Internal medicine

Radiology

Pathology

Brainstem

Blood pressure

Biology

Pathophysiology

Magnetic resonance imaging

Posterior reversible encephalopathy syndrome

Eclampsia

Encephalopathy

Pregnancy

Hypertensive encephalopathy

Edema

Genetics

Medicine

Frontiers in Neurology

Posterior reversible encephalopathy syndrome (PRES) is a condition clinically characterized by headache, altered mental status, seizures, and visual loss and may be associated with systemic hypertension, preeclampsia/eclampsia, chemotherapy, immunosuppressive therapies in the setting of organ transplantation, and uremic encephalopathy. While brain imaging in patients with PRES typically reveals symmetric vasogenic edema within the parietal and occipital lobes, PRES may present with atypical imaging findings such as central brainstem and deep gray involvement without subcortical edema, and even spinal cord involvement. Additionally, PRES may be complicated in some cases by the presence of cytotoxic edema and hemorrhage. This review will serve to summarize the pathophysiologic theories and controversies underlying PRES, imaging features encountered in atypical and complicated PRES, and the implications these findings may have on patient prognosis.

Imaging of Atypical and Complicated Posterior Reversible Encephalopathy Syndrome