Distinct Imaging Patterns and Lesion Distribution in Posterior Reversible Encephalopathy Syndrome

By Walter Bartynski, J. Boardman. American Journal of Neuroradiology, 2007

635 citations recorded by the source corpus.

BACKGROUND AND PURPOSE: Although the term posterior reversible encephalopathy syndrome (PRES) was popularized because of the typical presence of vasogenic edema in the parietal and occipital lobes, other regions of the brain are also frequently affected. We evaluated lesion distribution with CT and MR in a large cohort of patients who experienced PRES to comprehensively assess the imaging patterns identified. MATERIALS AND METHODS: The locations of the PRES lesion at toxicity were comprehensively identified and tabulated in 136 patients by CT (22 patients) and MR (114 patients) imaging including the hemispheric, basal ganglial, and infratentorial locations. Clinical associations along with presentation at toxicity including blood pressure were assessed. RESULTS: Vasogenic edema was consistently present in the parietal or occipital regions (98%), but other locations were common including the frontal lobes (68%), inferior temporal lobes (40%), and cerebellar hemispheres (30%). Involvement of the basal ganglia (14%), brain stem (13%), and deep white matter (18%) including the splenium (10%) was not rare. Three major patterns of PRES were noted: the holohemispheric watershed (23%), superior frontal sulcal (27%), and dominant parietal-occipital (22%), with additional common partial or asymmetric expression of these primary PRES patterns (28%). CONCLUSION: Involvement of the frontal lobe, temporal lobe, and cerebellar hemispheres is common in PRES, along with the occasional presence of lesions in the brain stem, basal ganglia, deep white matter, and splenium. Three primary PRES patterns are noted in the cerebral hemispheres, along with frequent partial or asymmetric expression of these PRES patterns. Awareness of these patterns and variations is important to recognize PRES neurotoxicity more accurately when present.

Subfields: Endocrinology, Diabetes and Metabolism, Psychiatry and Mental health, Rheumatology

View Paper: https://www.semanticscholar.org/paper/0bfcfe5213003d5640d5f5d0706994a47eca10d0

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In Endocrinology, Diabetes and Metabolism

1. Walter Bartynski
2. Alejandro Rabinstein

In Psychiatry and Mental health

1. J. Fugate
2. Alejandro Rabinstein
3. Walter Bartynski

In Rheumatology

1. J. Fugate
2. Alejandro Rabinstein
3. Walter Bartynski
4. J. Forbes
5. M. Cooper

Citations in the corpus

• Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions (2015, background): “TNFα and Study design Number of patients Population Main fi ndings Bartynski and Boardman (2007)2 Retrospective 114 Radiology database Atypical brain regions are involved: frontal lobes (68% of patients), temporal lobes (40%), cerebellum (30%), basal ganglia (14%), brainstem (13%); three major…”
• Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features (2008, background): “Present in isolation or when the hemispheric pattern is incompletely expressed (partial/asymmetric), the diagnosis of PRES can be challenging.(27,32) If cerebellar or brain stem involvement are extensive, hydrocephalus and brain stem compression may occur.”