Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)?

Moon, Seong-Nam; Jeon, Soon‐Ik; Choi, See Sung; Song, Chang June; Chung, Gyung Ho; Yu, In Kyu; Kim, Dea Ho

doi:10.1177/0284185113491252

Cited by 63 publications

(52 citation statements)

References 26 publications

(57 reference statements)

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“…Association of renal failure with PRES is present in 55% cases [7]. Prognosis of PRES is favourable, and most patients recover fully in about 75-90% cases [8] as seen clinically in both of our cases. There are three MRI patterns reported in 70% cases in radiology literature: a dominant parietooccipital pattern, holohemispheric watershed pattern and superior frontal sulcus pattern.…”

Section: Discussionsupporting

confidence: 57%

Posterior Reversible Encephalopathy Syndrome (PRES) Associated with Papilledema Mimicking Multiple Sclerosis and Boomerang Sign on Imaging: Report of Two Cases

Jain¹,

Khan²,

Ahmad³

2017

J Neurol Exp Neurosci

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Posterior reversible encephalopathy is a clinical syndrome of acute neurological symptoms like seizures, disturbed vision, headache, and altered mental state in the setting of renal failure, heart failure, blood pressure fluctuations, cytotoxic & anti-epileptic drug overdose or withdrawal, autoimmune disorder and eclampsia leading to sub cortical vasogenic edema as a result of endothelial injury. Here we are reporting two cases that presented as altered mental state and diagnosed posterior reversible encephalopathy syndrome (PRES) in the presence of risk factors, including renal, heart failure and eclampsia and fluctuations of blood pressure with subcortical white matter hyperintensities on brain imaging. Our first case had bilateral papilledema and MRI brain revealed subcortical white matter hyperintesities mimicking multiple sclerosis. Second case showed diffusion restrictions in the posterior splenium region with reduced corresponding ADC level (Boomerang sign) on neuroimaging. Both of our patients were managed symptomatically and discharged in a stable condition. The clinicians should be aware of such uncommon presentations of PRES in view varied clinical and radiological features.

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Section: Discussionsupporting

confidence: 57%

Posterior Reversible Encephalopathy Syndrome (PRES) Associated with Papilledema Mimicking Multiple Sclerosis and Boomerang Sign on Imaging: Report of Two Cases

Jain¹,

Khan²,

Ahmad³

2017

J Neurol Exp Neurosci

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“…10 Subarachnoid hemorrhage (SAH) is the most common type and the second most common is parenchymal hemorrhage in patients with PRES. 7,9 Our patient had both types of hemorrhage in the right temporal lobe. Findings of PRES on angiography include focal or diffuse vasoconstriction, vasodilation or a ''string-of-beads'' appearance.…”

Section: Resultsmentioning

confidence: 68%

“…The classical form is characterized by clinical symptoms that are associated with bilateral and symmetric vasogenic edema in the parietal and occipital lobes, while the variant form demonstrates predominant involvement of the brain stem and cerebellum. 6,7 A new definition, termed ''central variant,'' describes the form involving the central brainstem and basal ganglia but lacking cortical and subcortical oedema. 8 The patient in this report had a variant form where the pathologic process encompassed both the posterior and anterior circulations.…”

Section: Case Studymentioning

confidence: 99%

“…1 It was demonstrated that the involvement of the brain stem is not influential in the prognosis, and the influential factor in prognosis is the reversibility of lesions and hemorrhage. 7 Typical imaging findings are demonstrated as hyperintense areas on FLAIR images in the parietooccipital, posterior frontal cortical and subcortical white matter, while less commonly the brainstem, basal ganglia and cerebellum are involved. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI that our patient had intraparenchymal and subarachnoid hemorrhages.…”

Section: Case Studymentioning

confidence: 99%

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Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

Beker‐Acay

Ünlü

Okur

et al. 2016

Polish Annals of Medicine

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Available online xxxKeywords: Eclampsia Hypertensive encephalopathy Magnetic resonance imaging a b s t r a c t Introduction: HELLP syndrome (acronym comprised of hemolysis, elevated liver enzymes and low platelets) is seen in 0.1% of pregnant women. Posterior reversible encephalopathy syndrome (PRES) was reported to be 5% in patients with the HELLP syndrome. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI.Aim: We aimed to improve clinicians' perception about brain lesions in the HELLP syndrome with imaging findings.Case study: Here, we present a case of an 18-year-old patient with a pregnancy of 24 weeks admitted with HELLP syndrome, with CT and MRI findings of PRES and intracerebral hematoma. MRI scan of the brain showed vasogenic edema in the occipital, frontal and parietal lobes bilaterally, basal ganglia and brainstem. An emergency cesarean section was successfully performed to end the pregnancy on the same day. Repeat MRI of the brain three days after initial admission showed partial improvement of the previous abnormalities with full clinical recovery.Results and discussion: The patient in this report had a variant form of PRES where the pathologic process encompassed both the posterior and anterior circulations.Conclusions: An appropriate multidisciplinary approach is the key for reducing the morbidity and mortality of PRES syndrome.

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“…Reversibility of MRI findings is suggestive of a good prognosis. 16 Thus, leukoencephalopathy with severe hypertension is reversible both clinically and radiologically in the majority of children after the control of hypertension. 17 However, the literature has shown that a few patients may have residual damage and need to be followed-up.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Two Omani Children with Underlying Renal Diseases

El-Naggari¹,

Al-Nabhani²,

Elnour³

et al. 2015

Sultan Qaboos Univ Med J

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abstract:Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with a combination of clinical and radiological features. Clinical symptoms include headaches, confusion, seizures, disturbed vision or an altered level of consciousness. Classic magnetic resonance imaging (MRI) findings indicate subcortical and cortical oedema, affecting mainly the posterior cerebral region. We report two paediatric cases of PRES with underlying renal diseases presenting at the Sultan Qaboos University Hospital in Muscat, Oman, in April 2010 and August 2011. The first case was an 11-year-old girl diagnosed with systemic lupus erythematosus and the second was a six-and-a-half-year-old boy on peritoneal dialysis due to multi-drug-resistant nephrotic syndrome. Both patients were hypertensive and treated with blood pressure control medications. No residual neurological dysfunction was noted in the patients at a one-year follow-up and at discharge, respectively. The role of hypertension in paediatric PRES cases, among other important risk factors, is emphasised. Additionally, MRI is an important diagnostic and prognostic tool. Prompt diagnosis and aggressive management is fundamental to preventing permanent neurological damage.

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Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)?

Abstract: Even though BP influences the involvement of the brain stem, involvement of the brain stem is not influential on the prognosis. It seems that the influential factor to prognosis is the reversibility of lesions and hemorrhage.

Cited by 63 publications

References 26 publications

Posterior Reversible Encephalopathy Syndrome (PRES) Associated with Papilledema Mimicking Multiple Sclerosis and Boomerang Sign on Imaging: Report of Two Cases

Posterior Reversible Encephalopathy Syndrome (PRES) Associated with Papilledema Mimicking Multiple Sclerosis and Boomerang Sign on Imaging: Report of Two Cases

Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

Posterior Reversible Encephalopathy Syndrome in Two Omani Children with Underlying Renal Diseases

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