Original article / research Year :2018 Month : July Volume : 7 Issue : 3 Page : RO22 - RO26 Posterior Reversible Encephalopathy Syndrome: Study of Common Associations and Varying Imaging Features Madhav Hegde, Naveen Raj MB 1. Associate Professor, Department of Radiology, Sambhram Institute of Medical Sciences and Research, Kolar, Karnataka, India. 2. Senior Resident, Department of Radiology, Subbaiah Institute of Medical Sciences, Purley, Shivamogga, Karnataka, India.   Correspondence Address : Dr. Madhav Hegde, D1003, The Gardens Apartment, No. 9 , KP Agrahara, Magadi Road, Bengaluru-560023, Karnataka, India. E-mail: docmadhavhegde@gmail.com   ABSTRACT : Morphometry of body and neural arch of lumbar vertebrae is very crucial in manufacturing screws, interspinous implants as well as preoperative planning of surgeries involving dorsolumbar spine. Aim: To determine various dimensions of typical and atypical lumbar vertebrae. Materials and Methods: A descriptive osteological study was carried out which included 66 intact adult dry human lumbar vertebrae (53 typical and 13 atypical) which were free of any deformity or pathological features. All the 53 typical vertebrae were randomly obtained. The following parameters were measured with slide callipers- superior transverse diameter and superior antero-posterior diameters of vertebral foramen; transverse diameter, antero-posterior diameter and anterior height of vertebral body; width, height of pedicles; interpedicular distance; maximum thickness of lamina; length of transverse process; maximum length, maximum height and maximum central thickness of spinous process. The data was tabulated and analysed using Microsoft Excel software. Mean and standard deviation was calculated for each parameter. Unpaired t-test was applied and p-value was derived for parameters like width and height of pedicles, thickness of lamina and length of transverse process. The p-value<0.05 were considered as significant. Results: The vertebral foramen (superior transverse diameter- 20.41±2.54 mm, superior antero-posterior diameter- 13.3±2.04 mm); vertebral body (transverse diameter- 44.43±5.91 mm, antero-posterior diameter- 30.17±3.19 mm, anterior height- 24.01±1.84 mm); pedicle (width- 10.85±3.94 mm on left side and 11.04±4.01 mm on right side, height- 13.84±4.01 mm on left side and 13.8±1.93 mm on right side, interpedicular distance- 29.17±5.06 mm); lamina (thickness- 6.6±1.36 mm on left side and 6.85±1.34 mm on right side); transverse process (length- 20.94±4.01 mm on left side and 21.51±4.5 mm on right side); spinous process (maximum length- 26.01±3.73 mm, maximum height- 19.92±4.03 mm, maximum central thickness- 6.42±1.41 mm). The mean transverse diameter and antero-posterior diameter of vertebral foramen of atypical lumbar vertebrae were higher than those of the typical lumbar vertebrae and these differences were significant (p-value of 0.0001 for transverse diameter and p-value of 0.005 for antero-posterior diameter). Conclusion: Most of the parameters of atypical lumbar vertebrae were found to be more compared to those of typical lumbar vertebrae. This inference should be kept in mind during fixation of lumbar inter-spinous implants, designing of pedicular screws and spinal grafting. Keywords : Eclampsia, Reversible leukoencephalopathy, Seizure   INTRODUCTION PRES is a clinically bewildering encephalopathy syndrome which can be encountered in emergency room or in an already hospitalised patient. Contrary to its name, it can leave behind irreversible brain damage during the course of recovery. However, its etio pathogenesis has not been completely established (1),(2),(3),(4),(5). Its occurrence and mechanisms have been widely published mainly in the population of patients with transplant necessitated immunosuppression and not many studies have been carried out in the setting of many other risk factors (2),(6).There is also limited data on the frequency of occurrence in various clinical risk factors and the pattern of regional distributions of lesions in brain parenchyma in various systemic associations responsible for PRES (7).   REFERENCES 1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494-500. 2. Legriel S, Pico F, Azoulay E. Understanding Posterior Reversible Encephalopathy Syndrome. In: Vincent J-L (ed.). Annual Update in Intensive Care and Emergency Medicine. 2011 3. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65(2):205-10. 4. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: Associated clinical and radiologic findings. Mayo Clinic Proc. 2010; 85(5):427-32. 5. Bartynski WS. Posterior reversible encephalopathy syndrome, Part 2: Controversies sur-rounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008;29(6):1043-49. 6. Hedna VS, Stead LG, Bidari S, Patel A, Gottipati A, Favilla CG. Posterior Reversible Encephalopathy Syndrome (PRES) and CT perfusion changes. Int J Emerg Med. 2012;5:12. 7. Ganesh K, Nair RR, Kurian G, Mathew A, Sreedharan S, Paul Z. Posterior reversible ence-phalopathy syndrome in kidney disease. Kidney Int Reports [Internet]. 2018;3(2):502-07. Available from: https://doi.org/10.1016/j.ekir.2017.10.017 8. Ay H, Buonanno FS, Schaefer PW, Le DA, Wang B, Gonzalez RG, et al. Posterior leukoen-cephalopathy without severe hypertension. Neurology [Internet]. 1998;51(5):1369 LP-1376. Available from: http://n.neurology.org/content/51/5/1369 9. Kumar N, Singh R, Sharma N, Jain A. Case Report Atypical presentation of posterior reversible encephalopathy syndrome : two cases case reports. J Anaesthesiol Clin Pharmacol. 2018;34(1):120–22. 10. Nightingale S, Wood C, Ainsworth J. The posterior reversible encephalopathy syndrome in HIV infection. BMJ Case Rep [Internet]. 2012;2012:bcr0120125647. 11. Shankar J, Banfield J. Posterior reversible encephalopathy syndrome: A review. Can Assoc Radiol J. 2017;68(2):147-53. 12. Dandoy CE, Linscott LL, Davies SM, Leach JL, Myers KC, El-Bietar J, et al . Clinical utility of computed tomography and magnetic resonance imaging for diagnosis of posterior reversible encephalopathy syndrome after stem cell transplantation in children and adolescents. Biol Blood Marrow Transplant. 2015;21(11):2028-32. 13. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior re-versible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427-32. 14. Stevens CJ, Heran MK. The many faces of posterior reversible encephalopathy syndrome. Br J Radiol. 2012;85(1020):1566-75. 15. Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Haemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol. 2009;30(7):1371-79. 16. Khan SJ, Arshad AA, Fayyaz MB, ud din Mirza I. Posterior reversible encephalopathy syndrome in pediatric cancer: clinical and radiologic findings. J Glob Oncol [Internet]. 2017;(4):01-08. 17. Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007;28(7):1320-27. 18. Hugonnet E, Da Ines D, Boby H, Claise B, Petitcolin V, Lannareix V, et al. Posterior reversible encephalopathy syndrome (PRES): Features on CT and MR imaging. Diagn Interv Imaging. 2013;94(1):45-52. 19. Raman R, Devaramane R, Jagadish GM, Chowdaiah S.Various imaging manifestations of Posterior Reversible Encephalopathy Syndrome (PRES) on Magnetic Resonance Imaging (MRI). Pol J Radiol. 2017;82:64-70. 20. Shankar J, Banfield J. Posterior reversible encephalopathy syndrome: a review. Can Assoc Radiol J. 2017;68(2):147-53. 21. Lazo KG, DO, Mandel S, Pramanik B, Lee J, Maria V. Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report and Review of the Literature. Practical Neurology. [Available from]: http://practicalneurology.com/2016/04/ posterior-reversible-encephalopathy-syndrome-pres-a-casereport-and-review-of-the-literature¢er=181 22. Brewer J, Owens MY, Wallace K, Reeves AA, Morris R, Khan M, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208(6):468. e1-6. 23. Ibrahim NMA, Badawy ME. MRI imaging of posterior reversible encephalopathy syndrome associated with pregnancy. Egypt J Radiol Nucl Med [Internet]. 2014;45(2):505–10. [Avail-able from]: http://dx.doi.org/10.1016/j.ejrnm.2014.01.002 24. Camara-Lemarroy CR, Lara-Campos JG, Perez-Contreras E, Rodríguez-Gutiérrez R, Galarza-Delgado DA. Takayasu’s arteritis and posterior reversible encephalopathy syndrome: a case-based review. Clin Rheumatol. 2013;32(3):409-15.   TABLES AND FIGURES [Table / Fig - 1]   [Table / Fig - 2]   [Table / Fig - 3]   [Table / Fig - 4]   [Table / Fig - 5]   [Table / Fig - 6]   [Table / Fig - 7]   [Table / Fig - 8]   [Table / Fig - 9]

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