Fact-sheet: Reversible posterior leukoencephalopathy syndrome - PRES
Updated on 08/26/2020 at 2:30 PM
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Definition
Posterior reversible encephalopathy, or in English:
- Posterior Reversible Encephalopathy Syndrome (PRES),
- Reversible Posterior Leukoencephalopathy Syndrome (RPLS)
Clinical features
Bilateral vasogenic edema of the parieto-occipital white matter, which may progress to infarction and death if untreated.
Generally favorable course with treatment in uncomplicated forms.
Headaches, vomiting, confusion, seizures, visual disturbances.
Often severe hypertension.
Etiologies:
- Pregnancy / preeclampsia
- Malignant hypertension
- Immunosuppressive treatment (tacrolimus, cisplatin, cyclosporine A)
CT
Noncontrast CT:
- bilateral, asymmetric hypodensity of the white matter in the parieto-occipital regions of the brain
- may extend to the frontal lobes and toward the cerebellar hemispheres
MRI
Reference examination.
Relatively symmetric bilateral cortico-subcortical signal abnormalities, predominantly in the parieto-occipital regions, associating:
- T1 hypointensity
- T2 and T2 FLAIR hyperintensity
- isointense diffusion signal (or hypointense if significant vasogenic edema)
- increased apparent diffusion coefficient (vasogenic edema)
- absence of contrast enhancement
Rarely, breakdown of the blood-brain barrier and cytotoxic edema, associating:
- T1 enhancement after gadolinium injection
- hemorrhagic phenomena
- decreased ADC (cytotoxic edema)
Differential diagnosis
Venous ischemia
