Posterior reversible encephalopathy syndrome

  • Due to severe hypertension (eclampsia), chemotherapy, transplantation, immunosuppressive therapy (ciclosporin), autoimmune diseases
  • Dysfunction of posterior cerebral arterial circulation
  • Secondary cerebral vasogenic edema and/or vascular endothelial damage
  • Headache, seizures, confusion, cortical blindness, cerebellar syndrome, consciousness disorders
  • MRI
    • bilateral cortico-subcortical T2 confluent hyperintensities, mainly in watershed parietal and occipital lobes
    • brainstem and deep cerebral nuclei may be involved
    • DWI shows increased diffusivity – vasogenic edema
    • Lesions completely reverse after treatment
    • Angiography can show vessel dilatation and constriction
    • When severe with poor prognosis: areas of intraaxial hemorrhage, leptomeningeal or gyriform enhancement, or diffusion restriction
Read more

Stevens, C. J., and M. K. S. Heran. “The many faces of posterior reversible encephalopathy syndrome.” The British Journal of Radiology 85.1020 (2012): 1566-1575.

Bartynski, W. S. “Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features.” American Journal of Neuroradiology 29.6 (2008): 1036-1042.