Clinical and Radiological Spectrum of Posterior Reversible Encephalopathy Syndrome.
10.7461/jcen.2013.15.3.206
- Author:
Sang Duk YOON
1
;
Byung Moon CHO
;
Sae Moon OH
;
Se Hyuck PARK
;
In Bock JANG
;
Jong Young LEE
Author Information
1. Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. nschbm@hallym.or.kr
- Publication Type:Original Article
- Keywords:
Posterior reversible encephalopathy syndrome;
Radiological findings;
Clinical features
- MeSH:
Basal Ganglia;
Brain Stem;
Cerebellum;
Delayed Diagnosis;
Diffusion;
Eclampsia;
Edema;
Female;
Headache;
Humans;
Hypertension;
Pregnancy;
Prognosis;
Retrospective Studies;
Seizures;
Sepsis;
Subarachnoid Hemorrhage;
Thalamus
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2013;15(3):206-213
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental status, visual disturbances, and seizures. Typical radiological features include edema of the parieto-occipital lobes. The purpose of this study is to review the clinical and radiological findings in patients diagnosed with PRES. METHODS: All patients diagnosed with PRES between January 2006 and December 2012 were retrospectively included in this study. We reviewed demographic and clinical characteristics, and radiological findings. RESULTS: We identified 16 patients with PRES. The most common clinical presentation was seizure (n = 12, 75%). Clinical recovery occurred in all patients within days (mean, 5.7 +/- 4.6 days). Comorbid conditions included hypertension (n = 4, 25%), cytotoxic medications (n = 3, 18.8%), sepsis (n = 4, 25%), malignancy (n = 4, 25%), subarachnoid hemorrhage (n = 1, 6.3%), autoimmune disorders (n = 1, 6.3%) and eclampsia (n = 1, 6.3%). The most commonly involved location was the parieto-occipital lobe (n = 13, 81.3%). Atypical radiological findings included significant basal ganglia involvement in 4 episodes; brainstem in 3, cerebellum in 2, and thalamus in 3. Eleven patients (68.8%) underwent diffusion-weighted imaging and apparent diffusion coefficient mapping. Of those, 9 patients (81.8%) had hypo- or isointensity on diffusion-weighted imaging. On the apparent diffusion coefficient map, 10 patients (90.9%) had hyperintensity, and the other had normal values. CONCLUSION: We suggest that PRES may occur in patients with complex systemic conditions. The prognosis of PRES is usually benign. Physicians should be aware of certain atypical radiological findings to avoid a delayed diagnosis of PRES, as delayed diagnosis and treatment can result in permanent neurological sequlae.
