The aim of the study was to characterize the clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES) in a large cohort. The radiological report data bases of the authors′ university hospitals were searched for patients with PRES. Various imaging features at onset of symptoms and on follow-up as well as clinical and paraclinical data were tabulated in those patients fulfilling the criteria for PRES. Exploratory univariate analyses were performed. A total of 96 patients with PRES were included into the study. Wide differences in lesion location, diffusivity, distribution pattern, edema severity, hemorrhage, underlying diseases, symptoms, mean arterial pressure (MAP) and coagulation status were encountered. Hemorrhage occurred significantly more frequently in patients with altered coagulation state and was significantly associated with higher edema grades and with the presence of cytotoxic edema. There was a significant difference in MAP between toxic associations with higher MAP in infection, eclampsy and autoimmune disorders, while lower MAP was found in chemotherapy and immunsupression. In 82% of patients complete or near complete resolution of edema was noted during follow-up. Higher MAP levels were associated with incomplete edema resolution. In 43% of patients residual lesions were seen with a relatively even distribution between focal gliosis, infarction, posthemorrhagic residua, atrophy and laminar necrosis. PRES in this large hospital-based retrospective study comprises a wide radiological and clinical spectrum. Residual lesions were encountered more frequently than commonly expected. Our results point towards a differential contribution of high blood pressure to the course of PRES in different underlying etiologies.
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The research leading to these results has also received funding from the Federal Ministry of Education and Research (BMBF) through the Grant Center for Stroke Research Berlin (01 EO 0801), from the German Science Foundation (DFG; Neurocure) and from the Volkswagen Foundation (Lichtenberg program to Matthias Endres).
Conflict of interest
Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL (1996) Caplan LR: a reversible posterior leukoencephalopathy syndrome. N Engl J Med 334:494–500PubMedCrossRefGoogle Scholar
Bartynski WS, Boardman JF (2007) Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. Am J Neuroradiol 28:1320–1327PubMedCrossRefGoogle Scholar
Hefzy HM, Bartynski WS, Boardman JF, Lacomis D (2009) Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. Am J Neuroradiol 30:1371–1379PubMedCrossRefGoogle Scholar
McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, Teksam M (2007) Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. Am J Roentgenol 189:904–912CrossRefGoogle Scholar
Sharma A, Whitesell RT, Moran KJ (2010) Imaging pattern of intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome. Neuroradiology 52:855–863PubMedCrossRefGoogle Scholar
Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. Am J Neuroradiol 29:1043–1049PubMedCrossRefGoogle Scholar
Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol 29:1036–1042PubMedCrossRefGoogle Scholar
Lee VH, Wijdicks EF, Manno EM, Rabinstein AA (2008) Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 65:205–210PubMedCrossRefGoogle Scholar
Hinchey JA (2008) Reversible posterior leukoencephalopathy syndrome: what have we learned in the last 10 years? Arch Neurol 65:175–176PubMedCrossRefGoogle Scholar
Benigni A, Morigi M, Perico N, Zoja C, Amuchastegui CS, Piccinelli A, Donadelli R, Remuzzi G (1992) The acute effect of fk506 and cyclosporine on endothelial cell function and renal vascular resistance. Transplantation 54:775–780PubMedCrossRefGoogle Scholar