Learning objectives
Posterior reversible encephalopathy syndrome (PRES) a neuro- radiological syndrome characterized by seizures,
altered level of consciousness and visual disturbance.
PRES is associated with hyperintense lesions on magnetic resonance imaging (MRI) most commonly seen in the posterior regions.
In most cases symptoms and radiological lesions are reversible.
The aims of this article are:
The posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity,
which can vary widely its presentation,
being atypical in some cases.
The clinical diagnosis of PRES includes the presence of headache,...
Background
CLINICAL FEATURES
The clinical presentation of PRES is very broad and includes headaches,
confusion,
nausea and vomiting,
generalized seizures sometimes with status epilepticus,
cerebellar syndrome,
cortical blindness,
hemianopsia,
blurred vision,
hemiparesis,
coma and others.
These symptoms may develop over several days or may be recognized only in the acute setting.
Certain clinical conditions have been established as risk factors for the development of PRES (Table 1):
-Hypertension was the first condition who was described as a factor that promotes the development of PRES (hypertensive encephalopathy)....
Imaging findings OR Procedure details
• Patient 1
29 year old woman,
without known risk factors.
She was in her 30th week of pregnancy,
transferred from surgery after an urgent cesarean for fetal distress,
probably in the context of eclampsia,
with arterial blood pressure levels of 145/96 and presenting with generalized seizures.
The first imaging test was a CT that showed a subcortical white matter hypodensity in the parasagital left parietal lobe with petechial hemorrhage within the lesion.
An MRI was perfomed one day later that showed vasogenic edema (hyperintensity...
Conclusion
-Apart from the known risk factors,
such as hypertension,
immunosuppressants,
and renal failure of various etiologies may be the precipitants of PRES.
- Early recognition of PRES is important for early therapy start.
The patients must have clinical history of acute neurologic symptoms,
such as headache,
visual disturbance,
seizures or neurological deficit; brain imaging findings such as focal vasogenic edema and clinical or radiologic proof of reversibility.
-A large proportion of our patients with PRES present with atypical neuroimaging findings.
In accordance to recent articles...
References
W.S.
Bartynski,
Posterior Reversible Encephalopathy Syndrome,
Part 1: Fundamental Imaging and Clinical Features.
AJNR Am J Neuroradiol,
2008: 29:1036–42.
W.S.
Bartynski,
Posterior Reversible Encephalopathy Syndrome,
Part 2: Controversies Surrounding Pathophysiology of Vasogenic Edema.AJNR Am J Neuroradiol,
2008: 29:1043– 49.
E.
Hugonneta,
D.
Da Inesa,∗,
H.
Bobyb,
et al.
Posterior reversible encephalopathy syndrome (PRES): Features on CT and MR imaging.Diagnostic and Interventional Imaging,
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Jennifer E.
Fugate,
DO; Daniel O.
Claassen,
MD; Harry J,
et al.
Posterior Reversible Encephalopathy Syndrome: Associated Clinical and Radiologic Findings.Mayo...
