Keywords:
MR, Neuroradiology brain, Management
Authors:
E. Siebert, T. Liman, G. Bohner; Berlin/DE
DOI:
10.1594/ecr2011/C-0067
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:
hypoperfusion vs.
hyperperfusion
Widening of the spectrum
“atypical” imaging features are being reported in the recent literature with increasing frequency:
–localisation
–pattern of distribution
–cytotoxic edema
–infarction
–blood – brain barrier disruption
–hemorrhage
Purpose
• to characterize the radiological spectrum of PRES in a large group of patients
•to define the incidence of features commonly regarded as atypical