Posterior Reversible Encephalopathy Syndrome: Incidence of Atypical Regions of Involvement and Imaging Findings

McKinney, Alexander M.; Short, James H.; Truwit, Charles L.; McKinney, Zeke J.; Kozak, Osman; SantaCruz, Karen S.; Tekşam, Mehmet

doi:10.2214/ajr.07.2024

Cited by 671 publications

(718 citation statements)

References 31 publications

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“…Diffusion restriction on ADC maps, or low or pseudonormalized ADC values suggest cytotoxic edema and potentially irreversible infarction; this was seen in 17% of patients in one series and portends a poor prognosis 3. There was no evidence of diffusion restriction in our case on the ADC map consistent with vasogenic edema.…”

Section: Discussionmentioning

confidence: 46%

“…The hyperintense signal seen on diffusion weighted images was likely due to the T2 shine-through phenomenon; this is not a rare finding in PRES and may be seen in as many as 28% patients 3. Diffusion restriction on ADC maps, or low or pseudonormalized ADC values suggest cytotoxic edema and potentially irreversible infarction; this was seen in 17% of patients in one series and portends a poor prognosis 3.…”

Section: Discussionmentioning

confidence: 86%

“…The atypical patterns of involvement include superior frontal sulcus pattern, temporal lobes (40%), cerebellar white matter (30%), basal ganglia (14%), and brainstem (13%); the splenium was involved in 10% of cases 236. Recurrent episodes of PRES may also occur, but are rare.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging findings include symmetrical hyperintense lesions on T2 images in the parieto-occipital regions in typical cases. Holo-hemispheric, superior frontal sulcus, and uncommonly, involvement of brainstem, pons, cerebellum, basal ganglia, and splenium have also been described 23. The involvement of the medulla and cervical cord is very rare, with only few cases reported 45.…”

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confidence: 99%

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Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Choh

Jehangir

Rasheed

et al. 2011

Annals of Saudi Medicine

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The posterior reversible encephalopathy syndrome (PRES) is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord (apart from the typical parieto-occipital lesions)-an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Choh

Jehangir

Rasheed

et al. 2011

Annals of Saudi Medicine

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“…The presence of both neurological findings and clinical manifestations are required for diagnosis. A majority of patients with PRES are hypertensive at presentation; most common symptoms are headaches, visual disturbance, and seizures; whereas, the most common radiological finding is the presence of symmetrical white matter edema in the parietal-occipital area [2]. PRES has been increasingly reported as a side effect of anti-vascular endothelial growth factor (VEGF) agents and tyrosine kinase inhibitors, due to increased accessibility and frequent use of medications in these classes of drugs.…”

Section: Introductionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome (PRES) after bevacizumab therapy for metastatic colorectal cancer

Hamid

Ghani

Micaily

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognizable neuro-clinical syndrome. Clinical and neurological manifestations of PRES include hypertension, headache, encephalopathy, seizures, and symmetrical white matter changes on brain MRI. Most common precipitants of PRES are acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy, and chemotherapy. Bevacizumab is a monoclonal antibody that halts angiogenesis by inhibiting vascular endothelial growth factor. It has gained widespread popularity in oncology world especially for metastatic and recurrent cancers due to its inherent ability to stop angiogenesis; a vital step for tumor growth. Bevacizumab has also been implicated as the cause of PRES due to dysregulation of the blood-brain barrier. We are reporting a case of PRES induced by Bevacizumab in a patient of colorectal cancer.

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Reversible Posterior Leukoencephalopathy Syndrome in a Patient Treated With Ustekinumab

Gratton¹,

Szapary²,

Goyal³

et al. 2011

Arch Dermatol

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Background: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare, generally reversible neurologic syndrome that is diagnosed based on characteristic clinical and radiologic findings.Observations: We describe the first case of RPLS in a 65-year-old woman who underwent ustekinumab therapy for psoriasis. Approximately 2 1 ⁄2 years after the patient began ustekinumab therapy, she experienced an acute onset of confusion, headache, nausea, vomiting, and seizures. Computed tomographic scans and magnetic resonance images of her head revealed characteristic findings, including white matter abnormalities consistent with edema in the absence of infarction. There was no evidence of vasospasm, thrombosis, or infection. Cerebrospinal fluid tests were negative for the JC virus. The patient improved clinically and was discharged 6 days after she presented to the emergency department. She made a full neurologic recovery, with a reversal of the radiologic findings.Conclusions: Reversible posterior leukoencephalopathy syndrome is an increasingly recognized neurologic disorder that has been reported with the use of systemic and biologic agents to treat moderate to severe psoriasis. Although the relationship between RPLS and ustekinumab therapy remains unclear, this case emphasizes the need for dermatologists to recognize the syndrome's signs and symptoms and to refer patients promptly for evaluation and appropriate treatment if the clinical features of RPLS are suspected.

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Posterior Reversible Encephalopathy Syndrome: Incidence of Atypical Regions of Involvement and Imaging Findings

Abstract: This large series of PRES cases shows that atypical distributions and imaging manifestations of PRES have a higher incidence than commonly perceived, and atypical manifestations do not correlate well with the edema severity.

Cited by 671 publications

References 31 publications

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) after bevacizumab therapy for metastatic colorectal cancer

Reversible Posterior Leukoencephalopathy Syndrome in a Patient Treated With Ustekinumab

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