Type:
Educational Exhibit
Keywords:
Education and training, Imaging sequences, MR-Diffusion/Perfusion, MR, CT, Neuroradiology brain, CNS
Authors:
A. L. Reyes Ortiz1, E. Capilla2, I. Herrera3, J. M. Garcia Benassi3, R. González-Gutierrez3; 1Toledo, To/ES, 2Madrid/ES, 3TOLEDO/ES
DOI:
10.1594/ecr2013/C-1615
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,
seizures,
encephalopathy,
and visual disturbances,
as well as radiologic findings of focal reversible vasogenic edema,
best seen on magnetic resonance imaging (MRI) of the brain.
Despite the syndrome’s name,
lesions in PRES are rarely isolated to the “posterior” parieto-occipital subcortical.
White matter on imaging and instead often involve the cortex,
frontal lobes,
basal ganglia,
and brainstem.
Reversible: The clinical presentation and the edema observed in imaging tests completely resolve with treatment.
The clinical spectrum and pathophysiology of PRES remains poorly defined.
Complications,
such as ischemic infarction or intracranial hemorrhage can cause substantial morbidity and mortality.
This and the atypical imaging forms of presentation can make the diagnosis of PRES challenging and may delay the onset of treatment.
The underlying pathophysiology of PRES remains elusive.
Several theories have been proposed,
the most widely accepted states that rapidly developing hypertension leads to a breakdown in cerebral autoregulation,
particularly in the posterior region of the head,
where there is a relative lack of sympathetic innervation.