Etiology: Cerebrovascular autoregulatory disorder where hypertension and failed autoregulation leads to hyperperfusion which leads to endothelial dysfunction which leads to increased interstitial fluid and brain parenchymal vasogenic edema
Imaging CT: Not sensitive to detecting PRES
Imaging MRI: — Classically affects occipital and parietal regions relating to posterior cerebral artery supply — Characteristic imaging findings are subcortical or cortical vasogenic edema with or without diffusion restriction with or without hemorrhage – typically posterior and reversible — Note: Not always posterior, not always reversible (typically has vasogenic edema (reversible) but occasionally has cytotoxic edema (irreversible))
DDX:
Complications:
Treatment:
Clinical: — Risk factors: acute or subacute systemic hypertension, drug toxicity in particular: chemotherapy (cyclosporine, cisplatin, tacrolimus), immune suppression, severe infection, uremia, eclampsia or pre-eclampsia, thrombotic microangiopathies (DIC, TTP) — Acute or subacute presentation – altered mental status (60%) or headache (54%) or seizure (50%) or visual symptoms (36%) – cortical blindness or focal neurological defect (19%) — Formula for diagnosis is clinical suspicion – Risk factors and acute or subacute presentation and characteristic imaging findings
Radiology Cases of Posterior Reversible Encephalopathy Syndrome
Axial FLAIR MRI without contrast of the brain shows bilaterally multiple areas of hyperintense signal in the cortex and subcortical white matter.
