Skip to main content
SpringerLink
Log in

Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study

  • ORIGINAL ARTICLE
  • Published:
Radiation Medicine Aims and scope Submit manuscript

Abstract

Purpose

The aim of this retrospective study was to clarify the relation between the reversibility of posterior reversible encephalopathy syndrome (PRES) with three factors: the anatomical region of the brain involved, the background clinical cause, and the diffusion weighted image (DWI) intensity of PRES lesions.

Material and methods

This multicenter study, conducted by the PRES Study Group of the Neuroradiology Workshop, involved 52 cases from 28 institutions. Initial and follow-up magnetic resonance imaging were compared regarding the reversibility of PRES lesions according to anatomical location and clinical background. Initial DWI and apparent diffusion coefficient (ADC) maps were reviewed in 20 cases.

Results

Reversibility was significantly lower (P < 0.01) in the brain stem (44%) and deep white matter (47%) compared to the other cortical and subcortical areas (76%–91%). The reversibility was greater in the eclampsia subgroup followed by the hypertension and chemotherapy subgroups. DWI, even with ADC maps, had limitations in predicting the outcome of PRES lesions.

Conclusion

The typical cortical and subcortical PRES lesions showed reversibility, whereas the brain stem and deep white matter lesions showed less reversibility. PRES due to eclampsia showed maximum reversibility compared to hypertension- and drug-related PRES. DWI, even with ADC maps, had limitations in predicting the course of PRES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. J Hinchey C Chaves B Appignani J Breen L Pao A Wang et al. (1996) ArticleTitleA reversible posterior leukoencephalopathy syndrome N Engl J Med 334 494–500 Occurrence Handle8559202 Occurrence Handle10.1056/NEJM199602223340803 Occurrence Handle1:STN:280:BymC2MjgtFc%3D

    Article  PubMed  CAS  Google Scholar 

  2. SO Casey RC Sampaio E Michel CL Truwit (2000) ArticleTitlePosterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions AJNR Am J Neuroradiol 21 1199–206 Occurrence Handle10954269 Occurrence Handle1:STN:280:DC%2BD3M%2FotlOgtg%3D%3D

    PubMed  CAS  Google Scholar 

  3. C Lamy C Oppenheim JF Meder JL Mas (2004) ArticleTitleNeuroimaging in posterior reversible encephalopathy syndrome J Neuroimaging 4 89–96 Occurrence Handle10.1177/1051228403258161

    Article  Google Scholar 

  4. PS Rangi WJ Patridge ES Newlands AD Waldman (2005) ArticleTitlePosterior reversible encephalopathy syndrome: a possible late interaction between cytotoxic agents and general anaesthesia Neuroradiology 47 586–90 Occurrence Handle15997391 Occurrence Handle10.1007/s00234-005-1376-6 Occurrence Handle1:STN:280:DC%2BD2MvmsFGktw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. JM Provenzale JR Petrella LH Celso JC Wong S Engelter DP Barboriak (2001) ArticleTitleQuantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome AJNR Am J Neuroradiol 22 1455–6 Occurrence Handle11559490 Occurrence Handle1:STN:280:DC%2BD3MrhtFKjsw%3D%3D

    PubMed  CAS  Google Scholar 

  6. DJ Covarrubias PH Luetmer NG Campeau (2002) ArticleTitlePosterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images AJNR Am J Neuroradiol 23 1038–48 Occurrence Handle12063238

    PubMed  Google Scholar 

  7. PJ Oliverio L Restrepo SA Mitchell CS Tornatore SR Frankel (2000) ArticleTitleReversible tacrolimus induced neurotoxicity isolated to the brainstem AJNR Am J Neuroradiol 21 1251–4 Occurrence Handle10954277 Occurrence Handle1:STN:280:DC%2BD3M%2FotlOnsA%3D%3D

    PubMed  CAS  Google Scholar 

  8. J De Seze B Mastain T Stojkovic D Ferriby JP Pruvo A Destee et al. (2000) ArticleTitleUnusual brainstem findings of the brain in arterial hypertension AJNR Am J Neuroradiol 21 391–4 Occurrence Handle10696029 Occurrence Handle1:STN:280:DC%2BD3c7lvVGktA%3D%3D

    PubMed  CAS  Google Scholar 

  9. H Kitaguchi H Tomimoto Y Miki A Yamamoto K Terada H Satoi et al. (2005) ArticleTitleA brainstem variant of reversible posterior leukoencephalopathy syndrome Neuroradiology 47 652–6 Occurrence Handle15947925 Occurrence Handle10.1007/s00234-005-1399-z Occurrence Handle1:STN:280:DC%2BD2MrgtVynuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  10. T Shimono Y Miki H Toyoda H Egawa S Uemoto K Tanaka et al. (2003) ArticleTitleMR imaging with quantitative diffusion mapping of tacrolimus-induced neurotoxicity in organ transplant patients Eur Radiol 13 986–93 Occurrence Handle12695819

    PubMed  Google Scholar 

  11. RB Schwartz SK Feske JF Polak U DeGirolami A Iala KM Beckner et al. (2000) ArticleTitlePreeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy Radiology 217 371–6 Occurrence Handle11058630 Occurrence Handle1:STN:280:DC%2BD3crhtFeruw%3D%3D

    PubMed  CAS  Google Scholar 

  12. MD Savvidou AD Hingorani D Tsikas JC Frolich P Vallance KH Nicolaides (2003) ArticleTitleEndothelial dysfunction and raised plasma concentrations of asymmetric dimethyl arginine in pregnant women who subsequently developed preeclampsia Lancet 361 1511–7 Occurrence Handle12737861 Occurrence Handle10.1016/S0140-6736(03)13177-7 Occurrence Handle1:CAS:528:DC%2BD3sXjsVWhsLg%3D

    Article  PubMed  CAS  Google Scholar 

  13. H Kalimo M Kaste M Haltia (1997) Hypertensive angiopathy DI Graham PL Lantos (Eds) Greenfield's neuropathology. 6th edition Arnoid London 325–31

    Google Scholar 

  14. ME Haykin M Gorman J van Hoff RK Fulbright JM Baehring (2006) ArticleTitleDiffusion weighted MRI correlates of subacute methotrexate-related neurotoxicity J Neurooncol 76 153–7 Occurrence Handle1:STN:280:DC%2BD28%2Fitlamtw%3D%3D

    CAS  Google Scholar 

  15. SJ Na JM Hong JH Park TS Chung KY Lee (2004) ArticleTitleA case of reversible postpartum cytotoxic edema in preeclampsia J Neurol Sci 221 83–7 Occurrence Handle15178218 Occurrence Handle10.1016/j.jns.2004.02.007

    Article  PubMed  Google Scholar 

  16. Y Hasegawa M Fisher LL Latour BJ Dardzinski CH Sotak (1994) ArticleTitleMRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia Neurology 44 1484–90 Occurrence Handle8058154 Occurrence Handle1:STN:280:ByuA3sngt1A%3D

    PubMed  CAS  Google Scholar 

  17. BJ Dardzinski CH Sotak M Fisher Y Hasegawa L Li K Minematsu (1993) ArticleTitleApparent diffusion coefficient mapping of experimental focal cerebral ischemia using diffusion-weighted echo-planar imaging Magn Reson Med 30 318–25 Occurrence Handle8412602 Occurrence Handle1:STN:280:ByuD3MfltlI%3D

    PubMed  CAS  Google Scholar 

  18. H Takayama M Kobayashi M Sugishita B Mihara (2000) ArticleTitleDiffusion-weighted imaging demonstrates transient cytotoxic edema involving the corpus callosum in a patient with diffuse brain injury Clin Neurol Neurosurg 102 135–9 Occurrence Handle10996710 Occurrence Handle10.1016/S0303-8467(00)00079-2 Occurrence Handle1:STN:280:DC%2BD3M%2FitVGhtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. H Kassem-Moussa JM Provenzale JR Patrella DV Lewis (2000) ArticleTitleEarly diffusion weighted MR imaging abnormalities in sustained seizure activity AJNR Am J Roentgenol 174 1304–6 Occurrence Handle1:STN:280:DC%2BD3c3kvVKntw%3D%3D

    CAS  Google Scholar 

  20. N Lara I Pascual (2006) ArticleTitlePartial occipital seizures as main symptom of posterior encephalopathy secondary to immunosuppressants Neurologia 21 269–74 Occurrence Handle16788872 Occurrence Handle10.1159/000091354 Occurrence Handle1:STN:280:DC%2BD28zntlSmsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  21. RC Collins JW Olney (1982) ArticleTitleFocal cortical seizures cause distant thalamic lesions Science 218 177–9 Occurrence Handle7123229 Occurrence Handle10.1126/science.7123229 Occurrence Handle1:STN:280:BiyD3MnmtFQ%3D

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan

    Ajaya R. Pande, Kumiko Ando, Reiichi Ishikura, Yuki Nagami, Yoshihiro Takada & Norio Nakao

  2. Faculty of Medicine, Shimane University, Izumo, Japan

    Akihiko Wada

  3. National Cardiovascular Center, Osaka, Japan

    Yoshiyuki Watanabe

  4. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yukio Miki

  5. Department of Radiology, Saga Medical School, Saga University, Saga, Japan

    Akira Uchino

Authors
  1. Ajaya R. Pande
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kumiko Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reiichi Ishikura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuki Nagami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshihiro Takada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akihiko Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshiyuki Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yukio Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akira Uchino
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Norio Nakao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kumiko Ando.

Additional information

Some parts of the study were used for poster presentations at the Japan Radiological Society meetings in 2005 and 2006, in Yokohama, Japan.

About this article

Cite this article

Pande, A., Ando, K., Ishikura, R. et al. Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study. Radiat Med 24, 659–668 (2006). https://doi.org/10.1007/s11604-006-0086-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-006-0086-2

Key words

Search

Navigation