Over two decades have passed since posterior reversible encephalopathy syndrome (PRES) was first described in 1996. It has becoming increasingly recognised because of improved and more readily available imaging modality. The exact pathophysiological mechanism is not completely understood and remains controversial at present. Precise diagnosis is essential to guide prompt, proper management. Our ability of differentiating it from other acute neurological disorders is likely to improve as we learnt more about the spectrum of this entity in the last 20 years. We emphasise the importance of recognising its diagnostic criteria and biomarker, which would be of great relevance to either outcome evaluation or study design. PRES has a favourable prognosis generally, but neurological sequelae and even fatalities can occur, especially in severe forms that might cause substantial morbidity and even mortality, particularly when the syndrome is complicated by intracranial haemorrhage or brain infarction. In this review, the pathophysiology, approach to diagnosis, some controversies as to the prognosis, as well as the future research direction of PRES are described.

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Posterior reversible encephalopathy syndrome (PRES) represents a unique clinical entity with non-specific clinical symptoms and unique neuroradiological findings. This syndrome may present with a broad range of clinical symptoms from headache and visual disturbances to seizure and altered mentation. Typical imaging findings include posterior-circulation predominant vasogenic edema. Although there are many well-documented diseases associated with PRES, the exact pathophysiologic mechanism has yet to be fully elucidated. Generally accepted theories revolve around disruption of the blood-brain barrier secondary to elevated intracranial pressures or endothelial injury. In this article, we will review the clinical, typical, and atypical radiological features of PRES, as well as the most common theories behind the pathophysiology of PRES. Additionally, we will discuss some of the treatment strategies for PRES related to the underlying disease state.

Infections of the spine represent a rare but potentially debilitating and neurologically devastating condition for patients. Early diagnosis, imaging, and intervention may prevent some of the more critical complications that may ensue from this disease process, including alignment abnormalities, central canal compromise, nerve root impingement, vascular complications, and spinal cord injury. This article reviews the underlying pathophysiologic basis of infection, clinical manifestations, and imaging modalities used to diagnose infections of the spine and spinal cord.

Using this technique, we found some advantages. First, there is less need for free and local flaps. Second, there is a decrease in the operating time and donor-site morbidity (important for patients with multiple organ trauma). Third, it provides a good option for restoring defects in severe cases with combined bone and soft tissue defects in the same session. Fourth, its implementation for short bone defects (< 3 cm) gives acceptable aesthetic and functional results. Fifth, angulation of the segments and subsequent graduated correction of misalignment reduces the length of shortening needed in patients with severe soft tissue loss by sparing the bone from unnecessary debridement. Sixth, it permits definitive treatment using an external fixator device, enabling the possibility of early functional loading. On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries.

PRES patients with hemorrhage or cytotoxic edema are likely to have poor outcomes. Pre-eclampsia/eclampsia is associated with reduced risk of poor outcome in patients with PRES.

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