Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar-Apr;23(2):182-188.
doi: 10.4103/aian.AIAN_379_18. Epub 2020 Feb 25.

Clinical, Etiological and Imaging Profile of Posterior Reversible Encephalopathy Syndrome: A Prospective and Follow-Up Study

Saurabh Bansal  1 , Ramandeep Bansal  2 , Manoj Kumar Goyal  1 , Aastha Takkar  1 , Ramandeep Singh  3 , Paramjeet Singh  4 , Vivek Lal  1
Affiliations

Clinical, Etiological and Imaging Profile of Posterior Reversible Encephalopathy Syndrome: A Prospective and Follow-Up Study

Saurabh Bansal et al. Ann Indian Acad Neurol. 2020 Mar-Apr.

Abstract

Background: Although first described more than two decades ago, posterior reversible encephalopathy syndrome (PRES) continues to be enigmatic. We prospectively followed consecutive patients of PRES both clinically and radiologically for a better understanding of natural history, symptomatology, and prognosis of this not so uncommon entity.

Patients and methods: The current study included 22 consecutive patients of PRES who were followed both clinically as well as radiologically at a tertiary care institute in Northern India from December 2014 to June 2016.

Results: Mean age was 30.68 ± 12.68 years. The most common symptoms included altered sensorium (77.3%), headache (72.7%), seizures (63.6%), vomiting (36.4%), and visual disturbances (22.7%). About 94.5% of patients had parieto-occipital signal changes on neuroimaging. Magnetic resonance imaging (MRI) (n = 20) revealed involvement of sites considered atypical for PRES in 95% (frontal [55%], temporal [40%], cerebellum [40%], basal ganglia [15%], deep white matter [10%] and brainstem [10%]). Diffusion restriction, haemorrhage, and contrast enhancement were seen in 30%, 22.2%, and 25% of patients. At 3 months follow-up, modified Rankin scale was 0 in 19 patients and 1 in 1 patient. Two (9.1%) patients died. Eight (36.4%) patients had eclampsia, 5 (22.7%) each had chronic kidney disease and essential hypertension whereas 2 (9.1%) each had immune-mediated disorders and drug-induced PRES. None of the clinical or imaging features predicted outcome in PRES.

Conclusion: Atypical MRI presentations of PRES are common, and there is a need to keep a strong index of suspicion for the diagnosis of PRES. The prognosis of PRES is good, and most cases show excellent recovery, particularly if underlying etiology can be treated satisfactorily.

Keywords: Eclampsia; hypertension; posterior reversible encephalopathy; posterior reversible encephalopathy syndrome.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Diffusion restriction in a patient with posterior reversible encephalopathy syndrome (a) with resolution of signal changes (b) at follow up
Figure 2
Figure 2
Some uncommon imaging findings in posterior reversible encephalopathy syndrome. fluid-attenuated inversion recovery images showing hyperintense signal changes in bilateral cerebellar hemispheres (a and b, blue arrows) followed by resolution at follow up (c). T2 weighted (d) and susceptibility weighted imaging (e) showing right sided frontal cortical and subcortical hemorrhage with signal changes which resolved leaving an gliotic scar at follow up imaging (f). (g and h): T2 weighted images showing left insular and basal ganglionic signal changes (g) and extensive subcortical white matter changes (h)
Figure 3
Figure 3
Typical sites of involvement in posterior reversible encephalopathy syndrome. Bilateral parieto-occipital lobe signal changes on T2 weighted (a and d) and fluid-attenuated inversion recovery images (b and c) in different patients
See this image and copyright information in PMC

References

    1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. Areversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500. - PubMed
    1. Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al. Hypertensive encephalopathy: Findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159:379–83. - PubMed
    1. Schwartz RB, Bravo SM, Klufas RA, Hsu L, Barnes PD, Robson CD, et al. Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol. 1995;165:627–31. - PubMed
    1. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65:205–10. - PubMed
    1. Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA, et al. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg. 2010;112:886–91. - PubMed