CLINICAL, IMAGING SPECTRUM AND OUTCOME OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME

Abstract

Background: The posterior reversible encephalopathy syndrome (PRES), also known as acute hypertensive encephalopathy and reversible leukoencephalopathy syndrome (RPLS), is a clinico-radiological syndrome characterised by white matter vasogenic edema primarily affecting the parietal and occipital lobes of the brain and characterised by rapid onset of headache, seizures, loss of consciousness, and visual loss. The imaging findings, on the other hand, can be found in a variety of places, including the frontal lobes, thalami, basal ganglia, and brainstem.

Objective: To study the clinical, imaging spectrum and final disease outcome of PRES.

Materials And Methods: The study included 104 participants who had clinical symptoms and a radiological diagnosis of PRES. Each patient's clinical, imaging, and outcome data were examined.

Results: The study included 104 individuals ranging in age from 10 to 65 years old. Seizures were the most common symptom, followed by headache (60 percent), vomiting (37 percent), visual disturbances (33 percent), altered sensorium (15 percent), thalamic aphasia (6 percent), hemiparesis (4 percent), paresthesia (4 percent), ataxia (4 percent), quadriparesis (4 percent), quadriparesis (4 percent), and facial numbness (2 percent). The frontal lobe (52 percent), temporal lobe (17 percent), cerebellum (27 percent), thalamus (15 percent), brainstem (13 percent), basal ganglia (10 percent), and corpus callosum (10 percent) were all involved on MR imaging in the majority of the cases (2 percent ). Except in one case of central PRES, all lesions in atypical areas had lesions in usual locations. In 32% of instances, the dominant parieto-occipital pattern was detected, followed by the superior frontal sulcus pattern in 27%, holohemispheric pattern in 35%, and partial or asymmetric expression of primary patterns in 5%. Only about a quarter of the time, diffusion limitation and post-contrast enhancement were seen. In 91 percent of the cases, the symptoms were completely resolved, however four percent of the patients died. Symptoms persisted in 6% of cases after being followed up on.

Conclusion: PRES is a clinico-radiological illness that has a wide range of clinical and imaging manifestations. Atypical regions are frequently included. Lesions in atypical places, on the other hand, frequently have lesions in typical locations as well. Restricted diffusion and contrast enhancement are two examples of unusual imaging properties. Clinicians and radiologists must be aware of atypical lesion locations and imaging findings in order to correctly diagnose PRES in the appropriate clinical situation.

Keywords: Posterior reversible encephalopathy syndrome, imaging, reversible leukoencephalopathy syndrome