Posterior Reversible Encephalopathy Syndrome

Cytotoxic Edema in Posterior Reversible Encephalopathy Syndrome: Correlation of MRI Features with Serum Albumin Levels

“…26 The mass effect induced by larger areas of vasogenic edema would compress or shift the vessels passing through or around the edema region, which may result in regional hypoperfusion, elevation of tissue pressure, and reduction of CBF to ischemic levels, as well as vasoconstriction. 5,28 Subsequently, the areas surrounding marked vasogenic edema may progress to cytotoxic edema. We agree with the proposal that cytotoxic edema in PRES is probably related to local decreased perfusion and arteriolopathy.…”

“…Several theories exist as to why regions of reduced diffusion are seen in some cases of PRES. 5 The most popular theory is hyperperfusion causing severe mass effect from vasogenic edema with compression of local microcirculation. 6,7 Ay et al 6 suggested that increased tissue pressure eventually impairs the microcirculation and leads to ischemia in areas of massive vasogenic edema.…”

Headache in the Emergency Room

“…It is seen in clinical conditions that increase the permeability of the blood-brain barrier, especially vulnerable arteries in the posterior regions of the brain. 31 In a mixed prospective and retrospective analysis of 120 patients with PRES, Fugate et al found acute hypertension (86%) and seizures (74%) to be the most common presenting features, with headache (26%), encephalopathy (28%), and visual changes (20%) being less common. 32 Risk factors for developing PRES include concurrent immunosuppression therapy, existing hypertension, infection/sepsis, autoimmune conditions, as well as preeclampsia and eclampsia.…”

“…32 Risk factors for developing PRES include concurrent immunosuppression therapy, existing hypertension, infection/sepsis, autoimmune conditions, as well as preeclampsia and eclampsia. 31 Brain MRI usually shows T2-hyperintensity vasogenic edema of cortical and subcortical white matter, usually involving, but not exclusively, the posterior regions of the brain. 31 Treatment involves aggressive control of blood pressure, and addressing any related co-morbid conditions, e.g., removal of offending immunosuppressive agents.…”

“…31 Brain MRI usually shows T2-hyperintensity vasogenic edema of cortical and subcortical white matter, usually involving, but not exclusively, the posterior regions of the brain. 31 Treatment involves aggressive control of blood pressure, and addressing any related co-morbid conditions, e.g., removal of offending immunosuppressive agents. It can also be a complication of preeclampsia, in which case, delivery of the child can be helpful.…”