Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients.

Aleksandra Aracki-Trenkić,Marija Trenkić-Bozinović,Milan Trenkić,Dragan Stojanov,Saša Ristić,Zoran Radovanović,Jelena Ignjatović

doi:10.17305/bjbms.2016.1201

Aleksandra Aracki-Trenkić, Marija Trenkić-Bozinović + Show 5 more

Open Access

https://doi.org/10.17305/bjbms.2016.1201

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is an obstetric emergency frequently occurring in a pregnant or puerperal woman, manifested with an acute headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem and basal ganglia. Since magnetic resonance imaging (MRI) is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image.

Highlights

Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome was first described by Hinchey, in 1996, as a reversible syndrome manifested with an acute headache, consciousness impairment, seizures, and visual deficits, associated with white matter changes predominately affecting the posterior parietal and occipital lobes of the brain and involving the brainstem, cerebellum, and other cerebral areas [1,2,3]
On magnetic resonance imaging (MRI), hyperintensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images in the parieto-occipital and posterior frontal cortical and subcortical white matter is most commonly involved in the typical appearance of PRES
Since autoregulatory capability is completely attenuated if there is a severe endothelial injury, as it is the case in pre-eclampsia, even a moderate rise of blood pressure may lead to neurologic symptoms which culminate in eclamptic seizures [30]

Summary

Introduction

Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome was first described by Hinchey, in 1996, as a reversible syndrome manifested with an acute headache, consciousness impairment, seizures, and visual deficits, associated with white matter changes predominately affecting the posterior parietal and occipital lobes of the brain and involving the brainstem, cerebellum, and other cerebral areas [1,2,3].On magnetic resonance imaging (MRI), hyperintensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images in the parieto-occipital and posterior frontal cortical and subcortical white matter is most commonly involved in the typical appearance of PRES. Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome was first described by Hinchey, in 1996, as a reversible syndrome manifested with an acute headache, consciousness impairment, seizures, and visual deficits, associated with white matter changes predominately affecting the posterior parietal and occipital lobes of the brain and involving the brainstem, cerebellum, and other cerebral areas [1,2,3]. The significance of an early diagnosis of PRES with MRI is emphasized by the fact that its clinical presentation is often atypical.

Results

Conclusion