Detecting the Uncommon Imaging Manifestations of Posterior Reversible Encephalopathy Syndrome (PRES) in Adults: a Comprehensive Illustrated Guide for the Trainee Radiologist

Khan, Iram; Pai, Vivek; Mundada, Pravin; Sitoh, Yih Yian; Purohit, Bela

doi:10.1067/j.cpradiol.2020.11.002

Cited by 8 publications

(11 citation statements)

References 50 publications

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“…Furthermore, PRES incidence may be higher in women,[ 12 ] but the actual gender difference associated with the PRES development is still unknown. [ 1 , 2 , 7 , 13 ] Although it is unknown whether favorable or adverse effect ovarian dysfunction and Kaufmann’s treatment had on the cerebral vascular function and endothelial cells, our patient’s pathophysiology may be associated with those female hormonal dynamics, which attenuated endothelial functioning.…”

Section: Discussionmentioning

confidence: 94%

“…[ 1 , 7 , 13 ] In addition to PRES with the atypical locations, such as the cerebellum, basal ganglia, thalamus, brainstem, and spinal cord, unilateral PRES has been established as the disease concept. [ 2 , 13 ] In Khan’s report, our case is categorized into the unilateral variant PRES, which involves one cerebral hemisphere. [ 13 ] These types were mainly reported in the setting of preexisting vascular abnormalities that affected cerebrovascular hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 , 13 ] In Khan’s report, our case is categorized into the unilateral variant PRES, which involves one cerebral hemisphere. [ 13 ] These types were mainly reported in the setting of preexisting vascular abnormalities that affected cerebrovascular hemodynamics. As another report, Mc Kinney reported that 2.6% (2 out of 76 PRES patients) mimicked neoplasm with unilateral lesions after bone marrow transplantation and cyclosporine therapy.…”

Section: Discussionmentioning

confidence: 99%

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Unilateral posterior reversible encephalopathy syndrome characterized with a long and gradually exacerbating course over 3 years and that presented propofol infusion syndrome – A case report

Katsuki

Ozaki

Narita

et al. 2021

Surgical Neurology International

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Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurological symptoms and vasogenic edema, and most patients wholly recover. We report a unilateral PRES patient characterized by a gradual onset followed by propofol infusion syndrome (PRIS) due to general anesthesia therapy. Case Description: A 32-year-old woman had ovarian dysfunction treated by Kaufmann’s treatment for 17 years. Three years ago, she developed seizures, and photophobia and myoclonus sometimes occurred. This time, she had strong photophobia and nausea for 3 months and then developed tonic-clonic seizures for 3 min. Her blood pressure and laboratory test on admission were all within normal limits. She presented no neurological deficits at admission, but the T2-weighted image (T2WI) showed a high-intensity area (HIA), and arterial spin labeling (ASL) image described cerebral blood flow (CBF) increase in the left parieto-occipital region. We diagnosed PRES and started anticonvulsants, antihypertensive, and steroid pulse therapy. However, her aphasia and neuroimaging findings worsened, so we started general anesthesia treatment with propofol on day 29. On day 32, she suddenly developed multiple organ dysfunctions due to PRIS. After intensive care with other sedatives over 2 months, the systemic status and neurological symptoms gradually improved almost as before the onset. On day 90, HIA in the T2WI in the lesion became small, and CBF was severely downregulated in the ASL image. Conclusion: Unilateral PRES’s pathophysiology and the association with the female hormone remain unknown. Some patients undergo gradual onset and long-term courses, and we should care for PRIS during PRES treatment.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Unilateral posterior reversible encephalopathy syndrome characterized with a long and gradually exacerbating course over 3 years and that presented propofol infusion syndrome – A case report

Katsuki

Ozaki

Narita

et al. 2021

Surgical Neurology International

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“…Clinically, patient presentations most commonly include seizures, encephalopathy, and visual disturbances [ 127 , 130 ]. Unlike RCVS, overall, it is slightly more common in males than females [ 131 – 133 ].…”

Section: Posterior Reversible Encephalopathy Syndromementioning

confidence: 99%

Advances in Management of the Stroke Etiology One-Percenters

Osteraas

Dafer

2023

Curr Neurol Neurosci Rep

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Purpose of Review Uncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from “standard” care. Recent Findings Randomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in “high-risk” patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of l -arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance. Summary Less commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.

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“…Atypical PRES affecting bilateral basal ganglia although rare can occur as an isolated phenomenon sparing the cortex. 2 PRES can conflict the management of cerebral vasospasm.…”

mentioning

confidence: 99%

Hypertensive Therapy Leading to Atypical Posterior Reversible Encephalopathy Syndrome

Muthukalai¹,

Vanamoorthy²,

Sridhar³

2022

J Neuroanaesth Crit Care

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Detecting the Uncommon Imaging Manifestations of Posterior Reversible Encephalopathy Syndrome (PRES) in Adults: a Comprehensive Illustrated Guide for the Trainee Radiologist

Cited by 8 publications

References 50 publications

Unilateral posterior reversible encephalopathy syndrome characterized with a long and gradually exacerbating course over 3 years and that presented propofol infusion syndrome – A case report

Unilateral posterior reversible encephalopathy syndrome characterized with a long and gradually exacerbating course over 3 years and that presented propofol infusion syndrome – A case report

Advances in Management of the Stroke Etiology One-Percenters

Hypertensive Therapy Leading to Atypical Posterior Reversible Encephalopathy Syndrome

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