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The imaging spectrum of posterior reversible encephalopathy syndrome: A pictorial review

  • Emily Brady
    Correspondence
    Corresponding author at: Department of Radiology, Weill Cornell Medicine, 25 E. 68th Street, New York, NY 10065, United States.
    Affiliations
    Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States

    Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States
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  • Neal S. Parikh
    Affiliations
    Department of Neurology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States

    Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States
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  • Babak B. Navi
    Affiliations
    Department of Neurology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States

    Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States
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  • Ajay Gupta
    Affiliations
    Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States

    Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States
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  • Andrew D. Schweitzer
    Affiliations
    Department of Radiology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States
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      Highlights

      • Radiologic variants of posterior reversible encephalopathy syndrome (PRES) are reviewed.
      • Classically thought to be posterior (parieto-occipital), atypical variants of PRES are appreciated.
      • Several imaging characteristics and associated findings are reviewed.

      Abstract

      Posterior reversible encephalopathy syndrome (PRES) is characterized by the acute onset of neurologic symptoms (headache, altered mental status, visual changes, seizures) with accompanying vasogenic edema on brain imaging. Risk factors for PRES include infection, uremia, malignancy, autoimmune disorders, the peripartum state and hypertension. PRES is classically described as being posterior (i.e. parieto-occipital) but radiologic variants are increasingly recognized. This pictorial review demonstrates the heterogeneity of the different radiologic presentations of PRES in reference to lesion distribution, hemorrhage, diffusion restriction, contrast enhancement, and other associated findings.

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      References

        • Hinchey J.
        • Chaves C.
        • Appignani B.
        • Breen J.
        • Pao L.
        • Wang A.
        • et al.
        A reversible posterior leukoencephalopathy syndrome.
        N Engl J Med. 1996; 334: 494-500
        • Ozcan C.
        • Wong S.J.
        • Hari P.
        Reversible posterior leukoencephalopathy syndrome and bevacizumab.
        N Engl J Med. 2006; 354: 980-982
        • Bartynski W.S.
        Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features.
        AJNR Am J Neuroradiol. 2008; 29: 1036-1042
        • Bartynski W.S.
        • Boardman J.F.
        Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome.
        AJNR Am J Neuroradiol. 2007; 28: 1320-1327
        • Gupta V.
        • Bhatia V.
        • Khandelwal N.
        • Singh P.
        • Singhi P.
        Imaging findings in pediatric posterior reversible encephalopathy syndrome (PRES): 5 years of experience from a tertiary Care Center in India.
        J Child Neurol. 2016; 31: 1166-1173
        • Schweitzer A.D.
        • Parikh N.S.
        • Askin G.
        • Nemade A.
        • Lyo J.
        • Karimi S.
        • et al.
        Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome.
        Neuroradiology. 2017; 59: 379-386
        • Miller T.R.
        • Shivashankar R.
        • Mossa-Basha M.
        • Gandhi D.
        Reversible cerebral vasoconstriction syndrome, part 1: epidemiology, pathogenesis, and clinical course.
        AJNR Am J Neuroradiol. 2015; 36: 1392-1399
        • Li Y.
        • Gor D.
        • Walicki D.
        • Jenny D.
        • Jones D.
        • Barbour P.
        • et al.
        Spectrum and potential pathogenesis of reversible posterior leukoencephalopathy syndrome.
        J Stroke Cerebrovasc Dis. 2012; 21: 873-882
        • Fugate J.E.
        • Rabinstein A.A.
        Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions.
        Lancet Neurol. 2015; 14: 914-925
        • Karia S.J.
        • Rykken J.B.
        • McKinney Z.J.
        • Zhang L.
        • McKinney A.M.
        Utility and significance of gadolinium-based contrast enhancement in posterior reversible encephalopathy syndrome.
        AJNR Am J Neuroradiol. 2016; 37: 415-422
        • Bartynski W.S.
        • Boardman J.F.
        • Zeigler Z.R.
        • Shadduck R.K.
        • Lister J.
        Posterior reversible encephalopathy syndrome in infection, sepsis, and shock.
        AJNR Am J Neuroradiol. 2006; 27: 2179-2190
        • McKinney A.M.
        • Short J.
        • Truwit C.L.
        • McKinney Z.J.
        • Kozak O.S.
        • SantaCruz K.S.
        • et al.
        Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings.
        AJR Am J Roentgenol. 2007; 189: 904-912
        • Pande A.R.
        • Ando K.
        • Ishikura R.
        • Nagami Y.
        • Takada Y.
        • Wada A.
        • et al.
        Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study.
        Radiat Med. 2006; 24: 659-668
        • Covarrubias D.J.
        • Luetmer P.H.
        • Campeau N.G.
        Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images.
        AJNR Am J Neuroradiol. 2002; 23: 1038-1048
        • Liman T.G.
        • Bohner G.
        • Heuschmann P.U.
        • Endres M.
        • Siebert E.
        The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study.
        J Neurol. 2012; 259: 155-164
        • Kastrup O.
        • Schlamann M.
        • Moenninghoff C.
        • Forsting M.
        • Goericke S.
        Posterior reversible encephalopathy syndrome: the spectrum of MR imaging patterns.
        Clin Neuroradiol. 2015; 25: 161-171
        • Fugate J.E.
        • Claassen D.O.
        • Cloft H.J.
        • Kallmes D.F.
        • Kozak O.S.
        • Rabinstein A.A.
        Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings.
        Mayo Clin Proc. 2010; 85: 427-432
        • Ollivier M.
        • Bertrand A.
        • Clarencon F.
        • Gerber S.
        • Deltour S.
        • Domont F.
        • et al.
        Neuroimaging features in posterior reversible encephalopathy syndrome: a pictorial review.
        J Neurol Sci. 2017; 373: 188-200
        • McKinney A.M.
        • Jagadeesan B.D.
        • Truwit C.L.
        Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema.
        AJR Am J Roentgenol. 2013; 201: 631-638
        • Ishikura K.
        • Ikeda M.
        • Hamasaki Y.
        • Hataya H.
        • Shishido S.
        • Asanuma H.
        • et al.
        Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings.
        Am J Kidney Dis. 2006; 48: 231-238
        • Chen T.H.
        • Lin W.C.
        • Tseng Y.H.
        • Tseng C.M.
        • Chang T.T.
        • Lin T.J.
        Posterior reversible encephalopathy syndrome in children: case series and systematic review.
        J Child Neurol. 2013; 28: 1378-1386
        • McKinney A.M.
        • Sarikaya B.
        • Gustafson C.
        • Truwit C.L.
        Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging.
        AJNR Am J Neuroradiol. 2012; 33: 896-903
        • Junewar V.
        • Verma R.
        • Sankhwar P.L.
        • Garg R.K.
        • Singh M.K.
        • Malhotra H.S.
        • et al.
        Neuroimaging features and predictors of outcome in eclamptic encephalopathy: a prospective observational study.
        AJNR Am J Neuroradiol. 2014; 35: 1728-1734
        • Sharma A.
        • Whitesell R.T.
        • Moran K.J.
        Imaging pattern of intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome.
        Neuroradiology. 2010; 52: 855-863
        • Hefzy H.M.
        • Bartynski W.S.
        • Boardman J.F.
        • Lacomis D.
        Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features.
        AJNR Am J Neuroradiol. 2009; 30: 1371-1379
        • Tong K.A.
        • Ashwal S.
        • Holshouser B.A.
        • Shutter L.A.
        • Herigault G.
        • Haacke E.M.
        • et al.
        Hemorrhagic shearing lesions in children and adolescents with posttraumatic diffuse axonal injury: improved detection and initial results.
        Radiology. 2003; 227: 332-339
        • Stevens C.J.
        • Heran M.K.
        The many faces of posterior reversible encephalopathy syndrome.
        Br J Radiol. 2012; 85: 1566-1575
        • Ducros A.
        Reversible cerebral vasoconstriction syndrome.
        Lancet Neurol. 2012; 11: 906-917
        • Ducros A.
        • Boukobza M.
        • Porcher R.
        • Sarov M.
        • Valade D.
        • Bousser M.G.
        The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients.
        Brain. 2007; 130: 3091-3101
        • Singhal A.B.
        • Hajj-Ali R.A.
        • Topcuoglu M.A.
        • Fok J.
        • Bena J.
        • Yang D.
        • et al.
        Reversible cerebral vasoconstriction syndromes: analysis of 139 cases.
        Arch Neurol. 2011; 68: 1005-1012