Clinical And Imaging Features Of Reversible Posterior Encephalopathy In Different Causes Of Systemic Lupus Erythematosus And Nephrotic Syndrome

Background and Objective: Reversible posterior encephalopathy is a set of syndromes with various clinical and imaging manifestations,which can be reversible after positive treatment;its manifestations in clinics are shown as headache,Epileptic Seizure,disturbance of consciousness and paropsia;its typical imaging manifestation is vasogenic edema distributed in two sides of posterior parietal occipital lobe symmetrically.The disease is often secondary to some basic diseases,such as eclampsia/preeclampsia,hypertension,kidney failure and autoimmune disease,etc.Systemic lupus erythematosus and nephrotic syndrome associated with reversible posterior leukoencephalopathyoccur more in China.This research is mainly to summarize the clinical and imaging features of reversible posterior leukoencephalopathy syndrome(PRES)caused by nephrotic syndrome and systemic lupus erythematosus,thereby increasing recognition on this disease.Methods: A total of 53 patients diagnosed with reversible posterior encephalopathy syndrome from January 1,2013 to December 31,2017 at the General Hospital of the Eastern Theater of the Chinese People’s Liberation Army,with primary disease of systemic lupus erythematosus(SLE group,31 cases)or primary nephrotic syndrome(NS group,22 cases),were retrospectively analyzed,and basic information(gender,age,diastolic blood pressure,systolic blood pressure)was collected clinically The patients’ basic information(gender,age,diastolic blood pressure,systolic blood pressure),clinical symptoms,possible causative factors,laboratory findings(triglycerides,uric acid,sodium,calcium,chloride,magnesium,phosphorus,lactate dehydrogenase)and disease course regression were collected clinically,and the imaging manifestations,sites of involvement and severity of lesions in reversible posterior encephalopathy syndrome due to different etiologies were observed by different sequential MRI examination methods,and statistical analysis was performed by SPASS 22.0 software.To compare whether there were differences in clinical and imaging features between the two groups.Results: Incidence rates of visual impairment(χ2 =7.005,P=0.008)and epileptiform seizure(χ2 = 9.255,P=0.002)of the SLE group were lower than those in the NS group.In the SLE group,bilateral periventricular areas(adjusted χ2 = 5.377,P=0.020),basal ganglia(adjusted χ2 = 4.825,P=0.028)and centrum semiovale(χ2 =8.113,P=0.004)were mainly involved.The differences of imaging type between the2 groups were statistically significant(Fisher’s exact probability: P=0.029).The proportion of parietal occipital lobe distribution in NS group was significantly higher than that in SLE group(Fisher’s exact probability: P=0.016).After treatment,PRES recovery in the SLE group was better and faster than that in NS group(t = 2.612,P=0.013).Conclusions: Common pathogens of PRES namely SLE and NS are different in certain degree of imaging features,and this will be significant to understand pathophysiological mechanism and clinical diagnosis of this disease.