Posterior Reversible Eneephalopathy Syndrome: Associated Clinical and Radiologic Findings

Fugate, Jennifer E.; Claassen, Daniel O.; Cloft, Harry J.; Kallmes, David F.; Kozak, Osman S.; Rabinstein, Alejandro A.
May 2010
Mayo Clinic Proceedings;May2010, Vol. 85 Issue 5, p427
Academic Journal
OBJECTIVE: To identify and define clinical associations and radiologic findings of posterior reversible encephalopathy syndrome (PRES). PATIENTS AND METHODS: Patients prospectively diagnosed as having PRES from October 1, 2005, through April 30, 2009, were pooled with retrospectively identified patients admitted from August 1, 1999, through September 30, 2005. We performed a detailed review of clinical information, including demographics, presenting symptoms, medical history, and risk factors. All patients underwent computed tomography of the brain or magnetic resonance imaging. Findings on magnetic resonance imaging were analyzed independently by 2 neuroradiologists. RESULTS: We Identified 120 cases of PRES in 113 patients (mean age, 48 years). Mean peak systolic blood pressure was 199 mm Hg (minimum-maximum, 160-268 mm Hg), and mean peak diastolic blood pressure was 109 mm Hg (minimum-maximum, 60-144 mm Hg). Etiologies of PRES included hypertension (n=69 [61%]), cytotoxic medications (n=21 [19%]), sepsis (n=8 [7%]), preeclampsia or eclampsia (n=7 [6%]), and multiple organ dysfunction (n=1 [1%]). Autoimmune disease was present in 51 patients (45%). Clinical presentations included seizures (n=84 [74%]), encephalopathy (n=32 [28%]), headache (n=29 [26%]), and visual disturbances (n=23 [20%)). in the 115 cases (109 patients) for which magnetic resonance imaging findings were available, the parieto-occipital regions were the most commonly involved (n=108 [94%]), followed by the frontal lobe (n=88 [77%]), temporal lobe (n=74 [64%]), and cerebellum (n=61 [53%]). Cerebellar involvement was significantly more frequent in patients with a history of autoimmunity (P=.008), and patients with sepsis were more likely to have cortical involvement (P<.001). CONCLUSION: A substantial proportion of patients with PRES have underlying autoimmune conditions that may support endothelial dysfunction as a pathophysiologic mechanism. On brain Imaging, the location and severity of vasogenic edema were mostly similar for the different clinical subgroups.


Related Articles


    Arterial hypertension (AHT) gravity depends on the complications given to other target organs: brain, heart and kidneys. The neurological complications are multiple: hypertensive encephalopathy, stroke and vascular dementia. Strokes are the most common complications responsible for high...

  • Impact of subcortical white matter lesions on dopamine transporter SPECT. Funke, Elisabeth; Kupsch, Andreas; Buchert, Ralph; Brenner, Winfried; Plotkin, Michail // Journal of Neural Transmission;Jul2013, Vol. 120 Issue 7, p1053 

    Subcortical arteriosclerotic encephalopathy (SAE) can affect the nigrostriatal system and presumably cause vascular parkinsonism (VP). However, in patients with SAE, the differentiation of VP from idiopathic Parkinson's disease (IPS) is challenging. The aim of the present study was to examine...

  • Reversible Diffusion Weighted Imaging Changes in Propionic Acidemia. Kandel, Amit; Amatya, Sirisa Kandel; Yeh, E. Ann // Journal of Child Neurology;Jan2013, Vol. 28 Issue 1, p128 

    Propionic acidemia is an inborn error of metabolism with neurologic manifestations. We describe a 3-year-old boy with propionic acidemia presenting with a metabolic crisis including headache, vomiting, and altered mental status with metabolic acidosis. Electroencephalography showed focal slowing...

  • Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)? Still a challenge. Lv, Cui; Gao, Bo // Acta Radiologica;Jan2015, Vol. 56 Issue 1, pNP3 

    A letter to the editor is presented in response to the article "Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)?" by S. N. Moon, S. J. Jeon, S. S. Choi, and colleagues in the December 2013 issue.

  • Anatomical patterns and correlated MRI findings of non-perinatal hypoxic–ischaemic encephalopathy. WHITE, M. L.; ZHANG, Y.; HELVEY, J. T.; OMOJOLA, M. F. // British Journal of Radiology;Jan2013, Vol. 86 Issue 1021, p1 

    Non-perinatal hypoxic-ischaemic encephalopathy (HIE) has varying anatomical patterns dependent on the type of insult, the degree and duration of cerebral hypoxia, or presence and degree of hypoperfusion. Profound insults can affect the entire cerebral cortex or just the perirolandic cortex, the...

  • CASE REPORT. Michael Hughes, W.; Villalon-Gomez, Jose M. // Journal of Family Practice;Jun2015, Vol. 64 Issue 6, p358 

    The article presents a case study of a 55-year-old woman with a bifrontal headache for a day, with blurred vision and vomiting. The patient was diagnosed with posterior reversible encephalopathy syndrome (PRES) based on the patient's presentation and radiologic findings confirmed with magnetic...

  • Clinically isolated syndrome presenting as paroxysmal dysarthria: a rare but typical presentation. Jain, Rajendra; Handa, Rahul; Vyas, Arvind; Prakash, Swayam; Nagpal, Kadam // Neurological Sciences;Aug2014, Vol. 35 Issue 8, p1313 

    No abstract available.

  • Posterior Reversible Encephalopathy Syndrome with Involvement of the Cervical Cord and Medulla: a Case Report. XUAN HOU; JINFENG XU; ZAO CHEN; GGUOLIANG LI; HONG JIANG // Journal of Clinical & Diagnostic Research;Jan2015, Vol. 9 Issue 1, p1 

    Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, which is associated with symmetrical subcortical areas of vasogenic oedema that are preferentially parieto-occipital, and it typically resolves within a few weeks after appropriate treatment, We hereby report a case of a...

  • Idiopathic intracranial hypertension due to intralesional triamcenolone acetate. Arya, Abhishek; Jindal, Atul; Moulik, Nirmalya; Kumar, Archana; Kiykim, Ertugrul; Zubarioglu, Tanyel; Gupta, Shalu; Kapoor, Kapil; Devi, Utpala; Mahanta, Jagadish // Indian Pediatrics;Sep2014, Vol. 51 Issue 9, p754 

    The article describes the case of a three-year old boy who was diagnosed with idiopathic intracranial hypertension due to intralesional triamcenolone acetate. The results of the patient's magnetic resonance imaging (MRI) of brain and cerebrospinal (CSF) gram staining, cytology and biochemistry...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics