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Facts: Posterior Reversible Encephalopathy Syndrome (PRES)
- Usually reversible neurologic syndrome presenting with reversible headache, altered consciousness or vision loss accompanied by reversible imaging abnormalities
- Related to hypertension, eclampsia and preeclampsia and immunosuppressive medication (and several other causes have been described)
- Believed to be due to hyperperfusion state with blood brain barrier breakthrough
Typical Imaging Appearances
- CT is often abnormal at the time of presentation. MRI shows more lesions and extent.
- Cortical or subcortical edema
- Preferential involvement of posterior aspect of the lobes, particularly parieto-occipital lobes (gradient effect present)
- Sparing of calcarine and paramedian occipital lobe structures
- Usually bilateral
Our case: PRES (typical imaging appearance)
References:
1. Hinghey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. New Eng J Med 1996;334:494-500.
2. McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR 2007;189:904-912.
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