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VOLUME 26 , ISSUE 4 ( April, 2022 ) > List of Articles

Original Article

Study of Clinicoradiological Profile in Posterior Reversible Encephalopathy Syndrome: An Experience from North India

Gourav Goyal, Jitesh Jeswani

Keywords : Hypertension, Neuroimaging, Outcome, PRES

Citation Information : Goyal G, Jeswani J. Study of Clinicoradiological Profile in Posterior Reversible Encephalopathy Syndrome: An Experience from North India. Indian J Crit Care Med 2022; 26 (4):503-507.

DOI: 10.5005/jp-journals-10071-24172

License: CC BY-NC 4.0

Published Online: 13-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Posterior reversible encephalopathy syndrome (PRES) is a reversible condition. The Main pathological feature is vasogenic cerebral edema with predominant involvement of posterior part of the cerebrum. Clinical symptoms range from headache, seizure, and vision loss. We evaluated the clinicoradiological features of patients with PRES and their clinical outcome. Materials and methods: A retrospective study with 30 cases from January 2014 to May 2017. Results: Of thirty patients, 18 were females and twelve patients were male. The Mean age of the patients was 38.6 years. The most common presentation was seizure (66.6%) followed by altered mental status (53.3%) and headache (40%). The Main comorbid illnesses in our study were renal disease (36.7%), hypertension (23.3%), eclampsia, and postpartum sepsis (26.7%). The Most common site was the occipito-parietal region in the magnetic resonance imaging brain (66%). Atypical presentation involved the temporal lobe (16%), basal ganglia (6%), and microhemorrhage (6%). The Outcome was good with 20% mortalities. Conclusion: PRES is a reversible condition and has a good outcome in most patients. In our study, seizure was the most common presentation and renal disease is the most common comorbid illness.

  1. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 2010;85(5):427–432. DOI: 10.4065/mcp.2009.0590.
  2. Karuppannasamy D, Vikrant K, Raghuram A, Kumaar TM. Cortical visual loss in posterior reversible encephalopathy syndrome in late postpartum eclampsia: case series. Indian J Ophthalmol 2014;62(5):635–638. DOI: 10.4103/0301-4738.133525.
  3. McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012;33(5):896–903. DOI: 10.3174/ajnr.A2886.
  4. Patil VC, Agrwal V, Rajput A, Garg R, Kshirsagar K, Chaudhari V. Clinical profile and outcome of posterior reversible encephalopathy syndrome (PRES). Ann Trop Med Public Health 2015;8:105–112. DOI:10.4103/1755-6783.162354.
  5. Bansal S, Bansal R, Goyal MK, Takkar A, Singh R, Singh P, et al. Clinical, etiological and imaging profile of posterior reversible encephalopathy syndrome: a prospective and follow-up study. Ann Indian Acad Neurol 2020;23(2):182–188. DOI: 10.4103/aian.AIAN_379_18.
  6. Hauser RA, Lacey DM, Knight MR. Hypertensive encephalopathy. Magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol 1988;45(10):1078–1083. DOI: 10.1001/archneur.1988.00520340032007.
  7. Raroque HG Jr, Orrison WW, Rosenberg GA. Neurologic involvement in toxemia of pregnancy: reversible MRI lesions. Neurology 1990;40(1):167–169. DOI: 10.1212/wnl.40.1.167.
  8. Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol 2006;27(10):2179–2190. PMID: 17110690.
  9. Kur JK, Esdaile JM. Posterior reversible encephalopathy syndrome–an underrecognized manifestation of systemic lupus erythematosus. J Rheumatol 2006;33(11):2178–2183. PMID: 16960925.
  10. Primavera A, Audenino D, Mavilio N, Cocito L. Reversible posterior leucoencephalopathy syndrome in systemic lupus and vasculitis. Ann Rheum Dis 2001;60(5):534–537. DOI: 10.1136/ard.60.5.534.
  11. Schwartz RB. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334(26):1743. DOI: 10.1056/NEJM199606273342613.
  12. Pedraza R, Marik PE, Varon J. Posterior reversible encephalopathy syndrome: a review. Crit Care Shock 2009;12(4):135–143.
  13. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334(8):494–500. DOI: 10.1056/NEJM199602223340803.
  14. Lee SY, Dinesh SK, Thomas J. Hypertension-induced reversible posterior leukoencephalopathy syndrome causing obstructive hydrocephalus. J Clin Neurosci 2008;15(4):457–459. DOI: 10.1016/j.jocn.2006.12.019.
  15. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: Incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007;189(4):904–912. DOI: 10.2214/AJR.07.2024.
  16. Singer S, Grommes C, Reiner AS, Rosenblum MK, DeAngelis LM. Posterior reversible encephalopathy syndrome in patients with cancer. Oncologist 2015;20(7):806–811. DOI: 10.1634/theoncologist.2014-0149.
  17. Tambasco N, Mastrodicasa E, Salvatori C, Mancini G, Romoli M, Caniglia M, et al. Prognostic factors in children with PRES and hematologic diseases. Acta Neurol Scand 2016;134(6):474–483. DOI: 10.1111/ane.12570.
  18. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65(2):205–210. DOI: 10.1001/archneurol.2007.46.
  19. Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg 2010;112(10):886–889. DOI: 10.1016/j.clineuro.2010.07.023.
  20. Hinduja A, Habetz K, Raina S, Ramakrishnaiah R, Fitzgerald RT. Predictors of poor outcome in patients with posterior reversible encephalopathy syndrome. Int J Neurosci 2017;127(2):1–10. DOI: 10.3109/00207454.2016.1152966.
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