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Previous issue date: 2012-03-30 / INTRODUCTION : Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity that presents with headache, altered mental status, seizure and visual disturbance and is associated with a reversible probably vasogenic edema, predominantly in occipital and parietal lobes. The precise physiopathology remains unclear and there isn t an experimental model of this disorder. OBJECTIVES : The objectives of this paper were (1) the clinical and radiological evaluation of patients with PRES in the Hospital S?o Lucas-PUCRS and (2) the development of a translational model based on clinical features that mimetize this syndrome in pregnants Wistar rats. METHODS : It was performed a review of clinical data, neuroimage and blood basic test of 25 patients with PRES, that were followed in Hospital S?o Lucas-PUCRS in the period from March 15 of 2007 to September 15 of 2011. Based on clinical features and neuroimagem findings, we developed a rat model of PRES using pregnant Wistar rats, which were submitted to a reduction of uterine pressure perfusion (RUPP), measurement of arterial blood pressure with an invasive catheter and a brain anatomo-pathologic study, after Evans s blue venous infusion to verify the permeability of the blood-brain-barrier. RESULTS : Our clinical sample consisted of 25 patients (4 men and 21 women) with mean age of 27,84 years old (range from 2 to 74 years old). The most common causes of PRES reported in this series were associated with pregnant situations that occurred in 11 cases (44%). The symptom more commonly reported was headache in 18 patients (72%). The occipital lobe was the most common topography of the magnetic ressonance abnormality (edema) and occurred in 23 cases (92%). The highest value of the systolic blood pressure presented the mean of 176 mmHg and the highest value of the diastolic blood pressure presented the mean of 95,2 mmHg. Animals submitted to RUPP to simulate the PRES presented increase of the blood-brain-barrier permeability and elevation of blood pressure, when compared with the control animals. CONCLUSION : In our series, PRES occurred predominantly in women and the most frequent triggers were obstetric causes; headache was the most common symptom and the neuroimage findings showed a predominance of posterior alteration suggesting a vasogenic edema due a breakdown of blood brain barrier. The experimental rat model was developed based on these clinical observations, so, we used pregnant rats submitted to reduction of uterine pressure perfusion. We identified in these animals increase of blood pressure and a breakdown of blood brain barrier corroborating to establish an experimental model of PRES. We believe that an experimental model of PRES could be important for future studies allowing a better comprehension of this syndrome. / INTRODU??O : A S?ndrome Encefalopatia Revers?vel Posterior (Posterior Reversible Encephalopathy Syndrome PRES) ? uma entidade clinico-radiol?gica caracterizada por cefal?ia, altera??o do n?vel de consci?ncia, crises convulsivas e altera??o visual e est? associado a um edema provavelmente vasog?nico na subst?ncia branca encef?lica, predominantemente afetando os lobos occipitais e parietais. A fisiopatogenia do PRES permanece desconhecida e n?o existe um modelo experimental de tal dist?rbio. OBJETIVOS : O objetivo desse trabalho ? avaliar apresenta??o cl?nica juntamente com os exames de neuroimagem realizados por pacientes com S?ndrome da Encefalopatia Revers?vel Posterior no Hospital S?o Lucas-PUCRS e baseado nos achados cl?nicos desenvolver um modelo translacional que mimetize essa s?ndrome em ratos Wistar. M?TODOS : Foram revisados os prontu?rio juntamente com os exames de neuroimagem e laboratoriais de 25 pacientes portadores da s?ndrome da encefalopatia revers?vel posterior, os quais foram atendidos no Hospital S?o Lucas-PUCRS no per?odo de 15 de mar?o de 2007 ? 15 de setembro de 2011. A partir das caracter?sticas cl?nicas e de neuroimagem analisadas nesta pesquisa desenvolvemos modelo experimental de PRES com o uso de ratas Wistar gestantes, as quais foram submetidas ? redu??o da press?o de perfus?o uterina (RUPP do ingl?s Reduction of Uterine Pressure Perfusion), medida de press?o arterial invasiva e estudo anatomopatol?gico dos enc?falos dos animais, ap?s infus?o venosa de azul de Evans para avalia??o da permeabilidade da barreira hemato-encef?lica. RESULTADOS : Dos 25 pacientes com PRES analisados com idade m?dia de 27,84 anos (variando de 2 anos a 74 anos), 4 eram homens e 21 mulheres. As causas e/ou desencadeadores mais comumente encontrados foram de origem obst?tricas em 11 casos (44%). O sintoma mais freq?entemente referido foi cefal?ia em 18 pacientes (72%). A topografia mais comumente acometida pelo edema gerado pelo PRES foi occipital em 23 pacientes (92%). O valor da press?o arterial sist?lica m?xima em m?dia foi de 176 mmHg e a press?o arterial diast?lica m?xima em m?dia foi de 95,2 mmHg. Os animais submetidos ao modelo experimental proposto atrav?s do procedimento RUPP para mimetizar o PRES apresentaram altera??es de permeabilidade da barreira hematoencef?lica e eleva??o da press?o arterial quando comparado aos animais controles. CONCLUS?O : Na nossa casu?stica o PRES foi nitidamente predominante em mulheres, os fatores desencadeantes/causais mais frequentes foram os de origem obst?trica, predominando a cefaleia como sintoma; os exames de neuro-imagem confirmaram o predom?nio posterior das altera??es estruturais e sugerem serem decorrentes de edema vasog?nico com quebra da barreira hematoencef?lica. O modelo experimental em ratos Wistar foi desenvolvido baseado nestas observa??es cl?nicas motivo pelo qual utilizamos ratas gestante submetidas a redu??o da press?o de perfus?o uterina. Identificamos nestes animais a quebra da barreira hematoencef?lica corroborando para o estabelecimento do modelo experimental do PRES, o qual pensamos que possa ser de fundamental import?ncia para estudos posteriores que permitam uma melhor compreens?o desta s?ndrome.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1684 |
| Date | 30 March 2012 |
| Creators | Marrone, Luiz Carlos Porcello |
| Contributors | Costa, Jaderson Costa da |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 600, -8624664729441623247 |
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