The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits.
Diagnostic findings in patients with posterior reversible encephalopathy syndrome
| Diagnostic tool | Finding |
| Laboratory data | Hypomagnesemia Lactate dehydrogenase ↑ Liver function parameters ↑ Creatinine ↑ Albumin ↓ |
| Cerebrospinal fluid | Albumin ↑ Albuminocytologic dissociation |
| EEG | Diffuse theta slowing Delta slowing Rhythmic delta activity Sharp-slow wave activity Periodic lateralizing epileptiform discharges Diffuse or focal (symmetric) slowing of background activities |
| CT and MRI | Vasogenic edema Watershed distribution Parieto-occipital pattern Frontal and temporal lobe involvement Subcortical white matter lesions Bilateral, frequently symmetric distribution Hyperintense T2-weighted and FLAIR sequences Iso-, hypo-, or hyperintense lesions on DWI Facultative contrast enhancement Microbleeds, intracerebral hemorrhage possible Increased or decreased ADC values depending/indicating (ir)reversibility of lesions |
| Angiography | Vasoconstriction, vasospasm (diffuse or focal) |
EEG electroencephalogram, CT computed tomography, MRI magnetic resonance imaging, FLAIR fluid-
attenuated inversion recovery, DWI diffusion-weighted imaging, ADC apparent diffusion coefficient
Suggested criteria for the diagnosis of posterior reversible encephalopathy syndrome
- neurological symptoms of acute onset
- (focal) vasogenic edema on neuroimaging
- reversibility of clinical and/or radiological findings
References:
- Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017 Aug;264(8):1608-1616. [Medline]
- Geocadin RG. Posterior Reversible Encephalopathy Syndrome. N Engl J Med. 2023 Jun 8;388(23):2171-2178. [Medline]
Created Jan 03, 2024.
