Posterior reversible encephalopathy syndrome

Abstract

The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits. In a majority of patients the clinical presentation includes elevated arterial blood pressure up to hypertensive emergencies. Neuroimaging, in particular magnetic resonance imaging, frequently shows a distinctive parieto-occipital pattern with a symmetric distribution of changes reflecting vasogenic edema. PRES frequently develops in the context of cytotoxic medication, (pre)eclampsia, sepsis, renal disease or autoimmune disorders. The treatment is symptomatic and is determined by the underlying condition. The overall prognosis is favorable, since clinical symptoms as well as imaging lesions are reversible in most patients. However, neurological sequelae including long-term epilepsy may persist in individual cases.

Keywords: Chemotherapy; Encephalopathy; Hypertensive encephalopathy; Preeclampsia; Vasogenic edema.

Fig. 1

The two main hypotheses explaining the pathophysiology of posterior reversible encephalopathy and associated conditions

Fig. 2

Incidence of neurological signs in patients with posterior reversible encephalopathy syndrome

Fig. 3

Suggested criteria for the diagnosis of posterior reversible encephalopathy syndrome Modified after Fugate et al. (2010) [5]

Fig. 4

a–c Axial MR image (fluid-attenuated inversion recovery sequence) demonstrates extensive vasogenic edema in the occipital region bilaterally and right insular hemorrhage