)
Pages (from-to)306-312
Number of pages7
JournalNeurocritical Care
Issue number3
StatePublished - Jun 2009


  • Coagulopathy
  • Hypertensive encephalopathy
  • Intracerebral hemorrhage
  • Thrombocytopenia

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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