Purpose
Definition
“Posterior Reversible Encephalopathy Syndrome (PRES)” was first described as clinical – radiological entity in 1996
potentially reversible and predominantly vasogenic edema of the white matter with a predilection of parenchyma supplied by the posterior circulation
symptoms: holocephalic headache,
reduced consciousness,
epileptic seizures,
focal-neurologic deficits
Causes
hypertension
renal insufficiency
eclampsia
systemic inflammatory diseases
immunosuppressants
cytostatic drugs
organ transplantation
hematologic disorders
sepsis
Pathophysiology
Common final path:
–endothelial dysfunction
==> blood-brain barrier disruption
==> asogenic edema
–failure of cerebral autoregulation
==> vasogenic edeme (cytotoxic edema)
2 hypotheses:...
Methods and Materials
Data research
the radiological report data bases of the authors´ university hospitals were searched from 1999 to 2010 for:
•posterior reversible encephalopathy syndrom,
PRES,
neurotoxicity
•drugs: Cyclosporin,
FK506,
Tacrolimus
•predisposing disorders:
–eclampsia,
preeclampsia,
toxemia of pregnancy
–hypertensive encephalopathy
–autoimmunologic: lupus erythematodes,
SLE,
sclerodermia,
Wegener‘s granulomatosis
Study inclusion
•after review of all Neuro-MRIs: 141 cases of possible PRES
•in consensus with a neurologist taking all Neuro-MRIs and all medical reports into account: 94 cases of definite PRES
Edema grading
•Grade 1: circumscript edema of cortex and...
Results
•94 cases of definite PRES
Edema grading (Fig.
1)
•Grade 1: 16%
•Grade 2: 40%
•Grade 3: 27%
•Grade 4: 10%
•Grade 5: 4%
Localisation (Fig.
2-6)
•Lobar: occipital 81%,
parietal 76%,
frontal 51%,
temporal 44%
•Striatum 21%,
Thalamus 18%,
Hypothalamus 3%
•Midbrain 11%
•Pons 15%
•Cerebellum 24%
•Medulla oblongata 3%
•Corpus callosum 8%
Distribution pattern (Fig.
7-9)
•parieto-occipital (PO) pattern 51%
•superior frontal sulcus (SFS) pattern 17%
•holohemispheric watershed pattern 16%
•central pattern 6% •asymmetric expression 6%
•combination of patterns 25%:
–most frequently: SFS...
Conclusion
PRES comprises a large radiological spectrum
features regarded as atypical for PRES,
such as frontal lobe,
basal ganglia and brain stem involvement,
haemorrhages and strokes
occur more frequently than commonly considered
thus the imaging differential diagnosis can be broad
References
Hinchey J,
Chaves C,
Appignani B,
Breen J,
Pao L,
Wang A,
Pessin MS,
Lamy C,
Mas JL,
Caplan LR.
A reversible posterior leukoencephalopathy syndrome.
N Engl J Med.
1996;334:494-500.
Personal Information
Dr.
med.
Eberhard Siebert
Abteilung Neuroradiologie
Charité Universitätsmedizin Berlin
[email protected]